scholarly journals Visual analogies, not graphs, increase patients' comprehension of changes in their health status

2020 ◽  
Vol 27 (5) ◽  
pp. 677-689 ◽  
Author(s):  
Meghan Reading Turchioe ◽  
Lisa V Grossman ◽  
Annie C Myers ◽  
Dawon Baik ◽  
Parag Goyal ◽  
...  
Keyword(s):  
Health Status ◽  
Risk Perceptions ◽  
Response Times ◽  
Line Graph ◽  
Number Line ◽  
Hospitalized Patients ◽  
Order Effects ◽  
Lower Education Level ◽  
Patient Reported ◽  
Visual Analogy

Abstract  Objectives Patients increasingly use patient-reported outcomes (PROs) to self-monitor their health status. Visualizing PROs longitudinally (over time) could help patients interpret and contextualize their PROs. The study sought to assess hospitalized patients' objective comprehension (primary outcome) of text-only, non-graph, and graph visualizations that display longitudinal PROs. Materials and Methods We conducted a clinical research study in 40 hospitalized patients comparing 4 visualization conditions: (1) text-only, (2) text plus visual analogy, (3) text plus number line, and (4) text plus line graph. Each participant viewed every condition, and we used counterbalancing (systematic randomization) to control for potential order effects. We assessed objective comprehension using the International Organization for Standardization protocol. Secondary outcomes included response times, preferences, risk perceptions, and behavioral intentions. Results Overall, 63% correctly comprehended the text-only condition and 60% comprehended the line graph condition, compared with 83% for the visual analogy and 70% for the number line (P = .05) conditions. Participants comprehended the visual analogy significantly better than the text-only (P = .02) and line graph (P = .02) conditions. Of participants who comprehended at least 1 condition, 14% preferred a condition that they did not comprehend. Low comprehension was associated with worse cognition (P < .001), lower education level (P = .02), and fewer financial resources (P = .03). Conclusions The results support using visual analogies rather than text to display longitudinal PROs but caution against relying on graphs, which is consistent with the known high prevalence of inadequate graph literacy. The discrepancies between comprehension and preferences suggest factors other than comprehension influence preferences, and that future researchers should assess comprehension rather than preferences to guide presentation decisions.

Time after time: support for memory accounts of temporal preparation.

2019 ◽  
Author(s):  
Joe Butler ◽  
Samuel Ngabo ◽  
Marcus Missal
Keyword(s):  
Response Times ◽  
Reaction Times ◽  
Evidence Base ◽  
Higher Order ◽  
Order Effects ◽  
Previous Trial ◽  
Adaptive Responses ◽  
Temporal Preparation ◽  
Subsequent Trial ◽  
Higher Order Effects

Complex biological systems build up temporal expectations to facilitate adaptive responses to environmental events, in order to minimise costs associated with incorrect responses, and maximise the benefits of correct responses. In the lab, this is clearly demonstrated in tasks which show faster response times when the period between warning (S1) and target stimulus (S2) on the previous trial was short and slower when the previous trial foreperiod was long. The mechanisms driving such higher order effects in temporal preparation paradigms are still under debate, with key theories proposing that either i) the foreperiod leads to automatic modulation of the arousal system which influences responses on the subsequent trial, or ii) that exposure to a foreperiod results in the creation of a memory trace which is used to guide responses on the subsequent trial. Here we provide data which extends the evidence base for the memory accounts, by showing that previous foreperiod exposures are cumulative with reaction times shortening after repeated exposures; whilst also demonstrate that the higher order effects associated with a foreperiod remain active for several trials.

scholarly journals PROMIS Scales for Assessment of Persistent Post-COVID Symptoms: A Cross Sectional Study

2021 ◽  
Vol 12 ◽  
pp. 215013272110304
Author(s):  
Ravindra Ganesh ◽  
Aditya K. Ghosh ◽  
Mark A. Nyman ◽  
Ivana T. Croghan ◽  
Stephanie L. Grach ◽  
...  
Keyword(s):  
Health Status ◽  
Social Roles ◽  
Disease Process ◽  
Cross Sectional Study ◽  
Large Sample Size ◽  
Sectional Study ◽  
Cross Sectional ◽  
Data Set ◽  
Patient Reported ◽  
The Impact

