Abstract 12613: Patient-reported Outcomes in a Multidisciplinary Electrophysiology-psychology Ventricular Arrhythmia Clinic

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrew Nguyen ◽  
John Dornblaser ◽  
Andrew Gray ◽  
Karen Paladino ◽  
Adrienne Kovacs ◽  
...  
Keyword(s):  
Health Status ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Clinical Settings ◽  
Cardiac Device ◽  
Patient Reported ◽  
Item Level ◽  
History Of ◽  
Icd Shock ◽  
Level Analysis

Background: Ventricular arrhythmias (VAs) and their treatment have been associated with psychological distress and poorer quality of life (QOL) in research studies. Patient-reported outcome (PRO) measures are beginning to be introduced in clinical settings and early experiences with their clinical utility warrant attention. We wanted to describe PROs of patients attending a multidisciplinary VA clinic in order to elucidate roles that PRO measures might have in clinical settings. Methods: In this retrospective study, we enrolled patients with history of sustained VA and/or ICD shock at their initial visit to a clinic staffed by an electrophysiologist and a psychologist. Patients completed several PRO measures including the following: anxiety and depression symptoms, visual analog scales for health status and QOL, cardiac device acceptance, ICD shock anxiety, and general cardiac anxiety. Here we report total scores for general PROs and item-level analysis of the three cardiac-specific measures. Results: A total of 57 patients (56 ±15 years; 84% male) were included; 39% had a history of sudden cardiac arrest, 70% had prior ICD shock and 44% had previously undergone VA ablation. Symptoms that exceeded clinical thresholds were common for anxiety (49%) and depression (20%). On 0-100 visual analogue scales, the mean rating for health status was 57 ± 16 and for QOL was 66 ± 18. Item-level analysis of cardiac-specific PROs revealed that between 40% and 50% of patients endorsed specific concerns regarding return to work, resumption of physical activities, and sexual relations (Table 1). Conclusion: Among patients attending a VA clinic, elevated symptoms of anxiety and depression were common and self-reported health status and QOL were low. Although PRO total scores provided general information, review at the individual item level provided critical information about potential sources of anxiety that can guide cardiologists during discussions with patients.

scholarly journals Caregiver burden versus intensity of anxiety and depression symptoms in parents of children with cerebral palsy as well as factors potentially differentiating the level of burden: a cross-sectional study (Poland)

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e036494
Author(s):  
Barbara Gugała
Keyword(s):  
Cerebral Palsy ◽  
Health Status ◽  
Caregiver Burden ◽  
Depression Scale ◽  
Secondary Outcome ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Emotional Involvement ◽  
Children With Cerebral Palsy ◽  
General Strain

ObjectivesTo assess the relationship between caregiver burden and severity of symptoms of anxiety/depression in parents of children with cerebral palsy (CP), and to identify factors differentiating the level of caregiver burden.SettingRegional rehabilitation centres in South-Eastern Poland.ParticipantsThe study involved 190 parents of children with CP, that is, 138 women and 52 men.Primary and secondary outcome measuresCaregiver burden was assessed using Caregiver Burden Scale (CBS), while the intensity of anxiety and depression symptoms was measured using Hospital Anxiety and Depression Scale (HADS). Potential predictors were examined using Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Barthel Index (BI) as well as a questionnaire focusing on the characteristics of the child, the parent and the family. The analyses applied Pearson’s linear correlation coefficient as well as multiple regression analysis.ResultsAll the CBS measures are significantly correlated to HADS-A (anxiety) and HADS-D (depression). Intensity of anxiety is most visibly linked to CBS measures of disappointment and environment (p<0.0001), while severity of depression is related to emotional involvement and general strain (p<0.0001). The factors differentiating caregiver burden measure in the subscales of general strain (p<0.0001) and social isolation (p<0.0001) include the child’s age and BI, and the parent’s health status; in the subscale of disappointment (p<0.0001)—the child’s age, BI, GMFCS, as well as the parent’s age and health status; in the subscale of emotional involvement (p=0.0007)—BI, and the parent’s health status; in the subscale of environment (p=0.0002)—the child’s age and BI.ConclusionsThere is a positive linear relationship between the caregiver burden measures and severity of anxiety and depression. Effort should be made to relieve caregiver burden in parents of children with CP.

