Another Set of Eyes: Recipients’ Views of the Benefits of Geriatric Specialty Telehealth Services

The aim of GRECC Connect is to increase access to specialty care for medically complex, older, rural patients through e-consultations and telehealth visits. We interviewed 50 outpatient clinic staff and providers as well as 30 patients and caregivers about these services. Overall, the services were considered beneficial. For patients and caregivers, services alleviated the stress and cost of travel, they improved quality of life by increasing their understanding of the progression of an illness and providing treatment and guidance to increase patient functioning and reduce disruptive behaviors, and they eased anxiety associated with not receiving needed care. Having ‘another set of eyes’ on the patients reduced stress and anxiety for providers. Concerns included alignment of telehealth modality with the capabilities of older patients with cognitive problems, hearing loss and/or limited technological abilities and, for some providers, that the referral for and recommendations resulting from the service added to their workload.

Linking Free Text Documentation of Functioning and Disability to the ICF With Natural Language Processing

Background: Invaluable information on patient functioning and the complex interactions that define it is recorded in free text portions of the Electronic Health Record (EHR). Leveraging this information to improve clinical decision-making and conduct research requires natural language processing (NLP) technologies to identify and organize the information recorded in clinical documentation.Methods: We used natural language processing methods to analyze information about patient functioning recorded in two collections of clinical documents pertaining to claims for federal disability benefits from the U.S. Social Security Administration (SSA). We grounded our analysis in the International Classification of Functioning, Disability, and Health (ICF), and used the Activities and Participation domain of the ICF to classify information about functioning in three key areas: mobility, self-care, and domestic life. After annotating functional status information in our datasets through expert clinical review, we trained machine learning-based NLP models to automatically assign ICF categories to mentions of functional activity.Results: We found that rich and diverse information on patient functioning was documented in the free text records. Annotation of 289 documents for Mobility information yielded 2,455 mentions of Mobility activities and 3,176 specific actions corresponding to 13 ICF-based categories. Annotation of 329 documents for Self-Care and Domestic Life information yielded 3,990 activity mentions and 4,665 specific actions corresponding to 16 ICF-based categories. NLP systems for automated ICF coding achieved over 80% macro-averaged F-measure on both datasets, indicating strong performance across all ICF categories used.Conclusions: Natural language processing can help to navigate the tradeoff between flexible and expressive clinical documentation of functioning and standardizable data for comparability and learning. The ICF has practical limitations for classifying functional status information in clinical documentation but presents a valuable framework for organizing the information recorded in health records about patient functioning. This study advances the development of robust, ICF-based NLP technologies to analyze information on patient functioning and has significant implications for NLP-powered analysis of functional status information in disability benefits management, clinical care, and research.

Efficacy of galcanezumab in patients with migraine and history of failure to 3–4 preventive medication categories: subgroup analysis from CONQUER study

Background Chronic migraine (CM) and episodic migraine (EM) are associated with substantial headache-related disability, poor quality of life and global societal burden. In this subgroup analysis from the CONQUER study, we report efficacy outcomes from a pre-specified analysis of galcanezumab versus placebo in patients with CM or EM and 3–4 prior preventive medication category failures due to inadequate efficacy (after at least 2 months at maximum tolerated dose), or safety or tolerability reasons. The patient population is of particular interest due to evidence of decreased quality of life and increased economic burden among patients with migraine that is inadequately managed and is of interest to decision-makers globally. Methods Key outcomes included overall mean change from baseline in monthly migraine headache days and proportions of patients achieving ≥30% (CM), ≥50%, and ≥ 75% reduction (response rates) in monthly migraine headache days across Months 1–3. Patient functioning and disability were evaluated at Month 3. Results Of the 462 randomized patients, 186 (40.3%) had a history of 3–4 preventive category failures. Galcanezumab versus placebo resulted in significantly (P ≤ .001) larger overall mean reduction in monthly migraine headache days (total: − 5.49 versus − 1.03; CM: − 6.70 versus − 1.56; EM: − 3.64 versus − 0.65). Similarly, the ≥50% response rate was significantly (P ≤ .001) higher with galcanezumab versus placebo (total: 41.0 versus 12.7; CM: 41.5 versus 8.4; EM: 41.1 versus 16.5). In the CM group, the ≥30% response rate was significantly higher in the galcanezumab group than the placebo group (CM, 57.5 versus 19.8, P ≤ .0001) as was the ≥75% response rate (13.3 versus 2.6, P ≤ .05). Galcanezumab also resulted in significant (P < .0001) improvements in patient functioning and reductions in disability. Conclusions Galcanezumab was effective in a difficult-to-treat population of patients with CM or EM who had failed 3–4 prior preventive medication categories. Trial registration CONQUER. Clinicaltrials.gov identifier: NCT03559257.

