4-item Questionnaire Research Articles

English use anxiety, motivation, self-efficacy, and their predictive effects on Chinese top university students' English achievements.

The present study examined English use anxiety, motivation, self-efficacy, use of English, and their predictive effects on top university students' English achievements. Two hundred and twenty-three students of the Top-Notch Students of Basic Disciplines Training Program in a top Chinese university answered a battery of questionnaires, which consisted of the 8-item English Use Anxiety Questionnaire, the 5-item Motivational Self-Talk Questionnaire, the 3-item Self-Efficacy Questionnaire, the 19-item Language Learning Orientations Questionnaire, and a Background Information Questionnaire. Analyses of the data revealed the following major findings: (1) the participants had a low level of extrinsic motivation-introjected regulation, a low-to-medium level of English use anxiety, extrinsic motivation-external regulation, intrinsic motivation-knowledge, and a medium-to-high level of motivational self-talk, self-efficacy, extrinsic motivation-identified regulation, intrinsic motivation-accomplishment, and intrinsic motivation-stimulation, (2) use of English anxiety (UAE) and language learning orientation were generally significantly negatively correlated with each other, and significantly correlated with other measured variables, (3) UAE and intrinsic motivation-knowledge significantly predicted the participants English achievements, measured both by standardized test scores and self-rated overall English proficiency, and (4) use of English and self-efficacy mediated the effects of English use anxiety and language learning orientations on the participants' English achievements. These findings further pinpoint the importance of anxiety and motivation in second/foreign language learning.

Implementation of EHR medication-adherence screening tool in breast cancer clinic.

438 Background: Nonadherence to prescribed medications occurs frequently in patient with breast cancer (BC) and can affect BC outcomes as well as outcomes for comorbid conditions. We implemented a process to screen for medication adherence in the electronic health record (EHR) in an urban outpatient BC clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to implement a screening process for medication adherence for all patients seen in the outpatient breast oncology clinic. At check-in (via the patient portal or clinic based kiosks), patients were asked to complete an EHR adherence screener. Two PDSA cycles were completed. During cycle one (2/16/22-5/17/22), patients were asked if they received ≥1 prescribed medication; if yes they were asked to complete the questionnaire (y/n); if yes a 3-item questionnaire was used to screen for adherence to all medications over the prior 7 days. Adherence was defined as 3 of 3 responses “none of the time” to “I have missed my medicine;” “I have skipped a dose of my medicine;” and “I did not take a dose of my medicine.” During cycle two (5/17/22-6/5/22) the screener was simplified. Patients were no longer asked to complete the survey; and the survey was modified to 1-item “I did not take a dose of my medicine”, adherence was defined as response of “none of the time”. We evaluated response rate and self-reported non-adherence rate. Results: During PDSA cycle 1 (2/16/22-5/17/22), 2840 visits occurred and 722 (25%) responses were received; 80% noted prescription of ≥1 medication, 38% agreed to complete the survey; and 87% reported adherence to all prescribed medications while 13% reported non-adherence. During PDSA cycle 2 (5/17/22-6/5/22), 512 visits occurred and 172 (33%) responses were received. Of those, 73% reported prescription of ≥1 medication; of those 66%-reported adherence to all prescribed medications, 21% reported non-adherence, and 17% preferred not to answer. Conclusions: This EHR screener is a simple and scalable tool to rapidly screen for medication adherence. Up to a quarter of patients who completed screening reported non-adherence. Further tools are needed to assess adherence among patients who lack access to the patient portal or clinic kiosk, or are uncomfortable checking in with these mechanisms. Future interventions are necessary to further screen potentially non-adherent patients and for interventions to improve adherence once vulnerable patients are identified.

Three-question Skindex-Mini measures quality of life in children with atopic dermatitis

To the Editor: Skin disorders are often highly visible, pruritic, and painful, leading to considerable burden. Patient-reported symptoms and impacts of skin disease are important in determining well-being but are often missed in physician assessments and do not correlate well with visible signs of disease.1 The Skindex-29, Skindex-16, and Skindex-Teen are validated instruments that measure patients’ perceptions of the impact of skin disease on quality of life.1 The Skindex-Mini, a 3-item questionnaire assessing 3 domains (symptoms, emotions, and function), was created to retain the validity and reliability of its Skindex predecessors while prioritizing ease of use at in-office visits.

