Patient Recall Research Articles

Comparative Evaluation of the Efficacy of Light-Cured Calcium Hydroxide and a Fourth-Generation Calcium Silicate Cement (TheraCal LC) as Indirect Pulp Capping Materials in Patients With Deep Carious Lesions: A Randomized Parallel-Group Clinical Trial.

AimThe current study aims to evaluate and compare the efficacy of light-cured calcium hydroxide and a fourth-generation calcium silicate cement (TheraCal LC®) as indirect pulp capping (IPC) materials in patients with deep carious lesions.Materials and methodsA total of 28 patients were randomly divided into two groups (n=14). Group A was managed by light-cured calcium hydroxide, while group B was treated with TheraCal LC (a fourth-generation calcium silicate cement). Clinical examination was conducted to check for postoperative pain, tenderness, and neural sensibility, and radiographical examination was conducted to check for periodontal ligament space widening, presence of calcific barrier, and periapical radiolucency at patient recall of 21 days, three months, and six months. Primary and secondary outcome variables were based on clinical and radiographical success rates noted at six months’ follow-up.ResultsSuccess rate for light-cured calcium hydroxide group at follow-up came out to be 0% at 21 days, 85.71% at three months, and 92.85% at six months. The success rate for TheraCal LC group came out to be 0% at 21 days, 92.85% at three months, and 100% at six months. The overall success rate for IPC procedure was 89.28% at three months’ follow-up and 96.42% at six months’ follow-up for both groups. The difference was statistically non-significant at the end of three and six months’ follow-up.ConclusionWithin the limitations of our study, it was concluded that TheraCal LC can be used alternatively with light-cured calcium hydroxide in IPC, with a predictability of similar success outcome in patients with deep carious lesions.

Understanding the socioeconomic costs of dystrophic epidermolysis bullosa in Europe: a costing and health-related quality of life study

BackgroundDystrophic epidermolysis bullosa (EB) is a family of rare genetic dermatological conditions. Recent evidence indicated that in addition to its detrimental implications on patient health-related quality of life (HRQoL), there are substantial socioeconomic cost implications, especially regarding direct non-medical costs. This study aims to understand the burden of dystrophic EB (DEB) in Europe, using a primary EB patient-level dataset.MethodsA bottom-up, cross-sectional, study design was adopted for non-institutionalised patients diagnosed with EB who received outpatient care across EU5 countries: France, Germany, Italy, Spain, and the United Kingdom. A prevalence-based approach was used to estimate resource utilisation from a societal perspective, including direct (medical and non-medical) and indirect costs for patients and caregivers. Patient and caregiver outcomes were obtained using the EQ-5D questionnaire.ResultsA sample of 91 DEB patients was analysed. Overall, average EU5 annual cost per patient was estimated at €53,359, ranging from €18,783 (France) to €79,405 (Germany). Average EU5 annual direct medical costs were estimated at €8357 (15.7% of total), ranging from €5658 (France) to €12,576 (Germany); average direct non-medical costs were estimated at €41,353 (77.5% of total), ranging from €11,961 (France) to €57,000 (Germany); and average indirect costs were estimated at €3649 (6.8% of total), ranging from €1025 (Italy) to €9930 (United Kingdom). Costs varied across patients with different disability but also between children and adults. The mean EQ-5D index score for adult DEB patients ranged between 0.304 (United Kingdom) and 0.541 (Germany), with an EU5 average of 0.456, whereas the mean EQ-5D visual analogue scale score ranged between 47.5 (Germany) and 70.0 (France), with an EU5 average of 61.9. Limitations included potential patient selection bias, recall bias, and exclusion of bandaging and related costs.ConclusionsThe study revealed a substantial socioeconomic burden for DEB in Europe, attributable mostly to high direct non-medical costs, with the majority of patients requiring support from caregivers at home. Compared to the average economic burden of the overall EB patient population, costs for DEB patients are higher across all components of direct medical, direct non-medical and indirect costs.

Use of a Semiautomatic Text Message System to Improve Satisfaction With Wait Time in the Adult Emergency Department: Cross-sectional Survey Study

BackgroundMany factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time.ObjectiveWe aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician.MethodsWe performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs.ResultsA total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use.ConclusionsAlthough not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use.

