Median Completion Time Research Articles

Combined evaluation of personality, risk and coping in MS patients: A step towards individualized treatment choice – The PeRiCoMS-Study I

BackgroundMultiple sclerosis (MS) is a chronic inflammatory neurological disease requiring disease-modifying treatment (DMT). To provide patients with the optimal individual therapeutic option, treatment recommendations should be based not only on individual disease course and DMT specific benefit-risk estimates, but also on patient's individual characteristics such as personality, risk attitude and coping strategies. However, these characteristics are difficult to objectify in clinical routine practice without the support of appropriate evaluation instruments. ObjectiveTo identify and to assemble an objective test battery measuring personality, risk attitude and coping strategies in MS patients. MethodsA comprehensive literature search was performed to obtain all questionnaires assessing personality, risk attitude and coping strategies. Availability in German language, validation in a published normative collective and a reliability of >0.70 were required for our purposes. Based on these criteria, we chose the Big-Five-Personality Test, UPPS Impulsive Behaviour Scale, Domain-Specific Risk-Taking scale (DOSPERT), Brief-COPE and Stress & Coping Inventory (SCI). Results were compared to published normative controls of the respective questionnaires. ResultsOut of 22 MS patients (7 males, 15 females) participating in this study, 19 (86.4%) completed all questionnaires. The median completion time was 45min (min–max range: 25–60min). The median scores of the MS group were within the average range of published control samples in all questionnaires. ConclusionsWe report that traits of personality, risk attitude and coping strategies can be effectively and feasibly tested in MS patients by the instruments used in our exploratory study. There were no differences between MS patients and healthy controls, thus enabling assessment without being influenced by the diagnosis of MS. After validation in a larger cohort the “PeRiCoMS”-battery will be useful as another step towards a more individualized shared-decision-making in every day routine practice.

Partners of young breast cancer survivors: A cross-sectional evaluation of psychosocial issues and mental health.

184 Background: While evidence of the challenges of cancer caregiving has been growing, scant research addresses the experience of partners of young adults with cancer. These individuals and their relationships may be particularly vulnerable to stress, especially when managing the complexity of cancer care and survivorship with their partner. We sought to evaluate psychosocial concerns and mental health in the partners of young survivors of early stage breast cancer (BC). Methods: We invited partners of young women w/BC diagnosed at age ≤ 40 yrs enrolled in a prospective cohort study to participate in a one-time survey evaluating psychosocial concerns including quality of life, coping, social support, financial insecurity, partnership concerns, parenting concerns, anxiety and depression. Logistic regression was used to explore predictors of anxiety (score > 8 on Hospital Anxiety and Depression Scale (HADS)). Results: Most respondents (284/289) were male, with median age 43 yrs (range 27-65). The median time of survey completion was 62 months (range 16 -114) after their partner’s dx. Respondents were mostly white (93%), working full time (94%), and college educated (78%); 29% reported some financial stress, 74% were parenting children < 18 yrs, and 32% reported at least a fair amount of relationship concern. 42% (106/250) had anxiety (39/289 respondents (13%) had incomplete/missing HADS). In univariable analyses, lower education, working full time, parenting concerns, insufficient social support and maladaptive coping were associated (p < .05) with anxiety. In the multivariable model, only maladaptive coping remained significantly associated with anxiety (p < .01, OR = 2.32 (95% CI: 1.22, 4.39)). Conclusions: Partners of young BC survivors who used less constructive/more maladaptive coping strategies experience negative mental health outcomes after tx has ended. Caregivers’ anxiety may have implications for both their own and survivors’ health and QOL. Future interventions might focus on the development of constructive coping strategies to enhance adjustment and role effectiveness in dealing with the impact of cancer.

Feasibility and acceptability of implementing an electronic patient reported outcome (e-PRO) dysphagia screening tool for routine multidisciplinary care.

