Medical History Questions Research Articles

NURS-02. THE DEVELOPMENT AND IMPLEMENTATION OF SKINCARE TREATMENT PLANS AND PRODUCT KITS FOR PEDIATRIC PATIENTS RECEIVING TARGETED THERAPIES THAT CAUSE SKIN TOXICITY

Abstract BACKGROUND Mitogen-activated protein kinase (MAPK) pathway inhibitors are incorporated into the treatment regimens for several pediatric cancers. However, they commonly trigger dermatologic side effects, which can be challenging to manage and may have a significant impact on the quality of life. METHODS We previously performed a prospective study looking at the satisfaction and utilization of skincare kits and patient education regarding basic skincare practices. Based on these data, we developed revised skincare product kits and treatment plans that can be individualized for patients who are at risk of developing dermatologic side effects from targeted therapies. RESULTS Based on our prior study, 77% of patients thought the skincare kits and instructions were helpful. Seventy-seven percent of patients also recommended that they be distributed at the initiation of therapy. Through this study, we discovered that the patient reported medical history questions were inconsistent when compared with medical chart reviews. The most common discrepancies included information regarding patient’s diagnosis, prescribed medications, skin-related problems, and past medical history. From this data, we have developed a new skincare product kit and patient skincare plans which we distribute to every patient prior to starting their targeted therapy. The skincare kits consist of a cleanser, emollient, oral care products, sunscreen, pyrithione zinc containing shampoo, and facial moisturizers for adolescent patients. Our patient skincare plans consist of patient-specific information including diagnosis, medications, and their targeted agent. The plan provides details on how and when to use each product, application time, and order in which to apply products and topical medications. CONCLUSION Our project has highlighted the importance of patient education regarding dermatologic side effects in those starting targeted therapies. We have successfully implemented this by providing our patients with both skincare products and patient-specific care plans.

Reflections on ‘common’ genetic medical history questions: Time to examine the what, why, and how

ObjectiveA central goal of patient-centered care is to establish a therapeutic relationship. While remaining in tune with patient emotions, genetics providers must ask questions to understand medical histories that will inform the differential diagnosis, evaluation plan, and potential treatments. Methods195 audio-recorded conversations between providers and caregivers of pediatric patients with suspected genetic conditions were coded and analyzed. Coders identified sensitive history-taking questions asked by providers related to exposures and complications during pregnancy; ancestry and consanguinity; educational attainment of the caregiver; and family structure. ResultsWe highlight examples of providers: using stigmatizing language about conception or consanguinity; not clarifying the intent behind questions related to caregivers’ educational attainment and work history; and making presumptions or assumptions about caregivers’ race and ethnicity, family structure, and exposures during pregnancy. ConclusionSome questions and phrasing considered routine by genetics providers may interfere with patient-centered care by straining attempts to establish a therapeutic, trusting relationship. Additional research is needed to assess how question asking and phrasing impact rapport building and patient experience during genetics encounters. Practice implicationsReview of the purpose and need for medical history questions common to genetics practice could serve to improve patient-centered care.

Sleep habits and orofacial myofunctional self-assessment of children at risk for sleep breathing disorders.

To identify orofacial myofunctional complaints and sleep-disordered breathing and correlate them with sleep habits in childhood. The study included 71 parents/guardians of public school children aged 6 to 11 years. They answered a form with semi-structured medical history questions and the Nordic Orofacial Test-Screening - interview, the Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, and the Children's Sleep Habits Questionnaire - all of them in their Portuguese/Brazilian versions in an online format. Statistical analyses used Spearman's correlation, setting the significance level at 5%. There were 29 female children (40.8%) and 42 male ones (59.2%), with a mean age of 8.52 years. The study found orofacial myofunctional complaints related to breathing functions (35.2%), chewing and swallowing (32.4%), and deleterious habits (33.8%). All children were at a low risk of sleep-disordered breathing. As for sleep habits, 23 children (32.39%) had a lower total score, whereas 48 children (67.61%) exceeded 41 points. There was a correlation between the risk of sleep-disordered breathing in children with complaints of orofacial myofunctional disorders and poor sleep quality/habits.