scholarly journals Capsaicin in the Treatment of Refractory Neuropathic Pain after Mastectomy Surgery: A Case Report

2020 ◽  
Vol 13 (2) ◽  
pp. 997-1001
Author(s):  
Lilit Flöther ◽  
David Avila-Castillo ◽  
Anna-Maria Burgdorff ◽  
Ralf Benndorf
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Anxiety And Depression ◽  
Pain Medications ◽  
Oral Pain ◽  
Patient Reported ◽  
History Of ◽  
Oral Pain Medication ◽  
Pain Symptoms

A 62-year-old female patient with a history of mastectomy surgery and sentinel lymphadenectomy in the context of breast cancer therapy was referred to our clinic for the treatment of refractory neuropathic pain. She reported a complex set of symptoms including burning and electrical-like sensations as well as profound hyperesthesia, hyperalgesia, and allodynia. The symptoms persisted chronically over months with a strong intensity and did not sufficiently respond to oral pain medication and co-analgetics, that is, tapentadol and pregabalin. As the patient could hardly move her right upper arm due to the pain, the quality of life was greatly reduced. In addition, the patient reported pain-related anxiety and depression. Therefore, a therapy with capsaicin 8% patch was initiated. Treatment with capsaicin 8% led to pain relief without tolerance development and improved flexibility in the affected body area. Despite significant pain relief, previous oral pain medications (tapentadol, pregabalin) as well as the anti-depressant amitriptyline were maintained to fully resolve pain symptoms, anxiety, and depression. In conclusion, capsaicin 8% may represent an effective therapeutic alternative for patients suffering from refractory neuropathic pain.

scholarly journals The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Steve Peterson ◽  
James Piercy ◽  
Stuart Blackburn ◽  
Emma Sullivan ◽  
Chetan S. Karyekar ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Multinomial Logistic Regression ◽  
The United States ◽  
Anxiety And Depression ◽  
Relative Risk Ratio ◽  
Depression Symptoms ◽  
Patient Anxiety ◽  
Patient Reported ◽  
The Usa ◽  
The Impact

Abstract Background The prevalence of mood disturbances such as anxiety and depression is greater in rheumatoid arthritis (RA) patients than in the general population. Given this association, the primary aim of this study was to assess the incremental impact of anxiety or depression on patients with RA from the United States of America (USA) and Europe, independent of the impact of the underlying RA disease. Methods Rheumatologists (n = 408) from the USA and 5 European countries completed patient record forms for a predetermined number of RA patients who consulted consecutively during the study period; these patients completed patient-reported questionnaires. Descriptive statistics and multivariate regression were used to investigate the relationship between anxiety and depression with treatment and economic outcomes in RA patients. Results Of 1015 physician and patient pairs who completed all relevant questionnaire sections, 390 (38.4%) patients self-reported anxiety or depression, while 180 (17.7%) patients were reported to have anxiety or depression by their physicians. Controlling for age, gender, body mass index and clinical factors (flaring and severity), multiple regression analyses suggested that patients with anxiety or depression more often experienced treatment dissatisfaction (odds ratio [OR] 2.28; P < .001), had greater impairment in work (coefficient [β] = 11.82; P = .001) and usual activity (β = 14.73; P < .001), greater disability (β = .35; P < .001), and more often reported unemployment (OR 1.74; P = .001). Multinomial logistic regression revealed discordance between physician and patient satisfaction with treatment. For patients reporting anxiety or depression, physicians were more often satisfied with achievement of current disease control than patients (relative risk ratio 2.19; P = .002). Conclusion Concomitant anxiety or depression was associated with a significant incremental impact on the health-related quality of life and economic aspects of life of patients with RA. In light of observed differences between physician recognition of patient anxiety and/or depression versus patient reporting of anxiety and/or depression symptoms, further research is warranted to develop optimal screening and management of depression and anxiety in patients with RA.

scholarly journals Predictors of Persistent Postoperative Pain at Minimum Two-years After Arthroscopic Treatment of Femoroacetabular Impingement

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020
Author(s):  
Austin V. Stone ◽  
Philip Malloy ◽  
William H. Neal ◽  
Edward Beck ◽  
Brian Robert Waterman ◽  
...  
Keyword(s):  
Mental Health ◽  
Postoperative Pain ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Persistent Pain ◽  
Anxiety And Depression ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Persistent Postoperative Pain