Breakfast skipping and its relationship with academic performance in Ethiopian school-aged children, 2019

Breakfast skipping and its relationship with academic achievement among primary school children were investigated in this study. A cross-sectional study was conducted among 848 primary school children. Breakfast skipping was analyzed using a 2-item questionnaire. A 19-item Social Academic and Emotional Behavior Risk Screening questionnaire was used to collect data on children’s behavior. The prevalence of breakfast skipping was found to be 38.1%. Living in a rural area (AOR = 5.2; 95% CI: 3.54, 7.71); having illiterate parents (AOR = 6.66; 95% CI 3.0, 14.7); having parents with a primary education level (AOR 5.18, 95% CI: 2.25, 11.94); living with guardians or other relatives (AOR = 4.06; 95%CI: 2.1, 7.9); and having lower academic achievement (AOR = 2.76; 95% CI: 1.44, 5.29) were factors associated with skipping breakfast.In conclusion, breakfast skipping has been identified as a significant public health concern that requires an immediate response from stakeholders. It is recommended to intervene based on the identified factors.

Impact of social media on the emotional health and burnout of pediatric and adult oncology professionals: A SWOG and COG survey.

11013 Background: Social media (SoMe) engagement is common in oncology, especially for patients and support groups, allowing for education and support. However the impact on oncology professionals remains unknown. The purpose of this study was to evaluate professional SoMe use and its potential associations with wellbeing and burnout. Methods: An electronic survey was developed and piloted by pediatric and adult oncologists. Questions included demographics, details of SoMe use, and emotional health assessments including a 2-item burnout questionnaire. The survey was distributed to all members of SWOG Cancer Research Network and Children’s Oncology Group via Qualtrics. Data was analyzed as of 2/6/2022. Results: The initial survey demographic and emotional health questions were completed by 1558 individuals. Of these, 1069 (68%) reported not using SoMe professionally, while 489 (31%) did. SoMe engagers were primarily female, born 1976–1984, attendings, from academic institutions, and balanced across adult and pediatrics (Table). Among those who use SoMe professionally, 54% (267/489) reported burnout, compared to 66% (701/1069) in the non-SoMe group (p = 0.0001). Remaining emotional health outcomes were similar between groups: choosing this job/career again, time for personal/family life, and career satisfaction (p > 0.1 for all). An additional section on the impact of SoMe on emotional health was completed by 473 SoMe engagers. While 49% (233/473) reported that SoMe has no impact on burnout, 18% (86/473) felt that SoMe helps alleviate burnout. SoMe use was reported to have somewhat/extremely positive impact on wellness (defined as physical, mental, emotional, spiritual wellness) by 28% (131/473). Networking and recognized shared experiences were the top areas of SoMe that improved wellness. Close to half (208/473, 44%) responded that SoMe does not negatively impact wellness. Professional anxiety, amount of time spent online, and keeping up to maintain an online presence were the most frequently noted aspects that negatively impact wellness. Nearly half (232/473, 49%) somewhat/strongly agree that SoMe provides a sense of community. One limitation includes distribution to engaged cooperative group members which may impact results. Conclusions: This analysis suggests that social media engagement might help provide a positive impact on the wellness and reduce burnout among oncology professionals. We hope to further explore themes with qualitative interviews to better understand the impact of SoMe on our emotional health. Our goal is to develop educational interventions based on these salient positive and negative factors. [Table: see text]