“Are you otherwise fit and well?”: Past medical history questions in UK paediatric consultations

Accurate diagnosis and treatment depend upon detailed knowledge of both the child’s presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice. ObjectiveTo examine the function of the question “are you otherwise fit and well?” to elicit a child’s general medical history in UK paediatric allergy outpatient consultations. MethodsExamination of 30 video-recorded UK paediatric outpatient consultations involving children (2–10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question’s micro-design elements and their consequences for the consultation’s trajectory. ResultsAsking “Are you otherwise fit and well?” is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of “fitness” and “wellness”; negotiating opportunities for children’s participation; and importantly, a shift towards discussing more general wellbeing. ConclusionPast medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children. Practice implicationsClinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question ‘Are you otherwise fit and well’ clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children.

Burden of hyperphagia and obesity in Bardet–Biedl syndrome: a multicountry survey

BackgroundSigns and symptoms of Bardet–Biedl syndrome (BBS) occur during early childhood, progress over time, and place substantial, multifaceted burden on patients and their caregivers. Hyperphagia may be a contributing factor to early-onset obesity in BBS; however, there are limited insights into its impacts on patients and caregivers. We quantified disease burden as it relates to the physical and emotional impacts of hyperphagia in BBS.MethodsThe CAREgiver Burden in BBS (CARE-BBS) study was a multicountry, cross-sectional survey of adult caregivers of patients with BBS who have had hyperphagia and obesity. The survey consisted of questionnaires including Symptoms of Hyperphagia, Impacts of Hyperphagia, Impact of Weight on Quality of Life (IWQOL)-Kids Parent Proxy, and Patient-Reported Outcome Measurement Information System (PROMIS) v1.0-Global Health 7. In addition, clinical characteristics, medical history, and weight management questions were included. Outcomes were scored and summarized descriptively in aggregate and by country, age, and obesity severity according to weight class.ResultsThere were 242 caregivers of patients with BBS who completed the survey. Caregivers observed hyperphagic behaviors throughout the day, with negotiating for food (90%) and waking up and asking or looking for food during the night (88%) being the most frequent. Hyperphagia had at least a moderate negative impact on most patients’ mood/emotions (56%), sleep (54%), school (57%), leisure (62%), and familial relationships (51%). Hyperphagia affected concentration at school (78%), and symptoms of BBS contributed to patients missing ≥ 1 day of school a week (82%). Responses from the IWQOL-Kids Parent Proxy suggested obesity most greatly negatively affected physical comfort (mean [standard deviation (SD)], 41.7 [17.2]), body esteem (41.0 [17.8]), and social life (41.7 [18.0]). On the PROMIS questionnaire, mean (SD) global health score for pediatric patients with BBS and overweight or obesity (36.8 [10.6]) was lower than the general population (mean, 50).ConclusionsEvidence from this study suggests that hyperphagia and obesity may have broad negative impacts on the lives of patients with BBS, including physical health, emotional well-being, school performance, and personal relationships. Therapies that target hyperphagia may alleviate the extensive clinical and nonclinical impacts experienced by patients with BBS and their caregivers.

