Individual Question Responses Research Articles

A comprehensive analysis of the pre- and postoperative responses to each of the 12 Oxford knee score questions one year following knee arthroplasty.

To assess the pre- and postoperative responses to each of the 12 individual Oxford Knee Score (OKS) questions and percentages of those that were better, same or worse after primary knee arthroplasty (KA). A single centre retrospective cohort study conducted over a 24-month period which included 3259 patients with completed OKS preoperatively and 1-year after KA. There were 1286 males and 1973 females, with an overall mean age of 70.0 (range 34-94). The mean scores for each question of the OKS were compared between baseline and 1-year. The percentage of patients who reported better, the same or worse postoperative symptoms for each question were calculated and represented on a heatmap. There were significant (p < 0.001) improvements in all 12 questions, all of which demonstrated moderate (Q2, Q7) or large effect sizes. Improvements in individual question responses varied. Symptoms of pain and limping demonstrated the greatest improvement, with 86% of patients enjoying a positive change in their symptoms. Despite this improvement 1067 (41.4%) continued to have mild to severe pain in their knee, and 442 (17.3%) patients limped often to all the time when walking postoperatively. Whereas other questions that did not improve to the same extent for example washing and drying only improved in 53% of patients but only 347 (13.5%) had moderate/extreme trouble or found it impossible to do this postoperatively. Preoperatively four questions (Q1, Q6, Q7, Q8) demonstrated floor effects, postoperatively all questions apart from question 7 (kneeling) demonstrated ceiling effects. The mean improvement and outcome at 1-year for each of the 12 questions varied according to the patient's preoperative response. As a clinical tool, the heatmap (improvement, same and worse) will enable communication to patients about their potential change in their knee specific symptoms according to their preoperative responses. Retrospective study, Level III.

Item response theory in early phase clinical trials: Utilization of a reference model to analyze the Montgomery-Åsberg Depression Rating Scale.

In clinical trials, Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire data are added up to total scores before analysis, assuming equal contribution of each separate question. Item Response Theory (IRT)-based analysis avoids this by using individual question responses to determine the latent variable (ψ), which represents a measure of depression severity. However, utilization of IRT in early phase trials remains difficult, because large datasets are needed to develop IRT models. Therefore, we aimed to evaluate the application and assumptions of a reference IRT model for analysis of an early phase trial. A cross-over, placebo-controlled study investigating the effect of intravenous racemic ketamine on MADRS scores in patients with treatment-resistant major depressive disorder was used as a case study. One hundred forty-seven MADRS responses were measured in 17 patients at five timepoints (predose to 2 weeks after dosing). Two reference IRT models based on different patient populations were selected from literature and used to determine ψ, while testing multiple approaches regarding assumed data distribution. Use of ψ versus total score to determine treatment effect was compared through linear mixed model analysis. Results showed that determined ψ values did not differ significantly between assumed distributions, but were significantly different when changing reference IRT model. Estimated treatment effect size was not significantly affected by chosen approach nor reference population. Finally, increased precision to determine treatment effect was achieved by using IRT versus total scores. This demonstrates the usefulness of reference IRT model application for analysis of questionnaire data in early phase clinical trials.

Large scale clinical trials: lessons from the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has presented substantial new challenges to clinical and research teams. Our objective was to analyse the experience of investigators and research delivery staff regarding the research response...

Outcomes After Injection-Based Therapy: A Pain Outcomes Questionnaire for Veterans Univariate Analysis.

The Pain Outcomes Questionnaire-For Veterans (POQ-VA) was developed within the Veterans Health Administration (VHA) as a brief but psychometrically sound pain outcomes instrument that assesses key domains. In routine clinical practice, it is valid and reliable for evaluating effectiveness of treatment of chronic noncancer pain in veterans. We hypothesized that POQ-VA scores would improve across multiple domains in the veteran population following injection-based interventional treatment for chronic pain. We aggregated all available POQ-VA reports from veterans who underwent ≥ 1 interventional pain procedures between April 1, 2009 and April 1, 2019. Patients were included who had pre- and posttreatment POQ-VA results separated by ≤ 6 months (N = 112). A paired-samples t test was used to compare means, standard deviations, and ranges for each POQ-VA domain. Individual question responses were analyzed using a nonparametric Wilcoxon matched-pairs signed-rank test. All POQ-VA domains showed a statistically significant decrease posttreatment (P ≤ .03). Directionally, the responses to 17 of 20 individual POQ-VA questions reflect a small but statistically significant positive treatment response (P < .04). Most veterans undergoing injection therapy for chronic pain had statistically significant improvements in POQ-VA measures within a 6-month period. To conduct more rigorous, multivariate studies, continued and widespread use of the POQ-VA instrument is warranted.