0553 At-home Detection of REM Sleep Behavior Disorder using a Machine Learning Approach and Wrist Actigraphy

Abstract Introduction Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) affects over 1% of middle-aged and older adults and is in most cases a prodromal stage of alpha-synucleinopathy. However, a small fraction of them is currently diagnosed due to poor access to the gold-standard diagnostic procedure polysomnography (PSG). We aimed to test an ambulatory diagnostic procedure for iRBD based on wrist actigraphy alone and combined with a short questionnaire on nonmotor symptoms. Methods A total of 35 PSG-confirmed iRBD and 28 age-matched clinic and community control participants with and without a sleep disorder (1:1 ratio) wore high-frequency (25 Hz) wrist actigraphy for at least 7 nights and completed sleep diaries. Raw accelerometer data recorded during sleep was analyzed by deriving an activity count and extracting movement-related features for each night. Additionally, participants completed the Innsbruck RBD inventory (RBD-I) and a 3-item questionnaire on hyposmia, constipation, and orthostasis. We fitted machine learning models, specifically, boosted decision trees, in a leave-one-out cross-validation framework to classify iRBD patients from controls based on either actigraphy or questionnaire data. For each participant, model predictions from actigraphy were averaged across all available nights. Results The boosted decision trees classified iRBD with an area under the receiver-operator-characteristics (ROC) curve (AUC) of 0.972, a sensitivity of 97.1%, and a specificity of 89.3%. Analyses revealed that performance plateaued after one week of actigraphy. Best single feature “short immobile bursts” achieved an AUC of 0.958, a sensitivity of 94.3%, and a specificity of 78.6%. In this population, RBD-I item 3 best discriminated between groups with an AUC of 0.892, a sensitivity of 91.4%, and a specificity of 85.7%. The combination of a positive RBD-I item 3 and a positive actigraphy-based classification achieved a sensitivity of 88.6% and a specificity of 96.4%. Conclusion High-frequency actigraphy using machine learning detects iRBD with high accuracy. Addition of a single RBD question to this procedure increased specificity. These results need to be validated in a larger sample and lay the groundwork for an ambulatory screening paradigm in the general population. Support (If Any) The Klarman Family Foundation and the Feldman Foundation Ca.

PD25-03 ASSOCIATION BETWEEN FINANCIAL BURDEN AND TREATMENT REGRET IN MEN WITH LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD25-03 ASSOCIATION BETWEEN FINANCIAL BURDEN AND TREATMENT REGRET IN MEN WITH LOCALIZED PROSTATE CANCER Daniel D. Joyce, Christopher J. D. Wallis, Li-Ching Huang, Karen E. Hoffman, Zhiguo Zhao, Tatsuki Koyama, Ralph Conwill, David F. Penson, and Daniel A. Barocas Daniel D. JoyceDaniel D. Joyce More articles by this author , Christopher J. D. WallisChristopher J. D. Wallis More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Karen E. HoffmanKaren E. Hoffman More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Ralph ConwillRalph Conwill More articles by this author , David F. PensonDavid F. Penson More articles by this author , and Daniel A. BarocasDaniel A. Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better understand the importance of inclusion of financial discussions in patient counseling. METHODS: Utilizing the multicenter, population-based Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance as primary management for localized prostate cancer. Patient-reported functional outcomes were assessed at baseline and longitudinally through 5 years using the 26-item Expanded Prostate Index Composite questionnaire. Treatment regret was assessed at 3- and 5-year follow-up using Clark’s validated scale. Financial burden was similarly evaluated at 3 and 5 years using a previously published 4-item questionnaire. The association between financial burden and treatment regret was assessed using multivariable logistic regression controlling for demographics, disease characteristics, treatment, functional outcomes, and patient expectations. RESULTS: Of the 2,924 men who met inclusion criteria, both regret and financial burden assessments were available for 80.6% (n=2,359). Prostate cancer management included surgery (n=1,256, 53.2%), radiation (n=787, 33.4%), and active surveillance (n=316, 13.4%). Financial burden from “finances in general” was associated with treatment regret at 3 and 5 years, after adjusting for potential confounders (OR 2.47, 95% CI 1.33, 4.57). Similar associations with financial burden from direct costs, such as treatment (OR 1.02, 95% CI 0.47, 2.21), clinic visit (OR 1.85, 95% CI 0.92, 3.71), and health insurance costs (OR 1.71, 95% CI 0.89, 3.30) were not observed (see Table). CONCLUSIONS: In this representative, population-based sample of men with localized prostate cancer, we observed associations between overall financial burden and treatment regret. The lack of association between treatment regret and measures of financial burden due to direct treatment costs may indicate a more profound impact on patients from indirect costs and should guide future efforts to address financial toxicity in prostate cancer management. Source of Funding: This study was supported by the Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640) and the Patient-Centered Outcomes Research Institute (CE-12-11-4667). Data management was facilitated by Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from NCATS/NIH) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e422 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel D. Joyce More articles by this author Christopher J. D. Wallis More articles by this author Li-Ching Huang More articles by this author Karen E. Hoffman More articles by this author Zhiguo Zhao More articles by this author Tatsuki Koyama More articles by this author Ralph Conwill More articles by this author David F. Penson More articles by this author Daniel A. Barocas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of Health Literacy on Satisfaction Following Inflatable Penile Prosthesis Surgery