155 Background: In Ontario, Canada, longitudinal patient self-reporting of 9 common cancer symptoms and a global health scale (Edmonton Symptom Assessment System, ESAS) is mandated and used clinically as a screening tool for multidisciplinary precision care (chemo/rads/surg). However, a common GI symptom, dysphagia, is not assessed in the same setting. Methods: Mostly gastro-esophageal cancer outpatients (some head and neck and lung cancer patients undergoing radiation were also included for generalizability) received one of two versions (V1, V2) of the dysphagia screening tool based on PRO-CTCAE-derived language. The tool included two screening questions, which when answered affirmatively, led to more comprehensive dysphagia/odynophagia questioning. The survey was introduced on iPads with V1. An assessment of acceptability through patient survey was additionally included in V2, and the duration of survey completion was recorded. Exploratory in-depth interviews were conducted with oncologists to assess usability in the clinic setting. Results: Of 101 approached and eligible, 79 consented, and 66 completed the survey. Median completion time was 2.12 ± 0.80 min. 95% were happy to complete survey on a touchscreen tablet, 88% did not find completion of survey time-consuming, and 91% found completion of survey useful in order to tell the clinician how they feel physically and emotionally. The prevalence of dysphagia based on screening question #1 (“difficulty upon swallowing?”) was 38% (25/66), while for screening question #2 (“pain upon swallowing?”) prevalence was 18% (12/66). Five interviewed physicians found the survey to be clinically informative, not burdensome in terms of time consumption, and felt it would be a valuable addition to outpatient clinics. One recurring suggestion was to combine the two screening questions into one. Results were similar across GI, head and neck, and lung cancer sites. Conclusions: The e-PRO dysphagia screening tool is acceptable and feasible for patients, and useful for clinicians. Next, a modified one-question dysphagia tool will be assessed in the multidisciplinary care of gastro-esophageal cancer patients.

Screening of Patients with Chronic Medical Disorders in the Outpatient Department for Depression Using Handheld Computers as Interface and Patient Health Questionnaire-9 as a Tool.

Background and Objectives:Depression, especially in concurrence with chronic medical disorders, is highly prevalent worldwide. An average between 9.3% and 23% of patients with one or more chronic disease have co-morbid depression. This comorbid depression has the worst health scores of all the disease states. Despite this, patients with chronic medical disorders are not commonly screened for depression. Lack of objective screening by health-care providers as well as lack of infrastructure (time/space/personnel) probably contributes to gross underdiagnosis of depression. This issue can be addressed using short objective depression screening score (Patient Health Questionnaire-9 [PHQ-9]) (validated in native languages, e.g., Hindi) and paperless self-administered interface on handheld computer (tablet), which is the objective of the study.Subjects and Methods:One hundred consecutive patients with chronic medical disorders visiting our medicine outpatient department were screened for depression using tablets with PHQ-9 Hindi on a self-administered interface.Results:The overall prevalence of depression was found to be 25% (95% confidence interval 16.6–34.8). Nearly half of the patients with depression had moderate depression (PHQ-9 score 10–14) while rest had moderately severe or very severe depression (PHQ-9 score >14). Association of depression was not found to be statistically significant with age, duration of disease, gender, the type of disease, or the number of disease. Majority of patients rated ease of the use of tablet interface (on a visual analog scale) as very easy (approx 95%). All the patients were able to complete the tablet screener without assistance, answering all of the questions. The median time of completion with interquartile range was 4 (3–5) min. Majority of the patients (63%) completed the questionnaire within 5 min while rest completed it in 5–10 min.Conclusions:It is feasible to use tablets with PHQ-9 questionnaire in native language for screening depression in chronic medical disorders. With high prevalence of comorbid depression, any comprehensive care of patients with chronic medical disorders will not be possible, unless such patients are screened and treated for depression. A self-administered screening questionnaire for depression on handheld tablets can prove to be a handy tool to achieve above aim.

Convergent Validity of the Patient-Reported Outcomes Measurement Information System's Physical Function Computerized Adaptive Test for the Knee and Shoulder Injury Sports Medicine Patient Population