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy

Background: The use of patient-reported outcomes (PROs) is common practice in the treatment of patients undergoing hip arthroscopy. While the prospective collection of PROs is preferred, retrospective collection involving patient recall is not uncommon and may be subject to bias. Purpose: To assess the presence of recall bias between prospectively and retrospectively collected PRO scores in hip arthroscopy. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent hip arthroscopy between 2015 and 2021 and provided preoperative baseline responses for the International Hip Outcome Tool–12 (iHOT-12), the Hip disability and Osteoarthritis Outcome Score–Physical Shortform (HOOS-PS), and the modified Harris Hip Score (mHHS) were eligible for recruitment. After surgery, participants were asked to complete a study-specific survey and the same preoperative PROs retrospectively. Agreements between the prospective and retrospective scores were assessed, and associations between score discrepancies and patient characteristics were identified. Results: A total of 94 patients (43.3% participation rate) completed study requirements and were included for analysis. The mean ± standard deviation duration of symptoms before surgery was 25.3 ± 32.8 months, and the mean duration to recall (from the day of surgery) for the PROs was 29.6 ± 22.2 months. The iHOT-12 (intraclass correlation coefficient [ICC], 0.409; P < .001) and HOOS-PS (ICC, 0.415; P < .001) scores had low agreement between prospectively and retrospectively collected scores. The mHHS showed moderate agreement (ICC, 0.598; P < .001). The mean scores for the iHOT-12 (41.4 ± 22.6 vs 34.6 ± 16.3; P < .01), HOOS-PS (29.7 ± 18.5 vs 40.9 ± 17.1; P < .001), and mHHS (62.7 ± 16.5 vs 54.5 ± 14.8; P < .001) were all significantly different prospectively versus retrospectively. The average changes in score for the iHOT-12, HOOS-PS, and mHHS were −6.8, 11.2, and −8.2, respectively. Duration to recall and female sex were predictors of the difference between prospectively and retrospectively collected iHOT-12 data, while no predictors were significant for the HOOS-PS or mHHS. Conclusion: The retrospective collection of PROs for hip arthroscopy procedures is subject to bias. On average, retrospective (recalled) PROs reflected worse pain/function than their prospectively recorded counterpoints; therefore, retrospective patient recall is an unreliable source of clinical data, and the prospective collection of iHOT-12, mHHS, and HOOS-PS data should be prioritized.

44. Does recall bias exist in lumbar spine surgery patients as reported through PROMIS questionnaires?

<h3>BACKGROUND CONTEXT</h3> Surgical outcomes are increasingly judged on patients' perceptions of the results. Despite the improved quantitative data provided by patient-reported outcomes (PROs), they remain susceptible to confounding factors on patients' interpretations such as recall bias: the inability to accurately recall prior impairment. No studies to date have reported the accuracy of patient recall using PROMIS outcomes after lumbar spine surgeries. <h3>PURPOSE</h3> The purpose of this study is to determine the presence and extent of recall bias in adult patients after elective lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Subgroup analysis of ongoing prospective study. <h3>PATIENT SAMPLE</h3> This study included 98 patients who had undergone either lumbar decompression or lumbar decompression and fusion procedures. <h3>OUTCOME MEASURES</h3> Baseline preoperative PROMIS Physical Function (PF), PROMIS Pain Interference (PI) and recalled preoperative PROMIS PF and PI. <h3>METHODS</h3> Patients, at least 2 years after their index surgery, completed a recall questionnaire comprised of the PF CAT and PI CAT as though it was a time immediately before their surgery. All patients had prospectively completed PROMIS PF CAT and PI CAT prior to surgery and at 3 months, 6 months, 1 year and 2 years. T tests were used to compare recalled PROs with actual baseline PROs. Correlation coefficients were calculated to evaluate the agreement between recalled PROs and baseline PROs. Regression analysis was performed to determine the impact of patient characteristics or clinical factors. <h3>RESULTS</h3> Patient recollection of preoperative status at a minimum of 2 years postoperatively was significantly more severe than baseline preoperative status with mean difference in PF of -1.5 (p < 0.05) and PI of 2.1 (p < 0.01). There was only moderate correlation between recalled and baseline scores with regards to PF (r=0.52) and PI (r=0.38). No significant differences on recalled PROs were found based on age, gender, time between surgery and recalled outcomes, and duration of symptoms before surgery. <h3>CONCLUSIONS</h3> Our data indicate that patient recall of preoperative status after lumbar surgery is significantly different than actual baseline preoperative status as measured by PROMIS PF and PI scores with only moderate correlation existing between the two. Patients' interpretations of improvement after surgery may be impacted by significant recall bias. This may have an impact on patient satisfaction and perceived value of lumbar spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Clinical Performance of a "No Wait" Universal Adhesive in Noncarious Cervical Lesions: A Two-year Randomized Controlled Clinical Trial.