ABSTRACT Introduction Health literacy - the ability to obtain, comprehend, and act on basic medical information - can impact surgical outcomes and patient quality of life (QOL). Urologic prosthetic surgery aims to improve a patient's QOL, therefore patient satisfaction is a fundamental measure of success. Objective We sought to determine whether health literacy impacts patient satisfaction following inflatable penile prosthesis (IPP) surgery for erectile dysfunction. Methods We performed a single-institution retrospective study of patients who underwent IPP insertion between January 1st 2016 and July 31st 2020. A patient satisfaction phone questionnaire was administered between October 2020 and January 2021 to measure: (1) overall satisfaction with IPP surgery on a Likert scale and (2) if patients would undergo IPP surgery again. Baseline health literacy was measured using the Brief Health Literacy Screen (BHLS) – a validated 3-item questionnaire. Ordinal logistic regression was used to assess the association between health literacy and patient satisfaction, adjusting for the predetermined covariates of patient age, marital status, preoperative Sexual Health Inventory for Men (SHIM) scores, time from surgery to phone questionnaire, and device functionality. Results A total of 162 IPP patients met study inclusion criteria. The cohort consisted of primarily Caucasian (81.5%) and married (74.7%) men with a median age of 64.5 years and an interquartile range (IQR) of 57.5-69.5 years. The median (IQR) BHLS score was 15 (13-15) and the median (IQR) time from the index surgery to phone questionnaire administration was 2.41 (1.39-3.98) years. 69.8% of men were either very satisfied or satisfied with their procedure, and 74.1% of men would again undergo IPP surgery. After adjustment for potential confounders, BHLS score was significantly associated with patient satisfaction after IPP surgery (OR 1.31, 95% CI 1.11-1.54; p=0.001) and was positively associated with likelihood of again undergoing IPP surgery (OR 1.53, 95% CI 1.25-1.87; p<0.001) (Table 1). Conclusions Patients with lower health literacy are less likely to be satisfied following IPP placement. The BHLS score is an important tool that can be used to identify patients who may benefit from increased preoperative counseling and education to further improve patient expectations and QOL following IPP surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Evaluation of a 3-item screening tool to identify men with benign prostatic enlargement/obstruction in a primary care cohort.

Benign prostatic hyperplasia (BPH), a progressive condition and common cause of lower urinary tract symptoms (LUTS), is underdiagnosed in primary care, impacting patient outcomes. Here, we evaluate the utility of a BPH screening tool in general practice, to identify men confirmed to have BPH after urologist assessment of diagnostic test results. A 3-item questionnaire was developed to discriminate between LUTS due to BPH versus other conditions and was translated and validated cross-culturally. Its utility was assessed in a cohort study (FDC116114/NCT02757963) conducted in 47 centers across France, Germany, Italy, Russia, and Spain. The study enrolled men ≥50 years of age presenting to general practice clinics with a score of ≥3 on the BPH screening tool or ≥8 on the International Prostate Symptom Score (IPSS). In total, 561 men completed the study. The primary endpoint was the proportion of patients with a urologist-confirmed BPH diagnosis among those with a positive result on the BPH screening tool (score ≥3) and serum prostate specific antigen (PSA) ≥2 ng/mL. The primary endpoint was fulfilled; 88.3% (95% CI: 84.9, 91.2) of patients had urologist-confirmed BPH diagnoses among those with positive results on the BPH screening tool and serum PSA≥2 ng/mL, similar to the proportion seen with IPSS≥8 and serum PSA≥2 ng/mL (87.7%; 95% CI: 84.6, 90.4). The BPH screening tool, in conjunction with serum PSA, demonstrated adequate predictive value by allowing general practitioners to quickly screen men presenting with different medical conditions but identified as having urological symptoms.

Racial Disparities in Sleep: Potential Mediation by Discrimination and Psychological Distress.

