scholarly journals Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?

2019 ◽  
Vol 46 (12) ◽  
pp. 1634-1639 ◽  
Author(s):  
Kai Sun ◽  
Jackie Szymonifka ◽  
Henghe Tian ◽  
Yaju Chang ◽  
Jennifer C. Leng ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Rheumatic Disease ◽  
Patient Reported Outcomes ◽  
Multivariable Analysis ◽  
Chinese American ◽  
Chinese Americans ◽  
The United States ◽  
Targeted Interventions ◽  
Patient Reported

Objective.Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients.Methods.Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient Reported Outcomes Measurement Information System (PROMIS) short forms. TCM users and nonusers were compared. Factors independently associated with TCM use were identified using multivariable logistic regression.Results.Among 230 participants, median age was 57 years (range 20–97), 65% were women, 71% had ≤ high school education, 70% were on Medicaid insurance, 47% lived in the United States for ≥ 20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse self-reported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with nonusers. In multivariable analysis, TCM use was associated with belief in TCM, female sex, ≥ 20 years of US residency, reporting Western medicine as ineffective, and shorter rheumatic disease duration.Conclusion.Among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.

scholarly journals Understanding Patient Values and the Manifestations in Clinical Research with Traditional Chinese Medicine—With Practical Suggestions for Trial Design and Implementation

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Wei Mu ◽  
Hongcai Shang
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Clinical Research ◽  
Patient Reported Outcomes ◽  
Patient Choice ◽  
Rational Beliefs ◽  
Choice Preference ◽  
Patient Reported ◽  
Individual Participant ◽  
Patient Values

Objective. To define patient values, identify their manifestations in a randomized clinical trial, and investigate the possible implications for clinical research of traditional Chinese medicine.Methods. We categorized patient values manifestations into patient choice, preference, compliance, and patient-reported outcomes and summarized the underlying personal values through purposeful electronic searches for relevant reports. By hypothesizing a set of positive versus negative circumstances occurring in the enrollment, intervention allocation, treatment, and the follow-up stage of a trial, it is possible to discuss the potential implications of patient values manifestation on a trial with traditional Chinese medicine.Results. Patient values and its manifestations are ubiquitous in the process of clinical research with traditional Chinese medicine. These values may provide motivation for participation or engender the internal and external validity of the study.Conclusions. Trialists should attach sufficient importance to the needs and concerns of individual participant. To incorporate patient values into the design and conduct of a clinical study with traditional Chinese medicine, researchers are recommended to adopt participant-friendly design and use patient-reported outcomes, take convenience-for-patients measures, and help foster rational beliefs and behaviors of trial participants.

Economic burden associated with cervical cancer: An analysis of patient-reported outcomes in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17021-e17021
Author(s):  
Chizoba Nwankwo ◽  
Nate Alexander Way ◽  
Vicky Weitian Li
Keyword(s):  
Cervical Cancer ◽  
Economic Burden ◽  
Patient Reported Outcomes ◽  
Multivariable Analysis ◽  
The United States ◽  
Direct Costs ◽  
Medical Expenditure ◽  
Patient Reported ◽  
Hospitalization Costs ◽  
The Difference

e17021 Background: Although much is known about the prevention, screening, and treatment of cervical cancer (CC), less is known about its economic burden. This study compared patient-reported outcomes (PROs) between women diagnosed and treated for CC, women diagnosed and untreated for CC, and women without CC. Methods: Data were aggregated from the 2013-2015 US National Health and Wellness Surveys, a nationally-representative, self-administered, internet-based survey of adults (N = 269,447). Controlling for baseline patient demographics and characteristics, three matched cohorts were compared in multivariable analysis: treated CC, untreated CC, and no CC. Treated CC and untreated CC patients with other forms of comorbid cancer were excluded from analyses. Economic outcomes included healthcare resource use (HCRU) over the past six months and annualized direct costs. Direct costs were calculated using Medical Expenditure Panel Survey data. Results: Adjusted means are reported. Treated CC (N = 192), untreated CC (N = 829), and no CC (N = 1,018) cohorts largely differed by number of healthcare provider (HCP) visits (0.95 vs. 0.89 vs. 0.84, p’s < 0.05), hospitalizations (0.18 vs. 0.09 vs. 0.10, p’s < 0.05), and ER visits (0.29 vs. 0.19 vs. 0.16, p’s < 0.05), though the difference between untreated CC and no CC cohorts was not significant for hospitalizations nor ER visits. Treated CC, untreated CC, and no CC cohorts also largely differed by HCP costs ($14,143 vs. $11,187 vs. $10,573, p’s < 0.01), hospitalization costs ($12,006 vs. $4,202 vs. $4,908, p’s < 0.01), ER costs ($2,104 vs. $995 vs. $872, p’s < 0.01), and total direct costs ($30,768 vs. $16,613 vs. $16,776, p’s < 0.01), though the difference between untreated CC and no CC cohorts was not significant for HCP costs nor total direct costs. Conclusions: These results indicate substantial economic burden in women diagnosed with CC in the US. In terms of HCRU and direct costs, treated CC patients incur the greatest burden, untreated CC patients incur the second greatest burden, and individuals without CC tend to incur the least burden.