To evaluate the 24-month clinical performance of a "no wait" universal adhesive with different application modes in comparison with an etch-and-rinsew and two-step self-etch adhesive in non-carious cervical lesions (NCCLs). A total of 234 non-carious cervical lesions in 34 patients were restored following 5 different adhesive approaches: 1. Clearfil Universal Bond Quick, self-etch mode (CUQ-SE); 2. Clearfil Universal Bond Quick, selective etch mode (CUQ-SLE); 3. Clearfil Universal Bond Quick, etch-and-rinse mode (CUQ-ER); 4. Clearfil SE Bond (self-etch adhesive) (CSEB); 5. Tetric N-Bond Universal, etch-and-rinse mode (TBU-ER). All NCCLs were restored with a nanohybrid composite (Tetric N-Ceram). The restorations were evaluated at baseline, 6, 12, and 24months of clinical service regarding retention, marginal adaptation, marginal discoloration, secondary caries, post-operative sensitivity, color match, surface texture using modified United States Public Health Service (USPHS) criteria. The patient recall rate at 24 months was 73.5%. Eleven restorations, 6 of the CUQ-SE group, 4 of the CSEB group and 1 of the TBU-ER group, were clinically unacceptable due to retention loss. Regarding marginal adaptation and discoloration, CUQ-SE and CSEB groups exhibited higher bravo scores than other groups after 24 months (p < 0.05). At the end of 24-month examinations, no significant differences were detected among the groups regarding secondary caries, post-operative sensitivity, color match and surface texture. The clinical survival rates of the "no wait" universal adhesive at self-etch mode after 24 months were not acceptable. The "no wait" universal adhesive showed clinically acceptable performance in selective-etch and etch-and-rinse mode according to the evaluated USPHS criteria.

Problems with catch-up HPV vaccination after resumption of proactive recommendations.