Objective Persistent post-COVID symptoms are estimated to occur in up to 10% of patients who have had COVID-19. These lingering symptoms may persist for weeks to months after resolution of the acute illness. This study aimed to add insight into our understanding of certain post-acute conditions and clinical findings. The primary purpose was to determine the persistent post COVID impairments prevalence and characteristics by collecting post COVID illness data utilizing Patient-Reported Outcomes Measurement Information System (PROMIS®). The resulting measures were used to assess surveyed patients physical, mental, and social health status. Methods A cross-sectional study and 6-months Mayo Clinic COVID recovered registry data were used to evaluate continuing symptoms severity among the 817 positive tested patients surveyed between March and September 2020. The resulting PROMIS® data set was used to analyze patients post 30 days health status. The e-mailed questionnaires focused on fatigue, sleep, ability to participate in social roles, physical function, and pain. Results The large sample size (n = 817) represented post hospitalized and other managed outpatients. Persistent post COVID impairments prevalence and characteristics were determined to be demographically young (44 years), white (87%), and female (61%). Dysfunction as measured by the PROMIS® scales in patients recovered from acute COVID-19 was reported as significant in the following domains: ability to participate in social roles (43.2%), pain (17.8%), and fatigue (16.2%). Conclusion Patient response on the PROMIS® scales was similar to that seen in multiple other studies which used patient reported symptoms. As a result of this experience, we recommend utilizing standardized scales such as the PROMIS® to obtain comparable data across the patients’ clinical course and define the disease trajectory. This would further allow for effective comparison of data across studies to better define the disease process, risk factors, and assess the impact of future treatments.

scholarly journals How different are COPD-specific patient reported outcomes, health status, dyspnoea and respiratory symptoms? An observational study in a working population

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025132 ◽  
Author(s):  
Koichi Nishimura ◽  
Toru Oga ◽  
Kazuhito Nakayasu ◽  
Miyoko Ogasawara ◽  
Yoshinori Hasegawa ◽  
...  
Keyword(s):  
Health Status ◽  
Respiratory Symptoms ◽  
Smoking Status ◽  
Fixed Ratio ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Working Population ◽  
Specific Patient ◽  
Patient Reported ◽  
D 12

ObjectivesWe hypothesised that chronic obstructive pulmonary disease (COPD)-specific health status measured by the COPD assessment test (CAT), respiratory symptoms by the evaluating respiratory symptoms in COPD (E-RS) and dyspnoea by Dyspnoea-12 (D-12) are independently based on specific conceptual frameworks and are not interchangeable. We aimed to discover whether health status, dyspnoea or respiratory symptoms could be related to smoking status and airflow limitation in a working population.DesignThis is an observational, cross-sectional study.Participants1566 healthy industrial workers were analysed.ResultsRelationships between D-12, CAT and E-RS total were statistically significant but weak (Spearman’s correlation coefficient=0.274 to 0.446). In 646 healthy non-smoking subjects, as the reference scores for healthy non-smoking subjects, that is, upper threshold, the bootstrap 95th percentile values were 1.00 for D-12, 9.88 for CAT and 4.44 for E-RS. Of the 1566 workers, 85 (5.4%) were diagnosed with COPD using the fixed ratio of the forced expiratory volume in one second/forced vital capacity <0.7, and 34 (2.2%) using the lower limit of normal. The CAT and E-RS total were significantly worse in non-COPD smokers and subjects with COPD than non-COPD never smokers, although the D-12 was not as sensitive. There were no significant differences between non-COPD smokers and subjects with COPD on any of the measures.ConclusionsAssessment of health status and respiratory symptoms would be preferable to dyspnoea in view of smoking status and airflow limitation in a working population. However, these patient-reported measures were inadequate in differentiating between smokers and subjects with COPD identified by spirometry.