Initial Patient Satisfaction With Telemedicine in Neurosurgery Outpatient Clinic During the Early COVID-19 Pandemic

BACKGROUND: Throughout the COVID-19 pandemic, the medical community has been saturated by the necessity for telemedicine, or “telehealth”, appointments. With limited prior exposure, the many challenges that accompany telehealth visits have affected how physicians conduct daily tasks and how patients perceive healthcare experiences. In the early stages of the COVID-19 pandemic, telemedicine was new to most neurosurgical patients. This study seeks to evaluate the overall neurosurgical patient experience with telemedicine. OBJECTIVE: To assess overall neurosurgical patient satisfaction with telemedicine to build an understanding of the effectiveness of these encounters for future planning. METHODS: After a telemedicine appointment, patients received an electronic survey. Survey questions focused on demographic information, encounter type, medical history questions, and overall satisfaction with telemedicine. Responses for the survey questions were formulated using a 5-point Likert scale. RESULTS: Two hundred seventy patients were seen via telemedicine by 1 of 4 providers included in this study. 43 patients returned the surveys, with a completion rate of 16%. Patients indicated higher scores for overall satisfaction and quality of appointment. Of note, 23% of participants responded that they would be willing to pay out of pocket for a telemedicine appointment, while 77% responded they would not be willing to pay out of pocket. CONCLUSION: Our survey results show patients felt comfortable discussing healthcare issues using telehealth, that appropriate levels of care were received, and they would be willing to use telehealth again. Future efforts will be necessary to educate providers and patients about the utilization of technological devices, ensure patient access to telehealth, and standardize ethical guidelines.

The effect of technology on the occurrence of musculoskeletal disorders in students of high school in Greece

Background: There has been a rise in the proliferation of technological devices across the globe. Many children use electronic devices from the age of 3 years old, especially mobile phones. The prolonged use of electronic devices has led to a distortion of body posture, leading to musculoskeletal disorders, including neck, thoracic, and back pain, and tendonitis of the upper extremities, primarily when using one hand. Methods: To prove the positive correlation between technology and musculoskeletal disorders and to answer the above questions, an online questionnaire was distributed to 120 students of high school from all over Greece. The questionnaire comprises questions from two standardized questionnaires, the internet addiction test (IAT) and the Nordic musculoskeletal questionnaire (NQS). In addition, respondents completed a medical history and supplementary questions about their physical condition and their attitudes when using electronic devices. Results: The results show that there is a positive correlation between long-term use of electronic devices and the occurrence of musculoskeletal problems in all parts of the body (neck, chest, lower back, hip, and lower extremities), as well as students who chose the wrong postures, had much more symptoms in contrast to the students who chose the positions with the greatest alignment. Finally, physical activity decreased significantly as the respondents' hours of using electronic devices increased. Conclusions: Uncontrolled use of electronic devices can be a factor in the onset of symptoms, but adopting correct posture while using the devices and the good physical condition of the students would significantly reduce pain.

Relationship between Reaction Times and Post-COVID-19 Symptoms Assessed by a Web-Based Visual Detection Task.

Long-COVID is a clinical condition in which patients affected by SARS-CoV-2 usually report a wide range of physical and cognitive symptoms from 3 to 6 months after the infection recovery. The aim of the current study was to assess the link between self-reported long-COVID symptoms and reaction times (RTs) in a self-administered Visual Detection Task (VDT) in order to identify the predictor symptoms of the slowing in reaction times to determine attention impairment. In total, 362 participants (age (mean ± S.D.: 38.56 ± 13.14); sex (female-male: 73.76-26.24%)) responded to a web-based self-report questionnaire consisting of four sections: demographics, disease-related characteristics, and medical history questions. The final section consisted of a 23 item 5-point Likert-scale questionnaire related to long-term COVID-19 symptoms. After completing the questionnaire, subjects performed a VDT on a tablet screen to assess reaction times (RTs). An exploratory factorial analysis (EFA) was performed on the 23 long-COVID symptom questions, identifying 4 factors (cognition, behavior, physical condition, presence of anosmia and/or ageusia). The most important predictors of RTs were cognition and physical factors. By dissecting the cognitive and physical factors, learning, visual impairment, and headache were the top predictors of subjects' performance in the VDT. Long-COVID subjects showed higher RTs in the VDT after a considerable time post-disease, suggesting the presence of an attention deficit disorder. Attention impairment due to COVID-19 can be due to the presence of headaches, visual impairments, and the presence of cognitive problems related to the difficulty in learning new activities. The link between the slowing of reaction times and physical and cognitive symptoms post-COVID-19 suggests that attention deficit disorder is caused by a complex interaction between physical and cognitive symptoms. In addition, the study provides evidence that RTs in a VDT represent a reliable measure to detect the presence of long-COVID neurological sequelae.