Objectives: To evaluate predictors for persistent postoperative pain following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesized that patients with chronic preoperative pain, smokers, and those with co-morbid mental health disease would have greater persistent postoperative pain. Methods: Patients undergoing hip arthroscopy for FAIS were identified in a prospectively collected database with a minimum of two-year follow-up with patient reported outcomes (PROs). Previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by VAS-Pain scores as limited (≤30) and persistent (>30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression to identify predictors of postoperative pain. Results: The limited pain (n=514) and persistent pain (n=174) groups totaled 688 patients (449 females). The persistent pain group was significantly older with a greater proportion of revision arthroscopy, worker’s compensation cases, smokers, hypertension, a history of a psychiatric diagnosis and preoperative narcotic use. Both collegiate sport participation [odds ratio (OR) -6.09 (95% CI: -1.23--30.3, p=0.027) and frequent running (OR -1.75, 95% CI: -1.09--2.81; p=0.021) decreased risk for pain. Smokers were 2.22 times more likely to have persistent pain (p=0.032; 95% CI: 1.07-4.46). A history of anxiety and depression is associated with 2.87 greater risk for persistent pain (p=0.030; 95% CI: 1.11-7.45). Conclusion: Independent predictors for persistent postoperative pain include current smoking and mental health history positive for anxiety and depression. Running as a primary form of exercise and high-level athletic participation are protective against persistent pain. Additional risk factors for increased pain include increased age, workers’ compensation claim, previous comorbid disease treated with surgery, and decreased preoperative PROs. Our analysis demonstrated significant improvements in both pain and functional PROs in both the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly inferior PROs.

scholarly journals Sociodemographic, Clinical, and Psychosocial Characteristics of People with Hemophilia in Portugal: Findings from the First National Survey

TH Open ◽  
2018 ◽  
Vol 02 (01) ◽  
pp. e54-e67 ◽  
Author(s):  
Patrícia Pinto ◽  
Ana Paredes ◽  
Susana Pedras ◽  
Patrício Costa ◽  
Miguel Crato ◽  
...  
Keyword(s):  
Illness Perceptions ◽  
Activity Patterns ◽  
Self Report ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Psychosocial Characteristics ◽  
Patient Reported ◽  
Proxy Version ◽  
Adults And Children ◽  
Bleeding Episodes

AbstractHemophilia is a rare genetic bleeding disorder associated with pain, impaired functionality, and decreased quality of life (QoL). Several studies have focused on patient-reported outcomes of people with hemophilia (PWH) worldwide, but no such data are available for Portugal. This survey aimed to describe sociodemographic, clinical, and psychosocial characteristics of PWH of all ages in Portugal. Questionnaires were answered by self-report or by parents of children with hemophilia (proxy version). Variables assessed were sociodemographic and clinical, physical activity patterns, pain, functionality (HAL/PedHAL), QoL (A36 Hemofilia-QoL/CHO-KLAT), anxiety and depression (PROMIS), and illness perceptions (IPQ-R). One-hundred and forty-six PWH answered the survey: 106 adults, 21 children/teenagers between 10 and 17 years, 11 children between 6 and 9 years, and 8 children between 1 and 5 years. Most participants had severe hemophilia (60.3%) and type A was most commonly reported (86.3%). Bleeding episodes, joint deterioration, and pain were very prevalent, with the ankles and knees being the most affected joints, as illustrated by HAL/PedHAL scores. The A36 Hemofilia-QoL assessment showed moderate QoL (96.45; 0–144 scale) and significant anxiety and depression symptoms were found in 36.7 and 27.2% of adults, respectively. CHO-KLAT global score (0–100 scale) was 75.63/76.32 (self-report/proxy). Concerning hemophilia-related illness beliefs, a perception of chronicity and symptoms unpredictability was particularly prominent among adults and children/teenagers. This survey provided a comprehensive characterization of Portuguese PWH, including the first report of psychosocial characteristics. The findings allow for a deeper understanding of life with hemophilia in Portugal and the identification of relevant health care and research needs.

scholarly journals 156 Improvement in Disease Severity in Patients With Treatment-Resistant Depression Following Treatment With Intranasal Esketamine