scholarly journals Identifying Foot and Ankle Patients at Risk to Fall Based on Patient Reported Outcomes Assessments

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Judith Baumhauer ◽  
Jack Teitel ◽  
Allison McIntyre ◽  
David Mitten ◽  
Jeff Houck
Keyword(s):  
At Risk ◽  
Effect Size ◽  
Fall Risk ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Foot And Ankle ◽  
Falls Risk ◽  
Orthopaedic Patients ◽  
Patient Reported ◽  
Patients At Risk

Category: Other Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post-operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) can identify orthopaedic and specifically foot and ankle patients at risk to fall. Methods: Prospective patient reported outcomes (PROMIS CAT physical function, pain interference and depression and CMS fall risk assessment questions) and patient demographics were collected for all patients at each clinic visit from an academic orthopaedic multi-specialty practice between January 2015 and November 2017. Standardized yes/no validated self-reported fall risk questions include: “Have you fallen in the last year?” and “Do you feel you are at risk of falling?” Histograms, t-tests, confidence intervals and effect size were used to determine the fall risk “YES” patients were different than the “NO” for ALL orthopaedic patients and specifically foot and ankle patients. Logistic Regression was used to determine if age, gender, height, weight, and PROMIS scales predicted self-reported falls risk. Results: 94,761 orthopaedic patients comprising 315,273 visits (44% male, mean age 53.7+/-17 years) and 13,720 foot/ankle patients comprising 33,480 visits (37% male, mean age 52.7+/-16.1 years) had complete data for analysis. Table 1 provides the means/SD/p-values/effect sizes for patient self-identifying at risk to fall stratified by PROMIS PF/ PI/Dep t-scores. Although all PROMIS scores demonstrated significant impairment between patients at risk designation (yes/no), PROMIS PF had the largest effect size for ALL Ortho and FOOT AND ANKLE patients (0.8 and 0.7 respectively). Patients who are at risk to fall have PROMIS PF t-scores >1.5 lower than the United States normative population while the patients not at risk are less <1 SD. In the adjusted regression models gender and PROMIS PF had the largest coefficients. Conclusion: Falls are a major threat to quality of life and independence yet prevention/treatment strategies are difficult to implement across a health system. There is also a tremendous societal cost with orthopaedic surgeons often the recipient of these debilitated patients. PROMIS assessments are part of the AOFAS OFAR initiative to track patient recovery with treatment and can additional be used to fulfill a quality indicator requirement by CMS. This study demonstrates these assessments (PROMIS threshold values) can also be linked to self-report falls risk (yes/no) and may identify patients at risk with no face to face time required from the provider.

A patient reported outcomes of treatments for desmoid tumors: An international natural history study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11560-11560
Author(s):  
Danielle Braggio ◽  
Amanda Lucas ◽  
Lynne Hernandez ◽  
Kelly Mercier
Keyword(s):  
Natural History ◽  
Active Surveillance ◽  
Desmoid Tumor ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Desmoid Tumors ◽  
Targeted Agents ◽  
Natural History Study ◽  
Systemic Treatments ◽  
Patient Reported