To evaluate the convergent validity, precision, and completion times for the Physical Function Computerized Adaptive Test (PF-CAT) in a sports medicine patient population relative to standard measures of knee and shoulder function. We reviewed all patient visits from April through September 2014 with either knee or shoulder complaints from a university-based sports medicine clinic, during which PF-CAT, Single Assessment Numerical Evaluation (SANE), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) outcome scores for shoulder patients and PF-CAT, SANE, and International Knee Documentation Committee (IKDC) scores for knee patients were obtained, with an initial visit or one follow-up visit included in the study. Spearman correlation was used to evaluate pairwise agreement among scores. The McNemar χ2 test was used to evaluate a difference in the number of times floor and ceiling values occurred. Wilcoxon signed rank tests were used to compare differences in completion times. In total, 415 shoulder and 450 knee clinical evaluations qualified for inclusion in the study. A high correlation was found between IKDC and PF-CAT scores (r= 0.75, P < .0001), and a moderately high correlation was found between PF-CAT and both SST (r= 0.68, P < .0001) and ASES (r= 0.63, P < .0001) scores. Maximum differences in the sum of floor-ceiling values versus the PF-CAT were 15% for the SST (P < .0001), 2.5% for the ASES (ceiling only, P= .0133), and 5.8% for the shoulder SANE (floor P= .0012, ceiling P= .0269). The PF-CAT had values of 0.4% for the shoulder and 0.6% for the knee. Zero percent of IKDC scores but 6.9% of knee SANE scores hit floor or ceiling values (floor P= .0019, ceiling P= .0007). The PF-CAT median completion time was lower at 55seconds versus 268seconds for the IKDC assessment (P < .0001), whereas shoulder patients' times were 61, 139, and 116seconds for the PF-CAT, SST, and ASES evaluation, respectively (P < .0001). The PF-CAT showed a high correlation with IKDC scores and a moderately high correlation with ASES and SST outcomes. The PF-CAT takes significantly less time to complete and exhibits improved or similar floor and ceiling effects in comparison to IKDC, SST, and ASES scores. The PF-CAT can be used in evaluating sports medicine knee and shoulder patients. Level III, cross-sectional study.

Validity of LIDAS (LIfetime Depression Assessment Self-report): a self-report online assessment of lifetime major depressive disorder.

There is a paucity of valid, brief instruments for the assessment of lifetime major depressive disorder (MDD) that can be used in, for example, large-scale genomics, imaging or biomarker studies on depression. We developed the LIfetime Depression Assessment Self-report (LIDAS), which assesses lifetime MDD diagnosis according to DSM criteria, and is largely based on the widely used Composite International Diagnostic Interview (CIDI). Here, we tested the feasibility and determined the sensitivity and specificity for measuring lifetime MDD with this new questionnaire, with a regular CIDI as reference. Sensitivity and specificity analyses of the online lifetime MDD questionnaire were performed in adults with (n = 177) and without (n = 87) lifetime MDD according to regular index CIDIs, selected from the Netherlands Study of Depression and Anxiety (NESDA) and Netherlands Twin Register (NTR). Feasibility was tested in an additional non-selective, population-based sample of NTR participants (n = 245). Of the 753 invited persons, 509 (68%) completed the LIDAS, of which 419 (82%) did this online. User-friendliness of the instrument was rated high. Median completion time was 6.2 min. Sensitivity and specificity for lifetime MDD were 85% [95% confidence interval (CI) 80-91%] and 80% (95% CI 72-89%), respectively. This LIDAS instrument gave a lifetime MDD prevalence of 20.8% in the population-based sample. Measuring lifetime MDD with an online instrument was feasible. Sensitivity and specificity were adequate. The instrument gave a prevalence of lifetime MDD in line with reported population prevalences. LIDAS is a promising tool for rapid determination of lifetime MDD status in large samples, such as needed for genomics studies.

Validation of the MUSIC® Model of Academic Motivation Inventory for use with student pharmacists

ObjectiveTo assess the reliability and construct validity of the MUSIC Model of Academic Motivation Inventory in a student pharmacist population. MethodsThe MUSIC Inventory was administered via Qualtrics two weeks prior to mid-semester examinations in three required pharmacy courses, representing three distinct cohorts. Cronbach’s α reliability estimates were calculated to measure reliability. Exploratory factor analysis was conducted on the overall sample to measure construct validity. ResultsStudents returned 154 usable responses (response rate = 75%). Cronbach’s α values for the overall sample were close to or above 0.9 for all subscales. Exploratory factor analysis found that the items loaded to five distinct factors. The median completion time across the three cohorts was 119.8 seconds. ConclusionsThese preliminary findings suggest that the MUSIC Inventory may have sufficient reliability, validity, and ease of administration to be a useful tool for pharmacy faculty desiring to adjust their instructional design to maximize student motivation to learn.