We previously reported that the suspension of the proactive recommendation for human papillomavirus (HPV) vaccination in Japan led to an increase in infection rates and incidence of cytological abnormalities, 1 Sekine M Yamaguchi M Kudo R et al. Suspension of proactive recommendations for HPV vaccination has led to a significant increase in HPV infection rates in young Japanese women: real-world data. Lancet Reg Health West Pac. 2021; 16100300 PubMed Google Scholar , 2 Yagi A Ueda Y Ikeda S et al. The looming health hazard: a wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine. Lancet Reg Health West Pac. 2022; 18100327 PubMed Google Scholar and appealed for proactive recommendations to be reinstated. 3 Ueda Y Yagi A Ikeda S Enomoto T Kimura T Beyond resumption of the Japanese government's recommendation of the HPV vaccine. Lancet Oncol. 2018; 19: 1563-1564 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar In response to our findings, the Japanese Ministry of Health, Labour, and Welfare resumed proactive recommendations for the HPV vaccine in April, 2022, and initiated catch-up vaccinations for women who might have missed the opportunity to receive the vaccine during the period when proactive recommendations were suspended. 4 Haruyama R Obara H Fujita N Japan resumes active recommendations of HPV vaccine after 8·5 years of suspension. Lancet Oncol. 2022; 23: 197-198 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar A large proportion of women in the target age group (17–25 years) in Japan's fiscal year 2022 will be eligible for the recommended catch-up vaccination (figure). 5 Nakagawa S Ueda Y Yagi A Ikeda S Hiramatsu K Kimura T Corrected human papillomavirus vaccination rates for each birth fiscal year in Japan. Cancer Sci. 2020; 111: 2156-2162 Crossref PubMed Scopus (24) Google Scholar To reduce the incidence of invasive cervical cancer in Japan, a catch-up vaccination programme with at least 50% coverage will be required. 6 Simms KT Hanley SJB Smith MA Keane A Canfell K Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health. 2020; 5: e223-e234 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar To date, England, Sweden, Denmark, and the USA have successfully implemented national catch-up HPV vaccination programmes. In these countries, catch-up vaccination has been reported to have substantially reduced the incidence of cervical precancer and invasive cancer. However, in England, low vaccination coverage among the catch-up generation has been reported. Coverage of three doses of the HPV vaccine was high for women who received the routine vaccination at age 12–13 years (80·9–88·0%), but lower for the catch-up cohorts (70·8–75·7% for age 14–16 years, and 38·9–48·1% for age 16–18 years). 7 Falcaro M Castañon A Ndlela B et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398: 2084-2092 Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar Catch-up vaccination is challenging in Japan because no national HPV vaccine register exists, and immunisation histories are maintained individually by each municipality (approximately 1700) that has provided routine vaccinations. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar For example, if a woman who received the HPV vaccination at age 12–16 years in one municipality moves to a residential address in another municipality, it would not be possible to ascertain her vaccination history from the previous municipality. Thus, a woman who has received three doses of the HPV vaccine in one municipality would be advised to receive three more doses of the HPV vaccine if she moved to another municipality. Thus, the vaccination programme will rely on patient recall regarding personal vaccination history. In our previous study, 1230 women aged 20–22 years between fiscal year 2014 and fiscal year 2017 were asked in a questionnaire whether they had been vaccinated in the past. 140/308 (45·5%) of those who responded that they had not been vaccinated had received 1–3 doses of the vaccine. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar In our current analysis of 1778 women aged 20–26 years in fiscal year 2020 (appendix), 199/879 (22·6%) of those vaccinated reported that they had never been vaccinated. Recall of women who visited clinics with their parents at age 12–16 years and received the HPV vaccine was poor.

Improving the annual monitoring rates of testosterone replacement therapy patients in primary care

IntroductionTestosterone replacement therapy (TRT) is the treatment of choice for male hypogonadism. British Society for Sexual Medicine (BSSM) guidelines on adult testosterone deficiency recommend that TRT patients undergo annual monitoring...

Poster 194: Recall Bias in the Retrospective Collection of Common Pre-Operative Patient-Reported Outcome Measures in Hip Arthroscopy