11560 Background: The Desmoid Tumor Research Foundation (DTRF) launched the natural history study (NHS) in 2017. At this time, there are no standard-of-care options for this rare sarcoma. The treatments, clinical descriptors, and the patient reported outcomes to pharmacologic agents are described here within. Methods: The web-based natural history study launched September 2017 in collaboration with the National Organization of Rare Disorders. It contains 15 surveys covering diagnostics, disease, treatment, care management, and quality of life. Treatment types included in the DTRF NHS were pharmacology, surgery, radiation, high-intensity focused ultrasound (HiFU), and active surveillance (watch and wait). Results: While surgery was once the primary intervention for desmoid tumor patients, the NHS participants reported that 47.6% had received active surveillance or no systemic treatment at diagnosis. This is most common for desmoid tumors located in abdominal wall (54/103; 52.4%). There were 87 reported cases of complete surgical resection, 38 incomplete resections, and 23 bowel resections. 9 amputations were reported; 8 participants reported recurrent disease following the removal of the limb. The non-surgical interventions, such as radiation and HiFU, were mostly described for participants with chest wall tumors (15 pts) and joints/extremities (10 pts). Many options for systemic therapies were described including sorafenib (44/284; 15.5%), sulindac (36/284; 12.7%), and anti-hormonal agents tamoxifen and toremifene (34/285; 10.9%) were described. Targeted agents, such as gamma secretase inhibitor, pazopanib, and sorafenib, were greater in the United States than the non-US country participants (21% vs 9%). Multiple lines of treatments were reported by 81 participants, surgery is greatest as the first intervention for all tumor locations (49/81, 60%), with the exception of those with head/neck tumors who received chemotherapy (6/11, 55%). Analysis has started to evaluate the efficacy of systemic treatments from these NHS data. The table describes the participant reported outcomes of anti-hormonal agents, chemotherapeutics, non-steroidal anti-inflammatories, and targeted agents. Both chemotherapies and targeted agents were reported to have 38.1% response rates from the participants with 34.3% and 23.8% of participants reported progressive disease on therapy, respectively. Conclusions: Desmoid tumor NHS study participants reported the use of many treatment modalities demonstrating a range of frequency of use by tumor location and efficacy. Data collection through the DTRF NHS is ongoing.[Table: see text]

scholarly journals Theoretical Study of the anti-NCP Molecular Mechanism of Traditional Chinese Medicine Lianhua-Qingwen Formula (LQF)

2020 ◽  
Author(s):  
Chenghao Ye ◽  
Meina Gao ◽  
Wangqiang Lin ◽  
Kunqian Yu ◽  
Peng Li ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Molecular Mechanism ◽  
Hydrophobic Interactions ◽  
Killer Cell ◽  
Cell Receptor ◽  
The United States ◽  
Mapk Signaling ◽  
Binding Modes ◽  
Pathway Network

<div>Due to the good clinical efficacy in treating Novel Coronavirus Pneumonia (NCP) resulted from </div><div> </div><div>SARS-CoV-2, as the traditional Chinese medicine(TCM) prescription, Lianhua Qingwen Formula </div><div>(LQF) was composed into the Diagnosis and Treatment Programs of 2019 New Coronavirus<br></div><div> </div><div>Pneumonia (from fourth to seventh editions) formulated by the National Health Commission of China. </div><div> </div><div>Aiming to prevent and treat viral influenza, LQF was patented from 2003 in China, and passed the </div><div> </div><div>Phase II clinical trial by FDA in the United States in 2015. However, the molecular mechanism of LQF </div><div> </div><div>anti SARS-CoV-2 pneumonia is still not clear. It is shown that the docking scores of three components </div><div> </div><div>in LQF including Rutin, Forsythoside E, and Hyperoside to main protease of SARS-CoV-2 are very </div><div>large as -9.1, -9.0 and -8.7 kcal/mol, respectively, which are even better than those of Lopinavir at -7.3<br></div><div> </div><div>kcal/mol. Importantly, the binding modes between active compounds and protein were verified via </div><div> </div><div>molecular dynamics (MD) simulation and calculation all the binding free energies at MM-PBSA level. </div><div> </div><div>Note that these donor-acceptor systems were stabilized by non-polar interactions including hydrogen </div><div> </div><div>bonds and hydrophobic interactions. At last, from the constructed component-target-pathway network, </div><div> </div><div>it is shown that the components in LQF are related important pathways to improve the human immunity </div><div> </div><div>such as T cell, B cell receptor signaling, natural killer cell mediated cytotoxicity, as well as anti</div><div> </div><div>inflammatory pathways including Fc epsilon RI, ErbB, MAPK signaling and so on. The present </div><div> </div><div>investigation represents the first report on the molecular mechanism of LQF as NCP inhibitor</div>