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire.

AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation: A prospective evaluation.

Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.

Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study.

Dysphagia might affect 12% of the general population, and its complications include pneumonia, malnutrition, social isolation, and death. No validated Spanish symptom survey exists to quantify dysphagia symptoms among Latin Americans. Therefore, we performed a prospective cohort study in a tertiary care university hospital to validate the Spanish version of the 10-Item Eating-Assessment-Tool (EAT-10spa) for use in Colombia. After an interdisciplinary committee of five bilingual specialists evaluated the EAT-10spa(translated and validated in Spain) and deemed it appropriate for the Colombian culture, its feasibility, reliability, validity, sensitivity to change, and diagnostic capacity were evaluated. As a reference standard, we used the flexibleendoscopic evaluation of swallowing with sensory testing and a standardized clinical evaluation. All assessments were blinded. In total, 133 subjects were included (52% women, mean age 55years) and completed the EAT-10spa (median completion time: 2min [IQR 1-3min]), 39% of whom had an elementary-level education. Cronbach's α coefficient: 0.91; test-retest intra-class correlation coefficient: 0.94. The Spearman's correlation coefficient of the EAT-10spa with the 8-point penetration-aspiration scale was 0.54 (P<0.001). The area under the receiver-operating-characteristic-curve (AUC-ROC) for dysphagia and aspiration were 0.79 (P<0.001)and 0.81 (P<0.001), respectively. The best cut-off points for dysphagia and aspiration were EAT-10spa ≥2 (sensitivity 93.6%, specificity 36.4%) and EAT-10spa ≥4 (sensitivity 94.3%, specificity 49.5%), respectively. A reduction in the EAT-10 ≥3 was the best cut-off point for a clinically significant improvement (AUC-ROC 0.83; P<0.0001). The EAT-10spa showed excellent psychometric properties and discriminatory capacity for use in Colombia.

Development and Implementation of an Electronic Learning Module for Volumetric Image-Guided Radiation Therapy

BackgroundImage-guided radiation therapy (IGRT) through daily cone-beam computed tomography (CBCT) has significantly impacted the role of the radiation therapist at our institution; continuing education is crucial to ensure safe practice of technology in the clinical environment. The purpose of this work was to develop and implement an electronic learning (eLearning) module as a yearly refresher for CBCT-practicing radiation therapists. MethodsTo provide an innovative interface to engage the learner's interest, a module themed “Myths in Cone Beam Computed Tomography Practice” was developed by content experts at our institution. The eLearning tool focused on the technical aspects and fundamental theory of CBCT acquisition, with an aim to refresh the user's knowledge and confidence in image fusion and assessment. Ten myths were identified in the module and evidence-based content was referenced within each myth to support theory. Evaluation of the learner was performed through a multiple choice quiz at the end of the module. The tool and 12 multiple choice questions were reviewed and validated by subject matter and non–subject matter experts in CBCT–IGRT before departmental implementation. ResultsThe CBCT eLearning module has been clinically implemented and used over the last 3 years by radiation therapists in our department. Completion of the tool is an annual mandatory requirement for CBCT-practicing therapists; over 100 participants completed the module per year. The median time for module completion decreased over the 3-year interval, from 42 minutes 25 seconds during the first year of implementation to 20 minutes and 48 seconds in the third year. ConclusionsAn electronic online training tool for CBCT refresher training has been developed and implemented at our institution, with an aim to equip staff with the critical thinking skills and clinical judgment required to operate in a CBCT–IGRT environment. The module's format ensures delivery of consistent information as a component of yearly continuing education for radiation therapists.