Patient Satisfaction and Short-Term Outcome in Elective Cranial Neurosurgery

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Elina Reponen ◽  
Hanna Tuominen ◽  
Juha Hernesniemi ◽  
Miikka Korja
Keyword(s):  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Status ◽  
Patient Experience ◽  
University Hospital ◽  
Term Outcome ◽  
Major Morbidity ◽  
Patient Reported ◽  
Relationship Of

Abstract BACKGROUND: Patient-reported experience is often used as a measure for quality of care, but no reports on patient satisfaction after cranial neurosurgery exist. OBJECTIVE: To study the association of overall patient satisfaction and surgical outcome and to evaluate the applicability of overall patient satisfaction as a proxy for quality of care in elective cranial neurosurgery. METHODS: We conducted an observational study on the relationship of overall patient satisfaction at 30 postoperative days with surgical and functional outcome (modified Rankin Scale [mRS] score) in a prospective, consecutive, and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 at Helsinki University Hospital, Helsinki, Finland. RESULTS: Postoperative overall (subjective and objective) morbidity was present in 194 (46.4%) patients; yet almost 94% of all study patients reported high overall satisfaction. Low overall patient satisfaction at 30 days was not associated with postoperative major morbidity in elective cranial neurosurgery. Dependent functional status (mRS score ≥3) at 30 days, minor infections, poor postoperative subjective overall health status, and patient-reported severe symptoms (double vision, poor balance) may contribute to unsatisfactory patient experience. CONCLUSION: Overall patient satisfaction with elective cranial neurosurgery is high. Even 9 of 10 patients with postoperative major morbidity rated high overall patient satisfaction at 30 days. Overall patient satisfaction may merely reflect patient experience and subjective postoperative health status, and therefore it is a poor proxy for quality of care in elective cranial neurosurgery.

scholarly journals BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
A. Barnadas ◽  
◽  
M. Muñoz ◽  
M. Margelí ◽  
J. I. Chacón ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Status ◽  
Bone Metastasis ◽  
Assessment Tool ◽  
Metastatic Breast ◽  
Perceived Health ◽  
Perceived Health Status ◽  
Patient Reported

Abstract Background Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM. Methods Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL. Results Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity. Conclusions BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients. Trial registration NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).

scholarly journals Population Pharmacokinetics of Oxycodone and Metabolites in Patients with Cancer-Related Pain

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2768
Author(s):  
Bram C. Agema ◽  
Astrid W. Oosten ◽  
Sebastiaan D. T. Sassen ◽  
Wim J. R. Rietdijk ◽  
Carin C. D. van der Rijt ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pharmacokinetic Model ◽  
Compartment Model ◽  
Hospitalized Patients ◽  
Population Pharmacokinetic ◽  
Patients With Cancer ◽  
Pain Scores ◽  
Starting Point ◽  
Patient Reported ◽  
Pharmacodynamic Data

Oxycodone is frequently used for treating cancer-related pain, while not much is known about the factors that influence treatment outcomes in these patients. We aim to unravel these factors by developing a population-pharmacokinetic model to assess the pharmacokinetics of oxycodone and its metabolites in cancer patients, and to associate this with pain scores, and adverse events. Hospitalized patients with cancer-related pain, who were treated with oral oxycodone, could participate. Pharmacokinetic samples and patient-reported pain scores and occurrence and severity of nine adverse events were taken every 12 h. In 28 patients, 302 pharmacokinetic samples were collected. A one-compartment model for oxycodone and each metabolite best described oxycodone, nor-oxycodone, and nor-oxymorphone pharmacokinetics. Furthermore, oxycodone exposure was not associated with average and maximal pain scores, and oxycodone, nor-oxycodone, and nor-oxymorphone exposure were not associated with adverse events (all p > 0.05). This is the first model to describe the pharmacokinetics of oxycodone including the metabolites nor-oxycodone and nor-oxymorphone in hospitalized patients with cancer pain. Additional research, including more patients and a more timely collection of pharmacodynamic data, is needed to further elucidate oxycodone (metabolite) pharmacokinetic/pharmacodynamic relationships. This model is an important starting point for further studies to optimize oxycodone dosing regiments in patients with cancer-related pain.

scholarly journals Practical Application of Patient-Reported Health Status Measures for Transcatheter Valve Therapies