Predictors of high financial distress in a national, multiethnic sample of patients with cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 149-149
Author(s):  
Meera Vimala Ragavan ◽  
Rosie Cunningham ◽  
Andrea Incudine ◽  
Hala Borno ◽  
Thomas Stivers
Keyword(s):  
Cancer Treatment ◽  
Financial Distress ◽  
Financial Support ◽  
Financial Stress ◽  
The United States ◽  
Financial Assistance ◽  
Financial Toxicity ◽  
Targeted Interventions ◽  
Patients With Cancer ◽  
Patient Reported

149 Background: Financial toxicity is characterized by financial burden that patients face. Patients and providers are seldom aware of available resource to help mitigate this growing problem. To date, our understanding of the myriad of financial repercussions of cancer treatment remains limited. Prior published research has largely been single center, thereby limiting generalizability across the United States. This study leveraged a national, multi-ethnic sample of patients who receive financial support services including comprehensive financial assistance, navigation, planning, and a guidebook with relevant resources from a non-profit entity (Family Reach) to evaluate financial stress in during cancer treatment. Methods: Patients were identified for study participation if they received at least one financial support resource from Family Reach between 1/1/2020-6/30/2020. An 11-item survey was sent electronically to all eligible participants who were given a one-month time frame to complete. A multivariate model was employed to identify sociodemographic predictors of high financial distress. Results: A total of 832 patients were contacted, of whom 330 (40%) completed the survey. Demographic information is included in table. Patient reported financial distress in the prior week was high, with 46% of patients reporting a distress level of seven or higher on a ten-point scale. In a multivariate regression, Hispanic/Latinx ethnicity was associated with a higher distress rating and higher patient reported financial stress. Lower annual household income was associated with lower reports of feeling in financial control, lower reports of meeting monthly expenses, and higher reports of financial stress. Conclusions: Patient-reported financial distress was high in a national sample of patients with cancer who had utilized at least one financial resource provided by Family Reach. Hispanic ethnicity and Lower Annual Income were predictors of higher patient-reported financial distress. Larger samples are needed to confirm these patterns. Delivery systems should develop targeted interventions, including referrals to organizations providing financial assistance, for patient populations at high risk for financial toxicity. [Table: see text]

The Development and Initial Findings of A Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease (SPARC IBD)

2021 ◽  
Author(s):  
Laura E Raffals ◽  
Sumona Saha ◽  
Meenakshi Bewtra ◽  
Cecile Norris ◽  
Angela Dobes ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clinical Data ◽  
Bowel Disease ◽  
Patient Reported Outcomes ◽  
Data Entry ◽  
The United States ◽  
Predictors Of Response ◽  
Patient Reported ◽  
Inflammatory Bowel ◽  
Reported Data

Abstract Background Clinical and molecular subcategories of inflammatory bowel disease (IBD) are needed to discover mechanisms of disease and predictors of response and disease relapse. We aimed to develop a study of a prospective adult research cohort with IBD (SPARC IBD) including longitudinal clinical and patient-reported data and biosamples. Methods We established a cohort of adults with IBD from a geographically diverse sample of patients across the United States with standardized data and biosample collection methods and sample processing techniques. At enrollment and at time of lower endoscopy, patient-reported outcomes (PRO), clinical data, and endoscopy scoring indices are captured. Patient-reported outcomes are collected quarterly. The quality of clinical data entry after the first year of the study was assessed. Results Through January 2020, 3029 patients were enrolled in SPARC, of whom 66.1% have Crohn’s disease (CD), 32.2% have ulcerative colitis (UC), and 1.7% have IBD-unclassified. Among patients enrolled, 990 underwent colonoscopy. Remission rates were 63.9% in the CD group and 80.6% in the UC group. In the quality study of the cohort, there was 96% agreement on year of diagnosis and 97% agreement on IBD subtype. There was 91% overall agreement describing UC extent as left-sided vs extensive or pancolitis. The overall agreement for CD behavior was 83%. Conclusion The SPARC IBD is an ongoing large prospective cohort with longitudinal standardized collection of clinical data, biosamples, and PROs representing a unique resource aimed to drive discovery of clinical and molecular markers that will meet the needs of precision medicine in IBD.

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