Canadian Agility and Movement Skill Assessment (CAMSA): Validity, objectivity, and reliability evidence for children 8–12 years of age

PurposeThe primary aim of this study was to develop an assessment of the fundamental, combined, and complex movement skills required to support childhood physical literacy. The secondary aim was to establish the feasibility, objectivity, and reliability evidence for the assessment. MethodsAn expert advisory group recommended a course format for the assessment that would require children to complete a series of dynamic movement skills. Criterion-referenced skill performance and completion time were the recommended forms of evaluation. Children, 8–12 years of age, self-reported their age and gender and then completed the study assessments while attending local schools or day camps. Face validity was previously established through a Delphi expert (n = 19, 21% female) review process. Convergent validity was evaluated by age and gender associations with assessment performance. Inter- and intra-rater (n = 53, 34% female) objectivity and test–retest (n = 60, 47% female) reliability were assessed through repeated test administration. ResultsMedian total score was 21 of 28 points (range 5–28). Median completion time was 17 s. Total scores were feasible for all 995 children who self-reported age and gender. Total score did not differ between inside and outside environments (95% confidence interval (CI) of difference: −0.7 to 0.6; p = 0.91) or with/without footwear (95%CI of difference: −2.5 to 1.9; p = 0.77). Older age (p < 0.001, η2 = 0.15) and male gender (p < 0.001, η2 = 0.02) were associated with a higher total score. Inter-rater objectivity evidence was excellent (intraclass correlation coefficient (ICC) = 0.99) for completion time and substantial for skill score (ICC = 0.69) for 104 attempts by 53 children (34% female). Intra-rater objectivity was moderate (ICC = 0.52) for skill score and excellent for completion time (ICC = 0.99). Reliability was excellent for completion time over a short (2–4 days; ICC = 0.84) or long (8–14 days; ICC = 0.82) interval. Skill score reliability was moderate (ICC = 0.46) over a short interval, and substantial (ICC = 0.74) over a long interval. ConclusionThe Canadian Agility and Movement Skill Assessment is a feasible measure of selected fundamental, complex and combined movement skills, which are an important building block for childhood physical literacy. Moderate-to-excellent objectivity was demonstrated for children 8–12 years of age. Test–retest reliability has been established over an interval of at least 1 week. The time and skill scores can be accurately estimated by 1 trained examiner.

Persistent Immune Activation and Carotid Atherosclerosis in HIV-Infected Ugandans Receiving Antiretroviral Therapy.

Human immunodeficiency virus (HIV) infection and associated immune activation predict the risk of cardiovascular disease in resource-rich areas. Less is known about these relationships in sub-Saharan Africa. Beginning in 2005, we enrolled subjects in southwestern Uganda into a cohort at the time of antiretroviral therapy (ART) initiation. Multiple immune activation measures were assessed before and 6 months after ART initiation. Beginning in 2013, participants aged >40 years underwent metabolic profiling, including measurement of hemoglobin A1c and lipid levels and carotid ultrasonography. We fit regression models to identify traditional and HIV-specific correlates of common carotid intima media thickness (CCIMT). A total of 105 participants completed carotid ultrasonography, with a median completion time of 7 years following ART initiation. Age, low-density lipoprotein cholesterol level, and pre-ART HIV load were correlated with CCIMT. No association was found between CCIMT and any pre-ART biomarkers of immune activation. However, in multivariable models adjusted for cardiovascular disease risk factors, lower absolute levels of soluble CD14 and interleukin 6 and greater declines in the CD14 level and kynurenine-tryptophan ratio after 6 months of ART predicted a lower CCIMT years later (P < .01). Persistent immune activation despite ART-mediated viral suppression predicts the future atherosclerotic burden among HIV-infected Ugandans. Future work should focus on clinical correlates of these relationships, to elucidate the long-term health priorities for HIV-infected people in the region.

Network-Aware Scheduling for Data-Parallel Jobs

To reduce the impact of network congestion on big data jobs, cluster management frameworks use various heuristics to schedule compute tasks and/or network flows. Most of these schedulers consider the job input data fixed and greedily schedule the tasks and flows that are ready to run. However, a large fraction of production jobs are recurring with predictable characteristics, which allows us to plan ahead for them. Coordinating the placement of data and tasks of these jobs allows for significantly improving their network locality and freeing up bandwidth, which can be used by other jobs running on the cluster. With this intuition, we develop Corral, a scheduling framework that uses characteristics of future workloads to determine an offline schedule which (i) jointly places data and compute to achieve better data locality, and (ii) isolates jobs both spatially (by scheduling them in different parts of the cluster) and temporally, improving their performance. We implement Corral on Apache Yarn, and evaluate it on a 210 machine cluster using production workloads. Compared to Yarn's capacity scheduler, Corral reduces the makespan of these workloads up to 33% and the median completion time up to 56%, with 20-90% reduction in data transferred across racks.