The facilitators and barriers to exercise in the Noongar Aboriginal population in Perth, Australia.

Indigenous Standpoint Theory forms the epistemological foundation for this study and methodological choices were made within this theoretical framework to ensure culturally responsive research processes that engaged the Indigenous agenda of self-determination and rights. The objectives of this research were to determine: (i) Indigenous perceptions of the facilitators and barriers to exercise; (ii) The potential feasibility and sustainability of an exercise intervention. In this context, Participatory Action Research methods were used to design the data-gathering instrument for the study-a questionnaire, co-designed with the Noongar Aboriginal community of Perth, Western Australia. This self-administered questionnaire, distributed to participants by email, post and manual delivery, sought to elicit the factors that impact uptake and retention of regular exercise activities. Questionnaire data included individual demographic detail and specific question responses on labelled 5 point Likert Scales. Specific question responses were tabulated by Likert Scale label category and the response distribution for each question was enumerated. Simple descriptive statistics (measures of central tendency and variance) were used to characterize the data set and the Chi squared test was used to evaluate frequency differences between males and females. A total of 133 participants (71 females) completed the questionnaire. The results indicated that people valued exercise. The most common barriers indicated by participants were exercising with an injury (63%), changing diet (58%), finding time to exercise every day (55%) and exercising the next day with pain from exercising the day before (54%). A larger proportion of males (34%) than females (24%) reported greater ease in finding time to exercise every day (p < 0.05). Facilitators mainly related to the potential social and community benefits of exercising with other people, preferably in small groups, and the importance of a culturally secure venue. These findings shed light on what a culturally secure exercise programme might involve for the Noongar community. As this may have implications for other Aboriginal and Torres Strait Islander and international First Nations' Peoples, more focused research is needed on the place of traditional physical activities and the nature of culturally secure exercise programmes and spaces to enable wider application.

100 SCREENING FOR SLEEP DISTURBANCE AS PART OF THE COMPREHENSIVE GERIATRIC ASSESSMENT

Abstract Background Sleep disturbance is common in the older patient, and has been associated with many common comorbidities, falls, impaired quality of life, and mortality. Sleep disturbance screening and management are important elements of the comprehensive geriatric assessment (CGA). There are few sleep disturbance assessment tools, however, that have been validated for use in older patients, or in those with cognitive impairment. We sought to review the assessment and management of sleep disturbance within a regional integrated care outreach programme (ICOP), where the RU-SATED tool had been used. Methods From March–June’21 the notes of 30 consecutive patients, presenting to ICOP with cognitive complaints, were reviewed. Demographic and sleep disturbance data were collected, in addition to whether advice, treatment or further assessment for sleep disturbance was documented. Feedback from staff on the utility of the RU-SATED tool was also sought. Results Of those reviewed, the mean age was 80.3 (SD = 7.8), and the mean Montreal Cognitive Assessment score (MOCA) was 17.7 (SD = 5.9). Where data was available, the mean RU-SATED score was 7.6 (SD = 1.9), and 42% were frail (n = 11). The most commonly endorsed sleep symptom was sleep onset latency/sleep maintenance issues (n = 16). RU-SATED score did not significantly predict age, MOCA or frailty (p &amp;gt; 0.1 for all). Advice, treatment or further assessment of sleep disturbance was offered to 23% of patients (n = 7), and this was not predicted by overall RU-SATED score or by individual question responses (p &amp;gt; 0.1 for all). Staff also stated that they found elements of the tool difficult to explain and interpret. Conclusion Although the numbers are small, we have not found the RU-SATED tool to be helpful in guiding the management of sleep disturbance in our cohort. A more practical CGA tool is currently in development by the ICOP service.

Parental Views on the Non-Operative Management of Simple Appendicitis in Children: Results of a Cross-Sectional Survey.