Previous research has demonstrated that experiences of discrimination contribute to racial disparities in sleep, and that psychological distress mediates these relationships. However, previous research has not included race as part of the mediation pathway and has had limited dimensions of sleep health and psychological mediators. In the current study, we examine serial mediation pathways by which race and sleep health are mediated through discrimination and subsequently through psychological distress (i.e., depressive symptoms, chronic stress, and loneliness). Data were from the 2010 wave of the Health Retirement Study (HRS). The analytic sample (n = 7,749) included Black and White participants who were included in the enhanced face-to-face interview in 2010 and who completed the psychosocial questionnaire. Race was reported as either Black or White. Sleep health was assessed with a 4-item questionnaire. Depressive symptoms were assessed with the shortened CES-D, chronic stress via the ongoing chronic stressor scale, and loneliness via the UCLA loneliness scale. Covariates were included in all serial mediation models. Relative to White participants, Black participants reported increased experiences of discrimination, which was associated with increased psychological distress, and poorer sleep health. Findings demonstrate the significant adverse impact that discrimination has on both psychological well-being and sleep health.

Loneliness and Neuropsychiatric Symptoms in Cognitively Impaired Older Adults during COVID-19 Pandemic

Background: Cognitively impaired older adults living in the community have been vulnerable to the effects of COVID-19 confinement. The current study’s objectives were to examine the prevalence of loneliness in such adults along with impact of COVID-19 on neuropsychiatric symptoms and functional status. Methods: A cross-sectional study was conducted in community dwelling cognitively impaired older Veterans (N=41). Demographic data such as age, gender, race, and rurality were collected. Loneliness data were collected with the 3-item Loneliness Questionnaire. Cognition was assessed with the Tele-Montreal Cognitive Assessment (T-MoCA) and functional status of instrumental activities of daily living was assessed with the Functional Activities Questionnaire (FAQ). Neuropsychiatry symptoms including severity and distress were collected using the Neuropsychiatric Inventory (NPI), and change during COVID was also recorded for each symptom. Results: Demographic characteristics included: mean age of 71.9 (±8.6) years, 95.1% male, 46.3% rural, 75.6% Caucasian, and 19.5% African American. Loneliness was prevalent in most participants (62.5%). T-MoCA and FAQ mean scores were 15.1 (±4.5) and 10.0 (±8.6), respectively. Mean NPI total severity and total distress were 8.4 (±5.9) and 11.4 (±8.5), respectively. Irritability was most frequently reported symptom (65%), followed by agitation (57.5%), anxiety (55%), depression (50%), and night-time behavior (50%). A majority of the participants reported worsening of neuropsychiatric symptoms during COVID (71.1%). Among those that reported worsening neuropsychiatric symptoms, 70.4% noted an increase in ≥ two symptoms. Conclusion: Older adults with pre-existent cognitive impairment may be at high risk for loneliness and worsening of neuropsychiatric symptoms during the COVID pandemic.

Relationship between Social Determinants of Health and Loneliness during COVID-19 Pandemic

Background: Older adults are most vulnerable to social isolation and loneliness during the COVID-19 pandemic compared to other populations. Risk factors for loneliness include old age, rural living, number of medical comorbidities, and poor social networks. The objectives of this study were to examine the prevalence of loneliness in older adults during COVID-19 and determine the correlation between social determinants of health and loneliness. Methods: A cross-sectional study was conducted in community dwelling older Veterans (N=132). Demographic data were collected along with variables related to social determinants of health. Loneliness data were collected with the 3-item loneliness questionnaire, and social network was assessed using the 6-item Lubben social network scale. Results: Demographic data included: mean age 73.3 (±7.5) years, 93.2% male, 53.5% rural, 84.1% Caucasian, and 13.6% African American. The majority of the participants reported loneliness (65.6%). Mean Lubben social network score was 14.6 (±6.6). There was a strong negative correlation between loneliness and social network (p<0.0001, r=-0.57; 95% CI: -0.67, -0.44). The prevalence of loneliness was significantly greater in those living alone compared to those not living alone (p=0.017; 83.9% vs. 60.6%) and those lacking internet access compared to those with internet access (p=0.025; 86.4% vs. 61.5%). Conclusion: Loneliness was found to be highly prevalent in an older cohort during the COVID pandemic. Routine inquiry about loneliness is important. Social determinants of health are likely correlated with the presence of loneliness in older adults and could be greatly impacted by policy decisions made to control community disease transmission.