Burden of Atopic Dermatitis in Adults in Greece: Results from a Nationwide Survey.

The objective was to describe the AD burden in terms of quality of life (QoL), sleep, social life, work productivity, and resource utilization in Greece and assess the impact of disease severity. A nationwide cross-sectional survey was conducted. The questionnaire consisted of socioeconomic factors, medical history, AD screening, AD severity, QoL, sleep difficulties, social activities, and work productivity questions. AD was defined using the UK Working Party criteria (UKWP cohort) and a patient-reported AD diagnosis from a physician (Expert Diagnosis cohort). Self-reported moderate/severe AD was estimated using the Patient-Oriented Eczema Measure (POEM). In the UKWP cohort, the AD effect on QoL was moderate/extremely large in 84.3% of moderate/severe AD (vs. 55.7% in mild; p = 0.016), while in the Expert Diagnosis cohort, it was 72.2% (vs. 22.8%; p < 0.001). Disease severity was associated with a higher impact on sleep and social activities. Overall work impairment was high in both mild (32.7%) and moderate/severe (48.5%) AD of the UKWP cohort, while among the Expert Diagnosis cohort, it was significantly higher among those with moderate/severe (31.2%) versus mild AD (11.9%; p < 0.001). The AD burden in Greece is significant, especially for those in moderate/severe AD stages. Acknowledging this burden is the first step toward applying healthcare decisions that will benefit patients and the community.

Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening.

In 2018, the municipal Sexual Health Clinic in Seattle, implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and sexually transmitted infection (STI) symptoms in the clinic's computer-assisted self-interview (CASI) to improve care for transgender and nonbinary (TNB) patients. We calculated test positivity, the proportion of TNB patient visits that received testing for human immunodeficiency virus (HIV); syphilis; pharyngeal, rectal, and urogenital gonorrhea (GC); and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions, and the proportion of asymptomatic patients who received anatomic site-specific screening based on reported exposures. There were 434 TNB patients with 489 and 337 clinic visits during each period, respectively. Nonbinary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and nonbinary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men, and nonbinary patients AMAB were more likely to receive extragenital GC/CT screening compared with nonbinary patients assigned female at birth. After implementation of trans-inclusive questions, there was a 33% increase in the number of annual TNB patient visits but no statistically significant increase in HIV/STI testing among TNB patients. TNB people had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.

Bilateral Optic Disc Drusen with Neuroretinitis

Background: Neuroretinitis is an inflammation of the posterior pole of the eye, resulting in optic disc edema and macular star formation. Systemic conditions associated with these findings include tuberculosis, toxoplasmosis, syphilis, lyme disease, toxocariasis, mumps, herpes simplex, and cat scratch disease. This case illustrates diagnosis and treatment for a patient with neuroretinitis complicated by preexisting vision loss. Case Report: A Caucasian male in his 40’s presented to the eye clinic for an emergency appointment with complaints of constant blurry vision, especially inferiorly upon awakening, in his right eye for the past two weeks. His ocular history included optic disc drusen in both eyes with profound peripheral vision loss in the left eye. The patient’s systemic history included cluster headaches and sleep apnea. Entering visual acuities were 20/150- OD and 20/20 OS. Additional medical history questioning revealed the recent adoption of a kitten. Conclusion: This case describes the diagnosis and treatment for the rare condition of neuroretinitis secondary to a Toxocara infection. While cat scratch disease was initially suspected, detailed laboratory testing identified the true, and more rare, causative infectious agent. A variety of differential diagnoses were ruled out through laboratory and imaging studies. Consultations with neuro-ophthalmology and infectious disease specialists were exceedingly valuable in contributing to a positive outcome for this patient. This patient’s preexisting ODD with vision loss heightened the concern to preserve the patient’s remaining vision and further added to the complexity of this challenging case. The importance of medical history questions regarding animal contact also proved vital for accurate diagnosis and treatment of this sight threatening condition.