Linking Free Text Documentation of Functioning and Disability to the ICF with Natural Language Processing

Background: Invaluable information on patient functioning and the complex interactions that define it is recorded in free text portions of the Electronic Health Record (EHR). Leveraging this information to improve clinical decision-making and conduct research requires natural language processing (NLP) technologies to identify and organize the information recorded in clinical documentation. Methods: We used NLP methods to analyze information about patient functioning recorded in two collections of clinical documents pertaining to claims for federal disability benefits from the U.S. Social Security Administration (SSA). We grounded our analysis in the International Classification of Functioning, Disability and Health (ICF), and used the ICF's Activities and Participation domain to classify information about functioning in three key areas: Mobility, Self-Care, and Domestic Life. After annotating functional status information in our datasets through expert clinical review, we trained machine learning-based NLP models to automatically assign ICF codes to mentions of functional activity. Results: We found that rich and diverse information on patient functioning was documented in the free text records. Annotation of 289 documents for Mobility information yielded 2,455 mentions of Mobility activities and 3,176 specific actions corresponding to 13 ICF-based codes. Annotation of 329 documents for Self-Care and Domestic Life information yielded 3,990 activity mentions and 4,665 specific actions corresponding to 16 ICF-based codes. NLP systems for automated ICF coding achieved over 80% macro-averaged F-measure on both datasets, indicating strong performance across all ICF codes used. Conclusions: NLP can help to navigate the tradeoff between flexible and expressive clinical documentation of functioning and standardizable data for comparability and learning. The ICF has practical limitations for classifying functional status information in clinical documentation, but presents a valuable framework for organizing the information recorded in health records about patient functioning. This study advances the development of robust, ICF-based NLP technologies to analyze information on patient functioning, and has significant implications for NLP-powered analysis of functional status information in disability benefits management, clinical care, and research.

Work and Social Adjustment Scale (WSAS): psychometric characteristics of a Spanish adaptation in a clinical population

Background: The Work and Social Adjustment Scale (WSAS) is an instrument that can be easily applied for routine evaluation of the impact of mental disorders on patient functioning. In spite of the interest in its use, there is very little information available on its psychometric characteristics and even less in Spanish. Aims: The objective of this study was to analyse its psychometric characteristics. Method: The sample consisted of 441 patients treated in a community mental health unit. They filled out the WSAS and two psychopathology measures, one for anxiety and the other for depression. Fifty-five of them, chosen at random, were asked to fill out the scale again a second time to explore its temporal reliability. Results: The scale showed high internal consistency, a single factor that explained 60.4% of the variance, and temporal reliability of .78 for the total score. Significant correlations were found between the WSAS scores and the psychopathological measures, as well as significant differences between those working and those on leave. Conclusions: The results confirm the validity and reliability of the scale and support its possible use for routine evaluation of the functional impact of mental disorders.

A systematic review of randomised controlled trials of psychosocial interventions for acute mental health inpatients

Background/Aims Inpatient wards provide an opportunity to intervene with medical, psychological and social care to contain distress and prevent future relapse. However, they have been criticised for an over-reliance on medication and risk management with limited psychosocial interventions. The aim of this study was to investigate clinical trials of psychosocial interventions for inpatients to identify interventions that are effective at improving quality of life, symptoms or patient functioning. Methods An electronic search of six databases was conducted for papers published from 1806 up until February 2017. A total of 18 randomised controlled trials was identified in which outcomes for symptoms, quality of life or functioning were reported. Results Overall, 15 trials showed a statistically significant result for at least one outcome. Seven categories were identified from the 18 studies, at least one in each category was found to be effective for symptoms, quality of life or functioning. The majority were effective (15 out of 18). Conclusions Given that the methodological quality was generally low and number of randomised controlled trials were small, it is difficult to draw definitive conclusions. Recommendations include more and repeated trials using rigorous methods of testing and reporting.

The Quality of Life in Patients with Epilepsy in the Context of Sleep Problems and Sexual Satisfaction

Epilepsy influences the quality of patient functioning in almost all aspects of life. This study aimed to assess the quality of difficulties with sleep initiation and those concerning sexual function, and to assess whether sleep disorders are associated with selected aspects of sexual function and quality of life. The study involved completing a quality-of-life questionnaire for persons with epilepsy: a QOLIE-31 questionnaire, and the present authors’ questionnaire, including 20 questions. A total of 170 questionnaires were completed by 89 men and 81 women. Sleep problems of various frequency were reported by 98 participants (57.6%). Only 41% of patients were definitely satisfied with their sex life. The respondents who declared dissatisfaction with their sex life more often reported difficulties with sleep initiation (χ2 = 10.20; p ≤ 0.001). Moreover, those who claimed that epilepsy might contribute to sex life problems more commonly declared dissatisfaction with their sex life (χ2 = 20.01; p ≤ 0.001) and more frequently, reported difficulties with sleep initiation (χ2 = 6.30; p ≤ 0.012). The issues should constitute the constant element of medical history taking, as improvement in these areas of functioning may promote better quality of life in patients with epilepsy.