To determine parental attitudes for the non-operative management of simple appendicitis and determine willingness to participate in research evaluating different management options. Voluntary cross-sectional survey of parents/guardians presenting to paediatric outpatient department. Likert scale of 0-10 (strongly disagree-strongly agree) was utilised, analysis by individual question responses. Results are presented as medians [IQR], paired t test, the Mann-Whitney U test and Kruskal-Wallis test analysis as appropriate. A p value of < 0.05 is considered significant. Of 311 respondents, 81% (252/311) completed all the questions. The majority (73%, 220/303) believed that appendicitis needed an urgent operation, and 88% (264/299) believed that perforated appendicitis was a life-threatening condition. Fifty-two per cent (131/252) preferred operative management, and 48% (121/252) preferred antibiotic treatment. The most important factors influencing treatment choice were removal of pain (84%, 246/293), removal of infection (83%, 244/293) and minimising complications (54%, 162/293). Concerns regarding antibiotic treatment included the potential for recurrence (75%, 204/271), the risk of progression (63%, 170/271) and the potential of future surgery (53%, 145/271). The perceived beneficial factors of antibiotic treatment included avoiding surgery, 64% (173/269) and surgical complications 68% (184/269). When asked to consider whether they would participate in clinical research evaluating the two treatment options, parents were equally in favour (39%), against (26%) or unsure (35%). Our study demonstrates equipoise in the parental acceptance of antibiotics as a treatment simple appendicitis in children, or participation in research evaluating this topic. However, the important factors that may influence this decision have been identified to guide future conversations.

Voice-related quality of life: Relation to objective spirometry measures in subglottic stenosis

ObjectivesThe current study seeks to identify the correlation between in-office spirometry data and voice-related quality of life in patients with subglottic stenosis (SGS). MethodsPatients with SGS of any etiology were included when in-office spirometric data was available in addition to voice-related patient-reported outcomes (PROM) data in the form of the Voice Handicap Index-10 (VHI-10) and/or the Voice-Related Quality of Life (V-RQOL) survey. Overall survey scores and individual question responses were assessed for degree of correlation to spirometric data. ResultsTwenty-nine patients were included in the final analysis. Overall mean total VHI-10 scores totaled 7.15 (SD 9.11), while mean overall V-RQOL scores totaled 78.41 (SD 16.45). Both PEF and PIF rates correlated to total scores on the VHI and V-RQOL surveys. This correlation was stronger with PIF than with PEF, and with the V-RQOL than with the VHI. Questions related to breathlessness most closely correlated with spirometric data. ConclusionVoice-related QOL is impacted in patients with SGS in a predictable way. Breathlessness while speaking may be more impactful than inability to produce speech in this population.

SUN-036 Evaluation of Gender Experience Among Individuals with Isolated GnRH Deficiency Compared to Controls

Background: Sex hormones play a role in gender identity development. For example, 46,XY individuals with complete androgen insensitivity typically have a female gender identity. Isolated GnRH deficiency (IGD) leads to hypogonadism due to decreased GnRH-induced gonadotropin production. It is unknown if decreased sex hormone exposure leads to differences in gender identity among individuals with IGD compared with the general population. Our objective was to determine if the gender identity in subjects with IGD differs from controls.Methods: We distributed a validated questionnaire; the Gender Identity/Gender Dysphoria Questionnaire for Adults and Adolescents (GIDYQ-AA) (1), to IGD participants who previously enrolled in a phenotyping study. Subjects also provided their age, sex assigned at birth (SAAB), gender and information about their condition and treatment. Group survey scores are expressed as mean ± SD. IGD subject scores were compared with control data (Student’s t-test) obtained from a validation study for the GIDYQ-AA (2).Results: Out of 79 subjects who were contacted, 8 males (M) assigned at birth and 7 females (F) assigned at birth chose to participate and one person actively declined. Average age was 30 y for F and 28 y for M. At the time of the study, all subjects were on hormone supplementation except for one F. A score of 5 indicates a gender identity congruent with SAAB. Among F, mean scaled IGD score was 4.73 ± 0.29 vs. controls (4.8 ± 0.28, n=57; not significant (ns)), and for M it was 4.62 ± 0.52 vs. controls (4.82 ± 0.24, n=37; ns). One female identified as “non-gendered”, one male identified as “intersex/DSD” (14% of respondents), one female did not respond and gender was congruent with SAAB in the remainder. The lowest mean score for an individual question for the IGD F group was in response to whether they felt satisfied being a woman and for the IGD M group, it was in response to whether they felt they were a real man.Conclusions: Men and women with IGD did not show a significant difference in their gender identity compared with controls, and gender was found to be congruent with SAAB for the majority. However, the individual question responses and the self-described gender in this small cohort may suggest that there are differences in how some individuals with IGD experience their gender development. We speculate that this may be related to how they perceive the differences in physical development that they experienced related to their condition. Larger studies in participants with IGD and other disorders that alter sex hormone production/effect are necessary to further understand the relationship between decreased sex hormone exposure during critical developmental periods and gender identity development.