Usability and Perceived Usefulness of the AFib 2gether Mobile App in a Clinical Setting: Single-Arm Intervention Study.

BackgroundAlthough the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation (AF) or atrial flutter to make informed decisions about using anticoagulation (AC), the best method for facilitating shared decision-making remains uncertain.ObjectiveThe aim of this study is to assess the AFib 2gether mobile app for usability, perceived usefulness, and the extent and nature of shared decision-making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used.MethodsWe identified patients visiting a cardiology provider between October 2019 and May 2020. We measured usability from patients and providers using the Mobile App Rating Scale. From the 8 items of the Mobile App Rating Scale, we reported the average score (out of 5) for domains of functionality, esthetics, and overall quality. We administered a 3-item questionnaire to patients relating to their perceived usefulness of the app and a separate 3-item questionnaire to providers to measure their perceived usefulness of the app. We performed a chart review to track the occurrence of AC within 6 months of the index visit. We also audio recorded a subset of the encounters to identify evidence of shared decision-making.ResultsWe facilitated shared decision-making visits for 37 patients visiting 13 providers. In terms of usability, patients’ average ratings of functionality, esthetics, and overall quality were 4.51 (SD 0.61), 4.26 (SD 0.51), and 4.24 (SD 0.89), respectively. In terms of usefulness, 41% (15/37) of patients agreed that the app improved their knowledge regarding AC, and 62% (23/37) agreed that the app helped clarify to their provider their preferences regarding AC. Among providers, 79% (27/34) agreed that the app helped clarify their patients’ preferences, 82% (28/34) agreed that the app saved them time, and 59% (20/34) agreed that the app helped their patients make decisions about AC. In addition, 32% (12/37) of patients started AC after their shared decision-making visits. We audio recorded 25 encounters. Of these, 84% (21/25) included the mention of AC for AF, 44% (11/25) included the discussion of multiple options for AC, 72% (18/25) included a provider recommendation for AC, and 48% (12/25) included the evidence of patient involvement in the discussion.ConclusionsPatients and providers rated the app with high usability and perceived usefulness. Moreover, one-third of the patients began AC, and approximately 50% (12/25) of the encounters showed evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app on a larger sample and with a controlled study design.Trial RegistrationClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270International Registered Report Identifier (IRRID)RR2-21986

High Prevalence of Monoclonal Gammopathy in a Population at Risk: The First Results of the Promise Study

High Prevalence of Monoclonal Gammopathy in a Population at Risk: The First Results of the Promise Study

Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA.

Sleep disordered breathing (SDB) is highly prevalent, but frequently unrecognized among stroke patients. Polysomnography (PSG) is difficult to perform soon after a stroke. We evaluated the use of screening questionnaires and portable sleep testing (PST) for patients with acute stroke, subarachnoid hemorrhage, or transient ischemic attack to expedite SDB diagnosis and management. We performed a single-center retrospective analysis of a quality improvement study on SDB screening of consecutive daytime, weekday, adult admissions to a stroke unit. We excluded patients who were unable to communicate and lacked available family members. Patients were screened with the Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire and underwent overnight PST and/or outpatient PSG. The 4-item STOP Questionnaire was derived from STOP-BANG for a secondary analysis. We compared the sensitivity and specificity of the questionnaires for the diagnosis of at least mild SDB (apnea hypopnea index (AHI) ≥5) on PST and correlated AHI measurements between PST and PSG using the Spearman correlation. Out of sixty-eight patients included in the study, 54 (80%) were diagnosed with SDB. Only one (1.5%) had a previous SDB diagnosis. Thirty-three patients completed all questionnaires and a PST. The STOP-BANG questionnaire had the highest sensitivity for at least mild SDB (0.81, 95% CI (confidence interval): 0.65–0.92) but a low specificity (0.33, 95% CI 0.10, 0.65). The discrimination of all questionnaires was overall poor (C statistic range 0.502–0.640). There was a strong correlation (r = 0.71) between the AHI results estimated using PST and outpatient PSG among 28 patients. The 4-item STOP Questionnaire was the easiest to administer and had a comparable or better sensitivity than the other questionnaires. Inpatient PSTs were useful for screening in the acute setting to facilitate an early diagnosis of SDB and to establish further outpatient evaluations with sleep medicine.