Epidemiological profile of patients utilizing dental public health services in the eThekwini and uMgungundlovu districts of KwaZulu-Natal province, South Africa

INTRODUCTION: Oral conditions such as dental caries, periodontal diseases, tooth loss and trauma affect millions of people globally. These conditions can be prevented when detected early, thereby avoiding adverse outcomes. The prevalence of oral conditions has been reported in most provinces. However, there is a paucity of data in KwaZulu-Natal. AIM AND OBJECTIVE: This study aimed to determine the prevalence of oral conditions at public health facilities in two health districts in KwaZulu-Natal, South Africa. MATERIALS AND METHODS: A cross-sectional analytical study design was used to determine the nature of oral conditions treated in dental facilities in the eThekwini and uMgungundlovu districts, in KwaZulu-Natal. The study was conducted over a 5-month period (November 2018 - April 2019). After clinicians examined the patients they entered the data in the patients clinical records and selected information (routine medical history questions as well as 16 possible diagnosis codes) were entered into a data extraction template. The data were analyzed using statistical software SPSS. RESULTS: Dental caries was the most prevalent oral condition at 66.4% followed by periodontal disease at 11.7%, trauma at 7.3% and lastly tooth loss at 5.9% CONCLUSION: These findings contribute to knowledge on the prevalence of these oral conditions found in the province.

A survey of the oral lesions in newborns and infants: A two-year cross-sectional study

Introduction. Oral lesions in newborns and infants represent a wide range of diseases often creating apprehension and anxiety among parents. Aim. We aimed to assess the type, prevalence and associated factors of oral lesions in newborns and infants. Material and methods. Participants were recruited during a two-year cross-sectional study among children who had their first teething assessed. The mothers answered medical history questions and the children underwent a clinical examination by paediatric dentists after training, calibration, and pilot study. Results. Two hundred and forty-eight children aged up to 12 months took part in the study. The mean number of teeth (SD) was 1.96 (2.55). 1.25% of children had natal teeth. Dental caries was observed in 3.2% children; traumatic dental injuries caused by falling in 7%; enamel hypoplasia in 1.9%, and mucosal lesions in 19.8% (Bohn’s nodules, mucocele, candidiasis). Conclusions. Oral lesions in infants may involve teething, teeth and oral mucosa. One child out of five children has mucosal lesions, most often Bohn’s nodules or candidiasis. There is a significant correlation between the prevalence of natal/neonatal teeth and of Bohn’s nodules.

Surgical Needs of Internally Displaced Persons in Kerenik, West Darfur, Sudan.

The burden of surgical disease in refugee and internally displaced person (IDP) populations has not been well defined. Populations fleeing conflict are mobile, limiting the effectiveness of traditional sampling methods. We employed novel sampling and survey techniques to conduct a population-based surgical needs assessment amongst IDPs in Kerenik, West Darfur, Sudan, over 4weeks in 2008. Satellite imagery was used to identify man-made structures. Ground teams were guided by GPS to randomly selected households. A newly created surgical needs survey was administered by surgeons to household members. One randomly selected individual answered demographic and medical history questions pertaining to themselves and first-degree blood relatives. All household members were offered a physical examination looking for surgical disease. There were 780 study participants; 82% were IDPs. A history since displacement of surgical and potentially surgical conditions was reported in 38% of respondents and by 73% of respondents in first-degree blood relatives. Surgical histories included trauma (gunshots, stabbings, assaults) (5% respondents; 27% relatives), burns (6% respondents; 14% relatives), and obstetrical problems (5% female respondents; 11% relatives). 1485 individuals agreed to physical examinations. Untreated surgical and potentially surgical disease was identified in 25% of participants. We identified and characterized a high burden of surgical and potentially surgical disease in an IDP population in West Darfur. Our study is unique in its direct assessment of a traumatized, mobile, vulnerable population. Health officials and agencies charged with the care of IDP and refugee populations should be aware of the high prevalence of surgical and potentially surgical conditions in these communities. This study adds to the growing body of evidence that investment in surgical resources may address a significant portion of the overall burden of disease in marginalized populations.