Balkan herbaria: do we have to worry about them?

The Balkan Peninsula has 57 herbaria listed in Index Herbariorum that have almost 5.5 million herbarium sheets. The aim of this study was to determine the status of these herbaria, in terms of their current technical capacities and manpower, their activities, and their communication with botanical societies via herbarium exchanges and loans. Data were gathered through a survey of 24 questions passed to the herbaria curators or other herbarium staff. Fifty-six percentage of the herbaria responded (32/57). Through the analysis of the data gathered, the current state, needs, potential and future perspectives for these Balkan herbaria were evaluated for the full individual question responses. The Balkan herbaria are mostly owned by universities, institutes and museums (30/32; 94%), and the majority have almost no formal protection of their collections (17/32; 53%). They are not sufficiently financed and functioned with too few staff. They are also not following modern herbarium standards, with problems mainly with insects and moulds (29/32; 91%), and with air conditioning mostly not used (18/27; 67%). Their exchange and borrowing frequencies are very low. Generally, there is little public access to the databases, and only a small fraction of the material has been digitized. The awareness of the problems of these herbaria at higher decision-making levels is low. Therefore, we can conclude that these herbarium collections in the Balkan Peninsula are under serious threat. Societies must be aware of this and must do as much as possible to preserve these collections and to enhance their active maintenance and use.

Care Experiences of Patients with Multiple Chronic Conditions in a Payer-Based Patient-Centered Medical Home.

Individuals with multiple chronic health conditions require additional support and medical services, incur higher health care costs, and often have a higher risk of hospitalization. The goal of this study was to examine care experiences of patients with multiple chronic conditions in the CareFirst patient-centered medical home (PCMH). The study used a repeated cross-sectional research design and included 1308 adult CareFirst plan members with multiple chronic conditions. Patient care experiences were collected using a structured telephone survey in 2015 and 2017. Composite scores and individual question responses for patient-provider communication, coordination of care, access to care, and self-management support were analyzed to determine differences between survey years. Overall, patients reported positive care experiences with communication, self-management support, and care coordination. Access to care indicators received lower composite scores. Between 2015 and 2017, patients reported higher ratings for appointment reminders, communicating test results, providers listening carefully, and care plan effectiveness. Patients who completed their CareFirst PCMH care plan had higher care experience scores than patients who did not. A key finding of this study is that care plan completion is associated with positive care experiences, indicating the importance of the care plan to this PCMH model. Lower scores on access to care measures suggest a need for improved pathways for patients to obtain care during nontraditional office hours. Payer-based PCMH models that include enhanced care coordination and additional provider payments to support these activities may be beneficial to patients with multiple chronic conditions.

Caregiver Medication Management and Understanding After Pediatric Hospital Discharge.

Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.

Examination of risk scores to better predict hospital-related harms.

Many hospitals use predictive scores to identify a person's risk of inpatient falls, pressure injury and malnutrition despite evidence of limited predictive accuracy. To examine whether we could improve predictive accuracy by generating a score combining all components of currently used tools. We performed a retrospective, cross-validation study in a single sub-acute (geriatrics and rehabilitation) hospital, extracting data regarding hospital risk scores, and incidence of falls, pressure injury and malnutrition from January 2014 to June 2016. The sample was randomly halved into training and testing data sets. For each harm outcome, model fit was examined using area under receiver operating characteristic curves (AUC) and proportions of people reclassified based on a combined score were calculated. Secondary analyses explored the predictive performance of individual question-responses. Data were available for 4487 admissions (median age 83.0 years). A total of 667 (15%) people had at least one fall, 499 (11%) had at least one pressure injury and 20 (0.4%) malnutrition. The currently used tools had, at best, moderate ability to predict risk of harm outcomes (AUC 0.56-0.73). Testing of the combined score models resulted in minimal change in AUC (<5.1%) and did not add value to risk category reclassification. Most of the predictive ability of the currently used tools relied on the performance of two individual question-responses. Combining scores or reducing to two-item question-responses did little to change predictive accuracy. This study highlights the limitations of hospital harm predictive scores and emphasises the importance of rigorous testing of predictive scores.

Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine

Health-related quality of life (HRQL) instruments are essential in value-driven health care, but patients often have more specific, personal priorities when seeking surgical care. The Scoliosis Research Society-22R (SRS-22R), an HRQL instrument for spinal deformity, provides summary scores spanning several health domains, but these may be difficult for patients to utilize in planning their specific care goals. Our objective was to create preoperative predictive models for responses to individual SRS-22R questions at 1 and 2years after adult spinal deformity (ASD) surgery to facilitate precision surgical care. Two prospective observational cohorts were queried for ASD patients with SRS-22R data at baseline and 1 and 2years after surgery. In total, 150 covariates were used in training machine learning models, including demographics, surgical data and perioperative complications. Validation was accomplished via an 80%/20% data split for training and testing, respectively. Goodness of fit was measured using area under receiver operating characteristic (AUROC) curves. In total, 561 patients met inclusion criteria. The AUROC ranged from 56.5 to 86.9%, reflecting successful fits for most questions. SRS-22R questions regarding pain, disability and social and labor function were the most accurately predicted. Models were less sensitive to questions regarding general satisfaction, depression/anxiety and appearance. To the best of our knowledge, this is the first study to explicitly model the prediction of individual answers to the SRS-22R questionnaire at 1 and 2years after deformity surgery. The ability to predict individual question responses may prove useful in preoperative counseling in the age of individualized medicine. These slides can be retrieved under Electronic Supplementary Material.

Gender Differences in Stoma-Related Quality of Life in Puerto Ricans With IBD

BACKGROUND: Prevalence of Inflammatory Bowel Disease has risen significantly in Puerto Ricans resulting in a considerable increase in surgery. Many IBD patients will require a temporary or permanent ostomy, causing anxiety and fear. Little is known about the influence of ethnic/cultural attitudes on the impact of a stoma on body image and intimacy. METHODS: Adult Puerto Ricans who had an ostomy as part of surgery for IBD were recruited during routine clinic visits. After informed consent, they completed the Stoma Quality of Life (QoL) questionnaire. This survey developed by Prieto et al has been translated and validated in Spanish. It has 20 questions and is self-completed. Score ranges from 1 to 4 per question; higher scores reflect better QoL. Demographics, diagnosis, duration, type and timing (urgent versus elective) of ostomy were charted. Data was analyzed using frequency distribution for categorical variables and summary measures for continuous variables. T-test and one-way ANOVA, followed by a Tukey post hoc test were used to determine group differences. STATA v.12.0 was used. The study was approved by the MSC IRB. RESULTS: Of 102 consented subjects, 95 completed the questionnaire. 58.5% were male. Mean age was 41.3 + 14.3 (19-78). 41 had Crohn's disease; 68 had an ileostomy and 22 a colostomy. Mean time with an ostomy was 39.36 + 60.88 months (0.5-312). Mean total score was 54.46 + 15.12. There was no association between final score and age, marital status, having children, emergency surgery, IBD diagnosis or type of ostomy. Having an ostomy for more than 40 months was significantly associated with a higher QoL (59.0 vs 50.7, P<0.05). Males had significantly better scores than females (59.94 vs 50.23, P=0.0019). Factors related to an ostomy that were of concern to most (over 60%) were separation of the wafer/bag, identification of the nearest restroom, odor from the bag and needing a rest during the day. Loss of sexual attraction was identified in 48% of respondents. Disgust over own body, being with other people, meeting new people, and fear of close physical contact like dancing were identified in less than 30%. However, when comparing individual question responses of women with men, we found that women had significantly lower scores in items about locating the nearest restroom, limitations imposed on choice of clothes, loss of sexual attraction, disgust with own body, and spending the night away. CONCLUSION(S): Findings in our Hispanic population were similar to those published for other groups, with Stoma QoL mean score in the range previously reported. Our findings suggest adaptation over time to the stoma. Concerns were mainly related to the function of the stoma. This suggests that early adequate training in the care of the stoma, and advanced methodic planning when going out may enhance stoma-related QoL and shorten the adaptation period. Lower QoL in females associated to body image and social interactions may represent an opportunity for a gender-focused early motivational and educational intervention. Better strategies are needed to improve the adaptation to life with a stoma in patients with IBD.