Objectives:To assess for the presence of recall bias between prospectively and retrospectively collected patient-reported outcome (PRO) scores in hip arthroscopy (HA).Methods:Patients that underwent HA between 2015-2021 and provided pre-operative baseline responses for the International Hip Outcome Tool-12 (iHOT-12), the Hip Disability and Osteoarthritis Outcome Score Physical Shortform (HOOS-PS), and the modified Harris Hip Score (mHHS) were eligible for recruitment. Eligible participants were asked to complete a study-specific survey and the same preoperative PROs retrospectively, requiring them to recall the status of the hip prior to surgery. Agreement between the prospective and retrospective scores was assessed using a two-way mixed effects intraclass coefficient (ICC) model. Paired t-tests were used to compare the mean scores of both groups and linear regression models were used to help identify associations between score discrepancies and patient characteristics.Results:A total of 222 patients were approached for participation, of whom 104 (60.6% female) completed study requirements and were included for analysis. The mean duration of symptoms before surgery was 24.5 ± 31.8 months and the mean duration to recall (from the day of surgery) for the retrospective completion of hip surveys was 29.1 ± 21.8 months. The iHOT-12 had a low amount of agreement between prospective and retrospectively collected scores (ICC=.452; P =.000). HOOS-PS scores also had a low amount of agreement (ICC=.458; P =.000). The mHHS had a moderate amount of agreement (ICC=.621; P =.000). Mean scores for iHOT-12 (41.5 ± 22.6 vs. 35.3 ± 17.7; P <.01), HOOS-PS (29.5 ± 18.9 vs 40.7 ± 17.9; P <.001), and mHHS (62.9 ± 16.5 vs 55.1 ± 15.3; P <.001) were all significantly different prospectively vs. retrospectively. The average changes in score observed for the iHOT-12, HOOS-PS, and mHHS were -6.2, 11.2, and -7.8, respectively. Multiple linear regression identified duration to recall and sex as significant predictors of the absolute difference between prospective and retrospectively collected iHOT-12 data while sex alone was predictive of a difference in HOOS-PS data.Conclusions:The retrospective collection of patient-reported outcomes for hip arthroscopy procedures, which requires patient recall of their preoperative condition, is subject to bias and inaccuracy. Recalled PROs consistently reflected worse pain/function than their prospectively recorded counterpoints; therefore, retrospective patient recall is an unreliable source of clinical data and the prospective collection of iHOT-12, mHHS, and HOOS-PS data should be prioritized.Figure 1.The mean scores of the three PROs collected prospectively and retrospectively. The mean changes in score for the iHOT-12, HOOS-PS, and mHHS were -6.2, 11.2, and -7.8, respectively. Note that a lower score on the iHOT-12 and mHHS axis indicates worse function/most pain while a lower score on the HOOS-PS axis indicates better hip condition.Figure 2.Scatterplot demonstrating the relationship between the prospectively collected PROs and recalled (retrospective) PROs for the iHOT-12, HOOS-PS and mHHS surveys. Points falling outside the areas bound by the parallel lines represent patients with recall scores that differ from preoperative scores to a greater extent than the minimal clinically important difference (MCID). Note that the currently accepted HOOS MCID (9.1 points) was used in the middle frame in lieu of a HOOS-PS MCID as no such value has been established.Table 1.A summary of patient demographics stratified by patient-reported outcome.

Study on the Correlation between Chinese Medicine Syndrome and Cognitive Dysfunction in Mild Cognitive Impairment.

Objective To investigate the correlation between Chinese medicine syndrome and cognitive dysfunction in patients with mild cognitive impairment (MCI). Methods 121 MCI patients were included for syndrome differentiation and syndrome scoring according to the Chinese medicine syndrome classification standard of senile dementia. The cognitive function and cognitive subitems (including visual space and executive function, naming, attention, language, abstraction, delayed recall, and orientation) of patients with different Chinese medicine syndromes were scored with the Montreal Cognitive Assessment (MoCA). Correlation analysis was made on Chinese medicine syndromes and cognitive domain damage. Results Chinese medicine syndromes from most to least were kidney deficiency and marrow reduction syndrome, turbid phlegm obstructing orifices syndrome, deficiency of heart and spleen syndrome, qi stagnation and blood stasis syndrome, and yin deficiency of heart and liver syndrome. There were no significant differences in MoCA scores among different Chinese medicine syndromes (P > 0.05).In the kidney deficiency and marrow reduction syndrome, the delayed recall score was 1.74 ± 1.23 and the difference was statistically significant when compared with deficiency of heart and spleen syndrome or the yin deficiency of heart and liver syndrome (P < 0.05). In the turbid phlegm obstructing orifices syndrome, the delayed recall score was 1.81 ± 1.33 and the difference was statistically significant when compared with the yin deficiency of heart and liver syndrome (P < 0.05). There was a significant negative correlation between the kidney deficiency and marrow reduction syndrome's Chinese medicine syndrome scores and MoCA scores (P < 0.01), and there was a negative correlation between the turbid phlegm obstructing orifices syndrome's Chinese medicine syndrome scores and MoCA scores (P < 0.05). Correlation analysis showed that the kidney deficiency and marrow reduction syndrome was significantly negatively correlated with delayed recall scores (P < 0.01), and it was also negatively correlated with visual space and executive function scores (P < 0.05). The turbid phlegm obstructing orifices syndrome was significantly negatively correlated with delayed recall scores (P < 0.01). Conclusion The kidney deficiency and marrow reduction syndrome and the turbid phlegm obstructing orifices syndrome were the most common syndromes in MCI. Patients with kidney deficiency and marrow reduction syndrome might have obvious damage in delayed recall function and have damage in visual space and executive function. Patients with turbid phlegm obstructing orifices syndrome might have obvious damage in delayed recall function.