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 95-96
Author(s):  
Abigail Nash ◽  
May Shawi ◽  
Jaskaran Singh ◽  
Ella Daly ◽  
Kimberly Copper ◽  
...  
Keyword(s):  
Large Scale ◽  
Rating Scale ◽  
Depression Symptoms ◽  
Inadequate Response ◽  
P Values ◽  
Weekly Treatment ◽  
Patient Reported ◽  
History Of ◽  
Reported Data ◽  
Psychotic Features

AbstractBackgroundRecognizing the importance not only of the clinician’s opinion but also of the patient’s experience and perspective, Sequenced Treatment Alternatives to Relieve Depression (STAR*D) utilized both clinician-reported and patient-reported outcomes in a large-scale multi-step study on antidepressant effectiveness in real-world settings. Both approaches indicate that <17% of Major Depressive Disorder (MDD) patients respond to novel oral treatments after two prior antidepressant failures. To address this low response rate and continue to investigate the use of patient-rated outcomes in clinical trials, an antidepressant with a new mechanism of action is being investigated for efficacy and safety utilizing both clinician-rated and patient-reported scales.MethodsThis is a post-hoc analysis of a Janssen R&D Phase 2a clinical trial (ESKETINTRD2003). Subjects aged 20-64 withMDD without psychotic features (DSM IV) and a history of inadequate response to ≥2 antidepressants were randomized [3:1:1:1] to 1 week of twice-weekly treatment with intranasal placebo (n=33), esketamine 28 mg (n=11), 56 mg (n=11), or 84 mg (n=12). Participants taking oral antidepressants at study entry continued treatment during the study. Changes in depression severitywere measured using the Clinical Global Impression Severity (CGI-S) and the Patient Global Impression Severity (PGI-S) scales.ResultsAt all esketamine doses (28 mg, 56 mg, 84 mg), subjects reported a one-point mean change in PGI-S from baseline to week one compared to no change on placebo (p-values 0.005, 0.001, 0.032 respectively). Similarly, mean CGI-S scores improved for subjects receiving esketamine at all doses (p-values 0.028, 0.004, 0.049 respectively) compared to no change inplacebo subjects. These data are consistent with previously reported data based on the Montgomery Åsberg Depression Rating Scale (MADRS) and support positive correlation between patient-reported and clinician-reported outcomes.DiscussionInitial results from this Phase 2a study suggest clinically relevant improvement in depression symptoms in as early as one week when treated with twice-weekly intranasal esketamine as reported by both clinicians and patients. This work will help guide future investigations of esketamine in larger populations to provide better therapeutic options for treatment resistantMDD patients.Funding AcknowledgementsJanssen

scholarly journals Clinimetric Criteria for Patient-Reported Outcome Measures

2021 ◽  
pp. 1-11
Author(s):  
Danilo Carrozzino ◽  
Chiara Patierno ◽  
Jenny Guidi ◽  
Carmen Berrocal Montiel ◽  
Jianxin Cao ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Subjective Experience ◽  
Rating Scales ◽  
Poor Performance ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinical Settings ◽  
Patient Reported ◽  
History Of ◽  
Clinical Measurements

Patient-reported outcome measures (PROMs) are self-rated scales and indices developed to improve the detection of the patients’ subjective experience. Given that a considerable number of PROMs are available, it is important to evaluate their validity and usefulness in a specific research or clinical setting. Published guidelines, based on psychometric criteria, do not fit in with the complexity of clinical challenges, because of their quest for homogeneity of components and inadequate attention to sensitivity. Psychometric theory has stifled the field and led to the routine use of scales widely accepted yet with a history of poor performance. Clinimetrics, the science of clinical measurements, may provide a more suitable conceptual and methodological framework. The aims of this paper are to outline the major limitations of the psychometric model and to provide criteria for clinimetric patient-reported outcome measures (CLIPROMs). The characteristics related to reliability, sensitivity, validity, and clinical utility of instruments are critically reviewed, with particular reference to the differences between clinimetric and psychometric approaches. Of note is the fact that PROMs, rating scales, and indices developed according to psychometric criteria may display relevant clinimetric properties. The present paper underpins the importance of the clini­metric methodology in choosing the appropriate PROMs. CLIPROM criteria may also guide the development of new indices and the validation of existing PROMs to be employed in clinical settings.

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