Students' Perceptions of Trigger Warnings in Medical Education

ABSTRACTPhenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education. Approach: As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses. Findings: Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

MP32-10 VARIATIONS IN THE PATIENT EXPERIENCE AT AN ACADEMIC UROLOGY DEPARTMENT: HOW SURVEY RESULTS DRIVE LIKELIHOOD TO RECOMMEND METRICS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-10 VARIATIONS IN THE PATIENT EXPERIENCE AT AN ACADEMIC UROLOGY DEPARTMENT: HOW SURVEY RESULTS DRIVE LIKELIHOOD TO RECOMMEND METRICS Richard Matulewicz, Kalen Rimar, Kent Perry, and Edward Schaeffer Richard MatulewiczRichard Matulewicz More articles by this author , Kalen RimarKalen Rimar More articles by this author , Kent PerryKent Perry More articles by this author , and Edward SchaefferEdward Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.985AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Results from patient experience surveys are an important metric of quality and patient centered care. CMS is also publicly reporting these scores and has tied them to hospital and physician reimbursement as part of its Quality Payment Program. Improvements in patient satisfaction have also been correlated with improved adherence and health outcomes for patients. Understanding the many factors that drive positive survey responses will help focus efforts for improving patient satisfaction and care. METHODS De-identified patient surveys results collected by a third-party company after outpatient clinic visits over a 4 year period were assessed. Our outcome of interest was a “top” score on any survey question, which was defined as the highest/best possible positive response. Overall scores and individual question scores were assessed. Likelihood to recommend (LTR) scores at the department and individual surgeon level were also analyzed. The association between individual question response and LTR responses were assessed using regression analyses. RESULTS Included were 39,662 individual question responses (3,428 unique patient surveys) corresponding to 11 surgeons collected from 2013-2016. The overall percentage of “top” score responses for all questions was 79.3%. Physician level results and variation are listed in Table 1. Overall, 81.8% and 80.5% of responses were “top” for LTR doctor and LTR practice, respectively (Table 2). Of the 10 unique questions asked, 4 had significant individual associations with a “top” LTR doctor response and 2 for LTR practice (Table 2) indicating greater likelihood of a LTR response if these criteria were fulfilled according to the patient. CONCLUSIONS There is moderate physician-level variation among patient survey responses. Certain factors, such as “time spent with doctor” and “confidence in the doctor”, align more strongly than others with a “top” LTR response. Focusing attention on improving these aspects of care may improve survey response scores and patient satisfaction. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e412 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richard Matulewicz More articles by this author Kalen Rimar More articles by this author Kent Perry More articles by this author Edward Schaeffer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Case study evaluating Just-In-Time Teaching and Peer Instruction using clickers in a quantum mechanics course

Just-in-Time Teaching (JiTT) is an instructional strategy involving feedback from students on prelecture activities in order to design in-class activities to build on the continuing feedback from students. We investigate the effectiveness of a JiTT approach, which included in-class concept tests using clickers in an upper-division quantum mechanics course. We analyze student performance on prelecture reading quizzes, in-class clicker questions answered individually, and clicker questions answered after group discussion, and compare those performances with open-ended retention quizzes administered after all instructional activities on the same concepts. In general, compared to the reading quizzes, student performance improved when individual clicker questions were posed after lectures that focused on student difficulties found via electronic feedback. The performance on the clicker questions after group discussion following individual clicker question responses also showed improvement. We discuss some possible reasons for the improved performance at various stages, e.g., from prelecture reading quizzes to postlecture clicker questions, and from individual to group clicker questions.5 MoreReceived 18 March 2016DOI:https://doi.org/10.1103/PhysRevPhysEducRes.12.020133Published by the American Physical Society under the terms of the Creative Commons Attribution 3.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article’s title, journal citation, and DOI.Published by the American Physical SocietyPhysics Subject Headings (PhySH)Research AreasInstructional strategiesProfessional TopicsUpper undergraduate studentsPhysics Education Research