Outcome prediction with a social cognitive battery: a multicenter longitudinal study

The interest in social cognition in schizophrenia is justified by the relationship between deficits in these skills and negative functional outcomes. Although assessment batteries have already been described, there is no consensus about which measures are useful in predicting patient functioning or quality of life (QoL). We investigated a set of five measures of recognition of facial emotions, theory of mind (ToM), and empathy in a cohort of 143 patients with schizophrenia or schizoaffective disorder at inclusion and, amongst whom 79 were reassessed 1 year later. The distribution was satisfactory for the TREF (Facial Emotion Recognition Task), V-SIR (Versailles-Situational Intention Reading), and QCAE (Questionnaire of Cognitive and Affective Empathy). Internal consistency was satisfactory for the TREF, V-SIR, V-Comics (Versailles Intention Attribution Task), and QCAE. Sensitivity to change was acceptable for the TREF. The TREF and V-SIR showed a cross-sectional relationship with functioning beyond the clinical symptoms of schizophrenia but not beyond neurocognition. Moreover, the TREF and V-SIR at inclusion could not predict functioning one year later, whereas most neurocognitive and clinical dimensions at inclusion could. Finally, only affective QCAE showed a significant cross-sectional, but not longitudinal, association with QoL. In conclusion, the TREF had satisfactory psychometric properties and showed a cross-sectional, but not longitudinal, association with objective outcome measures, thus appearing to be reliable in clinical practice and research. The V-SIR also showed promising psychometric properties, despite a possible weakness to detect change. However, these measures should be interpreted within the context of the good predictive power of the neurocognitive and clinical status on the outcome.

Sex-related differences in self-reported treatment burden in patients with atrial fibrillation

Funding Acknowledgements Type of funding sources: None. Background Treatment burden (TB) is defined as the patient’s workload of health care and its impact on patient functioning and well-being. High TB can lead to nonadherence, higher risk of adverse outcomes and lower quality of life. We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients. Methods A single-centre, prospective study included consecutive patients with AF under drug treatment for at least six months before enrolment from April to June 2019. Patients were asked to voluntarily and anonymously answer Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation. Results Of 331 patients (mean age 65.4 ±10.3 years, mean total AF history 6.41 ±6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p &lt; 0.001), also females more frequently reported TB ≥59 points than males (37.8% vs 20.6%, p = 0.001). Item-specific sex-related differences in self-reported TB questionnaire are showed in Figure. Sex-related differences in TB on multivariable regression analyses of the highest TB quartile (≥59 points) are showed in Table. Conclusion Our study was first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than VKA in females and a rhythm control strategy in males could decrease TB to acceptable values. Table.Multivariable Logistic Regression analysis of the highest TB quartile (TB ≥59)VariableOR95% CIP valueFemalePPI therapy5.3541.97-14.560.001NOAC0.3190.12-0.830.019Diuretic therapy0.3180.13-0.760.010CHA2DS2-VASc score0.7000.49-0.990.045MaleAblation and/or ECV0.3830.18-0.810.012Supraventricular arrhythmias0.2220.05-0.980.047VKA Vitamin K antagonist; ECV: electrical cardioversion; AF: Atrial fibrillation; PPI: Proton pump inhibitor; PCI: Percutaneous coronary intervention; NOAC: Non-vitamin k antagonist oral anticoagulant.Abstract Figure.

Validation of an 8-item Recovery Assessment Scale (RAS-8) for people with schizophrenia in China

Background The 24-item Recovery Assessment Scale (RAS) is the most widely-used and well-validated tool for measuring recovery for people with mental illness. The current study aims to assess the reliability and validity of an 8-item short form of RAS (RAS-8) among a Chinese sample of people living with schizophrenia. Methods A sample of 400 people living with schizophrenia were recruited for scale validation. Internal consistency was tested by calculating Cronbach's α. Test–retest reliability was calculated using the intraclass correlation coefficient (ICC) for the total score and weighted kappa for each item. Factor structure was tested with confirmatory factor analysis, and concurrent validity was examined by investigating the correlation of the RAS-8 with patient symptoms, disability, depression, anxiety, patient functioning, quality of life and general health. Results The RAS-8 full scale and subscales showed good internal consistency with Cronbach’s alpha ranging from 0.87 to 0.92. ICC of 0.99 and weighted kappa ranged from 0.62 to 0.88, which generally indicates good test–retest reliability. The findings supported an a priori two-factor structure, χ2/df = 2.93, CFI = 0.98, TLI = 0.98, RMSEA = 0.07, SRMR = 0.035. Concurrent validity of the RAS-8 was further supported by its significant negative correlations with patient symptoms (r = −0.24, p < 0.01), disability (r = −0.30, p < 0.01), depression (r = −0.16, p < 0.05), and anxiety (r = −0.14, p < 0.05), and its significant positive relationships with patient functioning (r = 0.26, p < 0.01), quality of life (r = 0.39, p < 0.01) and general health (r = 0.34, p < 0.01). Conclusions This study confirmed the reliability and validity of an 8-item short-form RAS for people living with schizophrenia in Chinese communities. The validation of the RAS-8 allows for its use as an alternative for the full RAS as a rapid assessment tool in clinical and research settings. The findings are discussed for their implications for application and validation with other populations and in other countries.