Diagnostic accuracy of the Pain (P), Enjoyment (E), and General activity (G) scale, a three-item questionnaire, for grading the impact of orofacial pain-related dysfunction.

Purpose of this study was to examine the discriminative properties of the 3-item Pain (P), Enjoyment (E), and General activity (G) (PEG) questionnaire for grading impact of nondental orofacial pain. Two hundred eighty-six consecutive patients with orofacial pain of nondental origin filled out the PEG questionnaire and Graded Chronic Pain Scale (GCPS, version 2). Correlation between the PEG and GCPS scores, internal consistency of the PEG, and differences between groups were examined statistically (level of significance: P ≤ 0.05). The mean (±SD) age of the 213 patients (158 female) who were included in the analysis was 43.1 (±16.7) years. Of the sample, 48.8% (n = 104) had some degree of orofacial pain-related disability (mean overall characteristic pain intensity: 51.2 ± 23.2, average overall PEG score: 4.3 ± 2.7, and average PHQ-9 score: 8.2 ± 6.5). No significant differences were found between the sexes for any score. The number of disability points (GCPS) and overall PEG score showed a strong and positive correlation (Spearman ρ = 0.77, P < 0.001). The internal consistency of the PEG questionnaire was high (Cronbach α = 0.86). Assuming 3 different levels of orofacial pain-related disability (mild, moderate, and severe), we obtained overall accuracy of 69.01%, with high specificity for mild and severe cases. The 3 PEG groups (mild, moderate, or severe) differed from each other significantly regarding their clinical grading according to the GCPS (Kruskal-Wallis, P < 0.001). Analysis of the receiver operating characteristic curve showed that a single cutoff value of 3.8 points in the PEG score yields adequate validity (sensitivity = 0.91 and specificity = 0.78). The proposed 2 cutoff points (upper = 7 and lower = 4) yield low sensitivity for the upper threshold. The 3-item PEG questionnaire is suitable for grading impact of nondental orofacial pain.

Lifestyle segmentation of tourists: the role of personality

BackgroundThe significance of national tourism in the global data highlights the importance of studying the characteristics of Spanish tourists that show interest in visiting Valencia (Spain). Personality traits might influence tourism behavior, and their importance has scarcely been addressed in the prior tourism literature. ObjectivesWe aimed to identify the touristic profiles of national tourists based on their lifestyles and to analyze the influence of personality traits in tourism segmentation. Methodology329 individuals participated in this study, they responded questionnaires about sociodemography, personality, lifestyle and a 3-item questionnaire developed by the authors. We performed analysis to obtain profiles by lifestyle, we carried out tests to study differences in personality traits among profiles and we analyzed the effects of the responses to the author-developed questionnaire and the demographic characteristics of the subjects on their cluster membership. ResultsThe results show that this market can be segmented into four clusters. We found significant statistical differences in personality traits among profiles. In addition, the authors present an author-designed questionnaire that, together with demographic variables, is able to predict participants’ profiles. ConclusionThe results suggest that lifestyle is an appropriate indicator for this market segmentation and the analysis of its relationship with personality provides a deep comprehension of the resulting profiles. In addition, the profile prediction by the responses to the author-developed questionnaire constitutes a new basis for tourism segmentation, as these predictors might be used as “quick touristic classifiers”. Implications or recommendationsThe study of decision-making processes in tourism allows researchers and sellers to predict tourist behaviors and adapt offers to tourists’ preferences and interests.

Defining the optimal cut-point of self-reported ART adherence to achieve viral suppression in the era of contemporary HIV therapy: a cross-sectional study