Predicting hearing loss in children according to the referrer and referral cause

BackgroundHearing assessment in children is considered necessary in all cases involving a doubt regarding hearing acuity. Due to the fact that the number of referrals may be much greater than the actual capacity of a hearing institute, it would be desirable to have a filtering tool in order to detect the cases with higher suspicion of hearing loss. ObjectiveTo evaluate whether anamnesis details can be used as a sorting tool for detection of highly suspicious cases of hearing loss in preschool children. The anamnesis details may be one or more of the following: the reason for performing hearing test, which caregiver indicated the need for hearing evaluation, the parent's comprehension of their child hearing, and the medical history. Methodsthe parents of preschool children, who were referred to the hearing institute at Soroka university medical center, were asked to fill a questionnaire containing 18 questions. The questions referred to details such as: the reason for performing the hearing test; who suggested the existence of hearing impairment; medical history issues and questions regarding details that may indicate a risk of hearing loss. Details such as Otoscopy results were taken from the medical record of the patient. Results317 preschool and school patients were recruited to the study. Hearing loss was found in 42% of the cases. The most common reason for performing the hearing test was speech disturbance (33%). In cases which the parents were those who raised the suspicion of hearing loss – hearing impairment was found in 61% of the cases, compared to 36% when the speech therapist was the one raising the doubts and to only 18% when the kindergarten teacher was the one raising the doubt. The positive predictive value of patient that their parents suspected the hearing loss combined with pathologic otoscopy result was 82.6% when the reason for the test was hearing impairment suspicion, and 91.3% when the reason for the hearing test was speech disturbance. ConclusionsParents are the best in assessing their child's hearing followed by the speech therapist and the least sensitive is the school teacher.

American Association of Kidney Patients survey of patient preferences for hemodialysis vascular access.

To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease. The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences. Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter. Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.

The COMFORT Cohort: Identifying Biomarkers Relevant to Functional Gastrointestinal Disorders (P20-039-19)

ObjectivesThe links between food, gastrointestinal (GI) function and comfort, and mental well-being are at the forefront of nutritional research. Irritable Bowel Syndrome (IBS) is a functional GI disorder and the combination of detailed patient reported outcomes (PROs) combined with omic data could better define these disorders. MethodsThe Christchurch COMFORT cohort is a case-control study: 337 participants with functional GI disorders (functional constipation FC, functional diarrhoea FD, IBS constipation IBS-C, IBS diarrhoea IBS-D) and asymptomatic controls. Demographics, symptom scores, psychological scores and dietary intake were recorded using the ‘Modified Hunter New England’ (Rome IV diagnostic criteria questionnaires; Medical History Questions; Hospital Anxiety and Depression Scale, HADS). Demographics included Structured Assessment of Gastrointestinal Symptoms (SAGIS); and Diet Diary and Live Symptoms Score (FAST) along with PRO Measurement Information System (PROMIS). Biological samples collected for an untargeted LCMS analysis of plasma and shot-gun metagenome analysis of faecal DNA. Ethical approval was obtained from the University of Otago Human Ethics Committee (H16/094). ResultsSymptom questionnaires were able to cluster 287 subjects into: IBS (42%), functional disorders (18%) and healthy controls (40%). Within IBS, 46% were IBS-D, 23% were IBS-C and 31% were IBS-M. Severity scores were higher for all IBS cases with PROMIS-GI scales. A higher score of health worry was reported in IBS-C than other IBS subtypes. HADS anxiety and depression scales were higher in IBS cases (vs. healthy controls). The FAST diary symptoms correlated with PROMIS GI scales (exception for constipation). Metabolomic analyses detected differential plasma metabolites and pathways (bile acids, lipids, specific amino acids) affected between IBS-C + FC vs IBS-D + FD, healthy vs IBS-D and healthy vs IBS-C. Metagenomics suggests that carbohydrate, methane, and sulfur metabolism may be important in IBS. ConclusionsThese data will allow us to apply a systems biology approach to identify key pathways and correlate them with the questionnaire data to better understand functional GI disorders. Funding SourcesFunded by the NZ National Science Challenge High-Value Nutrition programme.