2021 ◽  
Author(s):  
Vittal Hejjaji ◽  
David J. Cohen ◽  
John D. Carroll ◽  
Zhuokai Li ◽  
Pratik Manandhar ◽  
...  
Keyword(s):  
Health Status ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Summary Score ◽  
Hazard Ratio ◽  
Valve Repair ◽  
Prognostic Information ◽  
Risk Of Death ◽  
Transcatheter Mitral Valve Repair ◽  
Patient Reported

Background: Health status assessment is essential for documenting the benefit of transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve repair on patients’ symptoms, function, and quality of life. Health status can also be a powerful marker for subsequent clinical outcomes, but its prognostic importance around the time of both TAVR and transcatheter mitral valve repair has not been fully defined. Methods: Among 73 699 patients who underwent transfemoral TAVR or transcatheter mitral valve repair between 2011 and 2018 (mean age, 81.9±7.0 years, 53% men, 92% TAVR), we constructed sequential models examining the association of health status (as assessed with the Kansas City Cardiomyopathy Questionnaire–Overall Summary Score; KCCQ-OS) at baseline, 30 days, change from baseline to 30 days, and combinations of these assessments with death and heart failure (HF) hospitalization from 30 days to 1 year. Results: Although higher baseline KCCQ-OS and 30-day KCCQ-OS scores were each associated with lower risk of death and HF hospitalization (in individual models and in a model including both measures), the 30-day KCCQ-OS was most predictive (death: hazard ratio, 0.89 per 5-point increase [95% CI, 0.89–0.90]; HF hospitalization: hazard ratio, 0.91 [95% CI, 0.90–0.91]). The 30-day KCCQ-OS also was most predictive when included in a separate model with change in KCCQ from baseline to 30 days. Similar findings were noted for the outcomes of death and of HF hospitalization, unadjusted and adjusted for patient factors. All interaction terms between procedure type and KCCQ were not significant, suggesting that health status provided similar prognostic information in both procedures. Conclusions: The patient’s assessment of their health status immediately before and 30 days after TAVR and transcatheter mitral valve repair is associated with subsequent risk of death and HF hospitalization, with the 30-day assessment being most strongly associated with outcomes. Our findings support the routine use of KCCQ data as a prognostic tool.

scholarly journals Effect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
John-Ross D. Clarke ◽  
Ralph Riello ◽  
Larry A. Allen ◽  
Mitchell A. Psotka ◽  
John R. Teerlink ◽  
...  
Keyword(s):  
Health Status ◽  
Health Related Quality ◽  
Reduced Ejection Fraction ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related ◽  
Reported Health ◽  
End Stage

Background: A growing population of patients with end-stage heart failure (HF) with reduced ejection fraction has limited treatment options to improve their quality and quantity of life. Although positive inotropes have failed to show survival benefit, these agents may enhance patient-reported health status, that is, symptoms, functional status, and health-related quality of life. We sought to review the available clinical trial data on positive inotrope use in patients with end-stage HF and to summarize evidence supporting the use of these agents to improve health status of patients with end-stage HF. Methods: A literature review of randomized controlled trials examining the use of positive inotropy in HF with reduced ejection fraction was conducted. We searched MEDLINE, SCOPUS, and Web of Science between January 1980 to December 2018 for randomized controlled trials that used as their main outcome measures the effects of inotrope therapy on (1) morbidity/mortality, (2) symptoms, (3) functional status, or (4) health-related quality of life. Inotropes of interest included adrenergic agents, phosphodiesterase inhibitors, calcium sensitizers, myosin activators, and SERCA2a (sarcoplasmic reticulum Ca 2+ -ATPase) modulators. Results: Twenty-two out of 26 inotrope randomized controlled trials measured the effect of inotropes on at least one patient-reported health status domain. Among the 22 studies with patient-related health status outcomes, 11 (50%) gauged symptom response, 15 (68%) reported functional capacity changes, and 12 (54%) reported health-related quality of life measures. Fourteen (64%) of these trials noted positive outcomes in at least one health status domain measured; 11 (79%) of these positive studies used agents that worked through phosphodiesterase inhibition. Conclusions: There has been a lack of standardization surrounding measurement of patient-centered outcomes in studies of inotropes for end-stage HF with reduced ejection fraction. The degree to which positive inotropes can improve patient-reported health status and the adverse risk they pose remains unknown.

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