Extension of the Thoracic Spine Sign: A New Sonographic Marker of Pleural Effusion.

Dyspnea is a common emergency department (ED) condition, which may be caused by pleural effusion and other thoracic diseases. We present data on a new sonographic marker, the extension of the thoracic spine sign, for diagnosis of pleural effusion. In this prospective study, we enrolled a convenience sample of undifferentiated patients who underwent computed tomography (CT) of the abdomen or chest, which was performed as part of their emergency department evaluations. Patients underwent chest sonography to assess the utility of the extension of the thoracic spine sign for diagnosing pleural effusion. The point-of-care sonographic examinations were performed and interpreted by emergency physicians who were blinded to information in the medical records. Sonographic results were compared to radiologists' interpretations of the CT results, which were considered the criterion standard. Forty-one patients were enrolled, accounting for 82 hemithoraces. Seven hemithoraces were excluded from the analysis due to various limitations, leaving 75 hemithoraces for the final analysis. The median time for completion of the sonographic examination was 3 minutes. The sensitivity and specificity for extension of the thoracic spine were 73.7% (95% confidence interval [CI], 48.6%-89.9%) and 92.9% (95%CI, 81.9%-97.7%), respectively. Overall, there were 5 hemithoraces with false-negative results when using the extension sign. Of those 5 cases, 4 were found to have trace pleural effusions on CT. When trace pleural effusions were excluded in a subgroup analysis, the sensitivity and specificity of extension of the thoracic spine were 92.9% (95% CI, 64.2%-99.6%) and 92.9% (95% CI, 81.9%-97.7%). We found the extension of the thoracic spine sign to be an excellent diagnostic tool for clinically relevant pleural effusion.

A Swedish version of the SCREEN II for malnutrition assessment among community-dwelling elderly.

The Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II) Questionnaire assesses nutritional risk among elderly people living at home. Our aim was to produce a Swedish language version of the SCREEN II and to examine response patterns, data completeness and the relationship between malnutrition and general health. The SCREEN II was translated into Swedish using dual panel methodology, and then followed up with field test interviews of 24 seniors (median age, 83 years). We used the survey data (n = 565) to assess item and score distribution, missing responses, and the relationship to the subject's general and nutritional health. The Swedish SCREEN II was considered easy to understand, respond to, and relevant (n = 21; 88% of subjects found it so in all three respects) and its median completion time was 5 minutes. The level of survey item data completeness was 94-99%, and 82% of surveys had computable total scores. Of those subjects with completed forms, 35% had no nutritional risk; 35% had moderate risk; and 30% were at high risk. The malnutrition risk increased with poorer perceived health. Our study results are similar to those using previous screen ii versions, indicating that the scale adaptation was successful and providing initial support for use of the Swedish SCREEN II questionnaire.

Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism

The majority of patients with primary hyperparathyroidism (PHPT) are diagnosed without the classic signs of renal or osseous complications. Vague and subjective symptoms have been attributed to PHPT but have been difficult to measure during the medical encounter. The Patient-Reported Outcomes Measurement Information System (PROMIS) of the National Institutes of Health contains validated measures of physical and mental health that can be administered by the use of computer-adaptive testing (CAT). The objective of this study was to evaluate the feasibility of PROMIS assessment in the clinical setting to measure changes in patient-reported health before and after parathyroidectomy. We hypothesized that patients undergoing parathyroidectomy for PHPT would report greater improvement in mental and physical health compared with control patients. Adult PHPT patients scheduled for parathyroidectomy and control patients requiring diagnostic thyroid operation were enrolled prospectively during a 6-month period. Patients were administered clinically relevant PROMIS health domains via CAT at a preoperative visit and 3 weeks after operation. A change in score of 5 or greater for each PROMIS instrument was defined as clinically important. Statistical significance of pre/post-surgery changes in scores was determined using paired t tests. A total of 35 patients with PHPT and 9 control patients completed the study. The mean number of PROMIS items answered during an assessment was 67 (range 51-121, SD 15.4). Median completion time was 8.2 minutes (range 3.4-38.4, SD 4.7). Clinically important improvement after parathyroidectomy in the PHPT group was greater than in the control group in 5 PROMIS domains. The score improvement experienced by PHPT patients was 8.8 in Fatigue, 6.7 in Sleep-Related Impairment, 5.0 in Anxiety, 7.0 in Applied Cognition, and 6.2 in Depression (all P < .05). PROMIS is an efficient clinical assessment platform for measuring patient-reported outcomes in PHPT via CAT. Several domains of physical and mental health in patients with PHPT show statistically and clinically important improvement after parathyroidectomy.