Increased Ascertainment of Transgender and Non-binary Patients Using a 2-Step Versus 1-Step Gender Identity Intake Question in an STD Clinic Setting.

Transgender inclusive and gender affirmative healthcare includes asking patients about gender identity and sex assigned at birth through what is known as the "2-step" methodology. In May 2016, the sexually transmitted disease (STD) clinic in Seattle, WA switched from using a 1-step to a 2-step gender identity question. We aimed to determine if the updated questions increased ascertainment of transgender and gender nonconforming (TGNC) patients and used the improved gender identity data to describe the human immunodeficiency virus/STD risk profile of TGNC patients. We conducted a pre-post analysis comparing the proportion of patients that identified as TGNC during the year before and after implementation of the 2-step questions. Gender identity and medical history questions were ascertained using a computer-assisted self-interview. The 2-step question included 2 new gender response options: non-binary/genderqueer and write-in. Institution of the 2-step question resulted in a 4.8-fold increase in patients who were identified as TGNC: 36 (0.5%) of 6635 to 172 (2.4%) of 7025 patients (P < 0.001). After implementation, 89 patients identified as non-binary/genderqueer (51.7% of TGNC patients). The proportion of patients identified as transgender men and women increased from 0.2% to 0.5% (P = 0.002) and 0.4% to 0.6% (P = 0.096), respectively. Non-binary patients' human immunodeficiency virus/sexually transmitted infection risk profile was distinct from that of transgender and cisgender men who have sex with men, suggesting that distinguishing subpopulations within the TGNC population is important for risk stratification. Using a 2-step gender identity question and including non-binary/genderqueer options increased our clinic's ascertainment of TGNC patients and more accurately captured gender identity among STD clinic patients.

DGP Interstitial Lung Disease Patient Questionnaire

Interstitial lung diseases (ILD) encompass different heterogeneous, mainly chronic diseases of the pulmonary interstitium and/or alveoli with known and unknown reasons. The diagnostic of ILD is challenging and should be performed interdisciplinary. The medical history is of major importance and therefore, in German-speaking countries the Frankfurter Bogen (published in 1985) was utilised to scrutinise the medical history of the patient. This by now more than 30-years-old questionnaire requires a revision with regard to content and language. Under the auspices of the clinical section of the DGP the new Interstitial Lung Disease Patient Questionnaire was developed in collaboration amongst pulmonologist, occupational medicine physicians and psychologists and supported by patient support groups. The questionnaire was finally optimised linguistically with the help of patients. The newly developed patient questionnaire for interstitial and rare lung diseases encompasses different domains: initial and current symptoms, medical history questions including prior drug treatments, previous pulmonary and extrapulmonary diseases, potential exposition at home, work and leisure time as well as family history and travelling. The newly developed questionnaire can facilitate the diagnosis in patients with suspicion on interstitial lung disease in clinical routine.

A Personal Reflection on the Medical History Questions facing Adopted Persons.

A Personal Reflection on the Medical History Questions facing Adopted Persons.