The Cross-cultural Adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) Patient-Reported Outcome Measure Into Bulgarian

Objective: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a well-recognized measure of upper limb function and symptoms. This patient-reported outcome measure (PRO) has been translated and culturally adapted into 50 different languages. To date, there is no PRO measure available in the Bulgarian language to measure outcomes for upper extremity pathology. The purpose of this study was to translate and culturally adapt the DASH questionnaire into Bulgarian. Methods: The process of translation and cross-cultural adaptation consisted of a 5-step process: forward translation into Bulgarian, synthesis of the Bulgarian translations, back translation into English, review and revision of the pre-final Bulgarian version, and pilot testing of the pre-final Bulgarian version. The pre-final version was given to 45 patients in order to perform a preliminary assessment of content validity and internal consistency. Results: Forty-five patients (35 males, 10 females) participated in the pilot testing of the Bulgarian DASH. All patients had posttraumatic or postsurgical conditions to the digits, thumb, or wrist. The completeness of item response was good, and individual question responses were well distributed (1-5) except for 1 question about the ability to manage transportation needs (1-3). The mean DASH score was 30.34 (SD: 18.51), with a range of 0 to 67.50. Internal consistency of the total score was high (Cronbach α = 0.948). Conclusions: This pilot assessment of the Bulgarian DASH demonstrates excellent internal consistency and good content validity when compared with similar studies of cross-cultural adaptation of the DASH questionnaire. A more thorough investigation into the reliability, validity, and responsiveness of the Bulgarian DASH is still needed.

Impact of Low Back Pain on Quality of Life: Assessment by Patient Functionality Questionnaire and Treatment Results Using a Combination of Diclofenac plus B Vitamins or Diclofenac Monotherapy

Objective: To analyze the Patient Functionality Questionnaire (PFQ) scores of the patients treated with either Diclofenac + B vitamins (Group DB) or Diclofenac monotherapy (Group D) in order to better understand the impact of the combination of diclofenac with vitamins B1, B6, and B12 on quality of life. Research Design/Methods: We performed a post-hoc analysis of tabulated data generated during the DOLOR study (Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study), using the software GraphPad Prism 5 for Windows, v5.04. The absolute number or percentage of “True”/“False” respondents for each questionnaire item at each study visit, together with the absolute number and percentage of subjects with no change, improvement, or worsening of each PFQ item at each study visit, within and between treatment groups were arranged on contingency tables and analyzed with the Chi-squared or Fisher’s Exact test. Results: At pretreatment there were no statistically significant differences between treatment groups (p > 0.05 for all items). At Visit 2 in both treatment groups, there were statistically significant improvements in individual question responses in each of the 12 items of the questionnaire (p < 0.05 for all items). At Visit 2, comparing the distribution of patients in each treatment group with “improvement”, “no change”, or “worsening”, there was a statistically significant superiority among subjects of group DB in response to items 1, 6, 8, and 10. At Visit 3, both groups had statistically significant (p < 0.001) improvements in each individual item of the PFQ in relation to pretreatment values. The distribution of subjects in each treatment group presenting with “improvement”, “no change”, or “worsening” at Visit 3 varied significantly in favor of group DB in the responses to item 4. At Visit 4, the subjects remaining in treatment in both groups showed statistically significant improvement in PFQ responses in relation to pretreatment values (p < 0.05). The distribution of subjects in each treatment group presenting with “improvement” or “no change” at Visit 4 varied significantly in favor of group D in the responses to items 5, 8, and 12. Conclusion: Improvement in overall PFQ scores was observed in both treatment groups, though the specific items of the questionnaire of the subjects in group DB at Visit 2 showed greater improvement in areas related to sleep quality, mobility, ability to wash and dry, ability to walk distances, and posture comfort. These results serve to corroborate the previously published data, which indicates a benefit of combining the B vitamins with diclofenac in the treatment of patients with low back pain, yielding shorter treatment time to resolution of the lumbago in the treated patients.