Traditional and Rasch psychometric analyses of the Quality of Life in Adult Cancer Survivors (QLACS) questionnaire in shorter-term cancer survivors 15 months post-diagnosis

ObjectiveThe aim of this paper is to provide new insights into the psychometrics of the Quality of Life in Adult Cancer Survivors (QLACS) questionnaire, originally developed for longer-term survivors 5+years post-diagnosis. Specifically, to examine the classic psychometric properties of QLACS in a sample of shorter-term survivors, and to undertake Rasch analysis to explore the extent to which the Generic and Cancer-Specific summary scales (and separately-analysed Benefits of cancer domain) are unidimensional, with linear measurement properties and no differential item functioning (DIF). MethodsPatients with potentially curable breast, colorectal or prostate cancer completed QLACS 15months post-diagnosis (N=407). Score distributions, floor and ceiling effects, internal reliability, and feasibility (completion time and missing data) were examined. Rasch analysis included examination of item fit, DIF and unidimensionality. ResultsThe QLACS domains and summary scales had very similar score distributions and classic psychometric properties (no ceiling effects, majority no floor effects, acceptable reliability) to those found in development work with longer-term survivors. Median completion time was 10min and total missing data 2.3%. The Generic summary scale contained several misfitting items and exhibited multidimensionality. The Cancer-Specific summary scale and Benefits domain showed fit to the Rasch model and demonstrated unidimensionality and no DIF, with just one or no item modifications respectively. ConclusionQLACS demonstrates similarly good classic psychometric properties among shorter-term as among longer-term survivors, and has good feasibility. The Cancer-Specific summary scale and Benefits domain showed an impressive degree of fit to the Rasch model, although the validity of computing the Generic summary score was not supported.

OC-048 Trans-anal Submucosal Endoscopic Resection (taser): A New Endo-surgical Approach To The Resection Of Giant Rectal Lesions

IntroductionTrans-anal surgical (TEMS/TAMIS) and advanced endoscopic resection (ESD, P-EMR) procedures have the potential to provide complete and successful eradication of giant rectal polyps. Both approaches however have limitations in terms...

Are immunohistochemical (IHC)/microsatellite instability (MSI) testing necessary as part of Lynch syndrome work-up in the era of multiplex genetic testing?

425 Background: IHC for mismatch repair proteins and MSI are commonly used to direct genetic testing for Lynch Syndrome. Abnormal results in the setting of a positive family history often lead to genetic testing for Lynch syndrome. The often cumbersome process of completing IHC/MSI requires obtaining stored tissue +/- blood from a family member affected with cancer. Upfront genetic testing is not favoured due to concerns about identifying variants of uncertain significance. We performed a review of Lynch syndrome work-up in Ireland, and propose a model that is the reverse of the current international standard, and may expedite and simplify work up of these families. Methods: Data was ascertained from three cancer genetics services in Dublin and included the following variables: date of birth, date of request and reporting results for IHC, MSI and genetic tests. Time intervals were determined for LS work-up for all patients who had the process initiated in these 3 centres. Results: Probands from 50 families referred for LS work-up were included.The median time from date of IHC request to date of IHC report (total of 50 patients) was 4 weeks (range: 4 days to 36 weeks). The median time between date of IHC request to date of MSI report (n = 32 patients) was 20 weeks (range: 4 to 56 weeks). The median time from date of genetic test request to date of result (n = 9 patients) was 9 weeks (range: 2 to 26 weeks). The median time for completion of all 3 tests in one individual (n=3 patients) was 14 weeks (range: 10 to 60 weeks). Conclusions: The diagnostic pathway for Lynch syndrome is cumbersome and often lengthy. Appropriate upfront multiplex genetic testing would expedite the identification of mismatch repair gene mutation carriers. IHC/MSI testing could be used to characterise variants of uncertain significance.