BackgroundWhen considering adherence to antiretroviral therapy (ART) for HIV, many different cut-points are used. The primary goals of this study were to identify a level of self-reported medication adherence that best distinguished HIV viral suppression from non-suppression, and to compare the ability of a single-item and a 3-item adherence questionnaire to predict HIV viral suppression.MethodsThis cross-sectional analysis included 380 persons with HIV (PWH) from the Florida Cohort study who completed a self-reported ART adherence measure within 30-days of having an HIV viral load test. We used Receiver Operating Characteristic (ROC) curve analyses and ROCContrast to compare the ability of a single-item and a 3-item self-reported adherence measure to predict HIV viral suppression (defined as ≤ 200 copies/mL). We used the Youden index and chi square statistics to assess specific cut-points, and repeated the analysis with a different definition of HIV viral suppression (≤ 1000 copies/mL).ResultsThe mean percent adherence was 92.4% using the single-item score and 90.4% using the 3-item score; 81.6% had viral suppression. The areas under the curve for the single-item and 3-item adherence measures were generally poor overall and not significantly different from each other (0.589 and 0.580, p = 0.67). The Youden index identified cut-points of 93% and 89% as maximizing the sensitivity and specificity for the single-item and 3-item measures, respectively, whereas a cut-point of 80% on the single-item measure was best able to discriminate those with viral suppression (58% vs. 84%, p < 0.001). Results were similar with viral suppression defined as ≤ 1000 copies/mL.ConclusionsIn this sample of PWH, a single question on medication adherence was as good as a 3-item questionnaire in predicting HIV viral suppression, although neither had good discriminatory ability. A cut-point close to 90% adherence maximized sensitivity and specificity, although viral suppression was very similar for nearly all measures above 80%.

PMH42 Early Improvements in Functioning and Quality of Life with AXS-05 in Major Depressive Disorder: Resultsfrom the GEMINI Trial

With existing therapies for major depressive disorder (MDD), improvements in functioning and quality of life, often trail behind depressive symptom improvement. AXS-05 (dextromethorphan-bupropion modulated delivery tablet) is a novel, oral, investigational NMDA receptor antagonist with multimodal activity being developed for MDD. Herein, we report the effects of AXS-05 on humanistic outcomes during the first 2-weeks of treatment. GEMINI (N=327) was a Phase 3, double-blind, placebo-controlled, multi-center study, in which subjects with moderate-severe MDD were randomized (1:1) to receive AXS-05 (dextromethorphan HBr 45 mg-bupropion HCl 105 mg) or placebo, twice daily for 6 weeks. The primary efficacy outcome, change from baseline in MADRS total score, demonstrated a rapid and statistically significant improvement starting at Week 1, which was maintained through Week 6 (primary timepoint). Starting at Week 1, secondary endpoints including the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) and the Sheehan Disability Scale (SDS) were assessed. The Q-LES-Q-SF is a self-reported, 16-item scale. Scores are expressed as the percentage of maximum score, with higher percentages reflecting better quality of life. The SDS is a 3-item questionnaire evaluating impairments in work, social life/leisure, and family life/home responsibility. Improvements from baseline were statistically significant for AXS-05 versus placebo on the Q-LES-Q-SF at Week 1 (9.04% and 5.79%, respectively, p=0.031), the first timepoint measured, Week 2 (13.2% and 8.88%, respectively, p= 0.017) and at every time point thereafter. On the SDS total score, improvements from baseline were statistically significant for AXS-05 versus placebo beginning at Week 2 (6.82 and. 4.47, respectively, p=0.003) and at every time point thereafter. AXS-05 improved depression and humanistic outcomes compared to placebo within 1-2 weeks of treatment. These improvements were maintained throughout the course of the study. These findings suggest that AXS-05, as a mechanistically novel medicine, rapidly improves depressive symptoms, quality of life, and functioning.

Rising patients" adherence to CVD preventive treatment via medical and psychological counseling using remote technologies

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Low adherence to healthy lifestyle and CVD preventive medical treatment is a seriouse problem in lowering of CVD morbidity and mortality. Using modern medical, psychological and remote technologies may help to increase patients" adherence. Purpose To study the efficacy of medical and psychological counselling using remote technologies in rising patients" adherence to CVD preventive treatment. Methods The study included 140 patients with risk factors for cardiovascular disease (RF CVD), who were divided into two comparable groups: group of medical and psychological counselling with the use of remote technologies (n = 70) and group of control (n = 70). The study lastet 12 months. Level of adherence was measured via standard Morisky-Green"s 4-item questionnaire as well as via additional questionnaire developed by authors for this study. Results Comparative analysis of the level of adherence in the two groups did not reveal statistically significant differences at baseline. After 12 months, the experimental group showed a statistically significant increase in adherence to preventive treatment compared with the control group (р=0,001) Conclusion(s) Medical and psychological counselling using remote technologies is an effective method for rising patients" adherence to CVD preventive medical treatment