'Implanting' knowledge - how best to aid patient understanding and retention of information regarding peri-implantitis.

Aims The study primarily assessed the efficacy of different communication methods on patients' comprehension and recall of knowledge relating to peri-implantitis. Secondarily, the study assessed the effect of different communication methods on patients' beliefs in line with the health belief model.Design A prospective randomised controlled trialMethods Ninety-nine patients with a diagnosis of peri-implantitis were recruited over 25 months. They were randomly allocated to one of three arms of the trial. Group one was given a leaflet with visual aids, group two a leaflet with no visual aids and group three verbal information only. A questionnaire was used to assess their understanding and retention of knowledge relating to peri-implantitis at baseline, three months and six months. Secondly, the questionnaire assessed the influence of the communication strategy on the components of the 'health belief model' relating to peri-implantitis - perceived severity, susceptibility, benefits, barriers, self-efficacy and behavioural intentions.Results Of the 99 patients who were initially recruited, 85 remained at three months and 78 at six months. At baseline, group one (who were provided with a leaflet and visual aids) showed better comprehension when compared to the other groups. This was statistically significant. However, there was no statistically significant difference in recall of information at three and six months, between any group. Questions relating to the health belief model showed there was statistical significance in the control group who perceived the barriers to good implant hygiene to be more difficult than both test groups. There was some statistical significance in the perceived susceptibility to peri-implantitis between groups.Conclusion The use of leaflets with visual aids as a communication strategy appears to improve patient comprehension of information regarding factors associated with peri-implantitis in the short term in this patient group. However, it does not appear to translate to improved recall of the same information at follow-up.

Symptom detection and the relationship with self-care in heart failure.

Patients with heart failure (HF) may have difficulty detecting symptom changes. However, most research has relied on medical record reviews or patient recall. Therefore, it is important to prospectively explore symptom detection in HF and the relationship with self-care. This study aimed at (i) prospectively identifying distinct symptom detection groups and comparing characteristics among the groups and (ii) exploring the association between symptom detection groups and self-care. One hundred and thirty-two patients rated their shortness of breath (SOB) using the modified Borg scale at four-time points after a 6-min walk test (6-MWT). A trained nurse simultaneously and independently rated patients' SOB using the same scale. Latent class growth modelling was used to identify distinct trajectories of the differences in SOB ratings between the patients and nurses after the 6-MWT. After identifying the symptom detection groups, the characteristics of each group were compared, and the relationship between self-care and the symptom detection groups was examined using the multivariate linear regression. Three distinct symptom detection groups were identified: over-estimation (6.1%), consistent (69.7%), and under-estimation (24.2%) groups. There were no significant sample characteristics among the three symptom detection groups, except for attention. There was no relationship between self-care and symptom detection groups. We identified three distinct symptom detection groups, implying that different approaches are needed to improve patients' symptom detection ability. The non-significant relationship between the symptom detection groups and self-care may be because we only measured symptom detection, which is only one aspect of the symptom perception process.

Patient recalls associated with resident-to-attending radiology report discrepancies: predictive factors for risky discrepancies

BackgroundThis study aimed to identify predictive factors for risky discrepancies in the emergency department (ED) by analyzing patient recalls associated with resident-to-attending radiology report discrepancies (RRDs).ResultsThis retrospective study analyzed 759 RRDs in computed tomography (CT) and magnetic resonance imaging and their outcomes from 2013 to 2021. After excluding 73 patients lost to follow-up, we included 686 records in the final analysis. Risky discrepancies were defined as RRDs resulting in (1) inpatient management (hospitalization) and (2) adverse outcomes (delayed operations, 30-day in-hospital mortality, or intensive care unit admission). Predictors of risky discrepancies were assessed using multivariable logistic regression analysis. The overall RRD rate was 0.4% (759 of 171,419). Of 686 eligible patients, 21.4% (147 of 686) received inpatient management, and 6.0% (41 of 686) experienced adverse outcomes. RRDs with neurological diseases were associated with the highest ED revisit rate (79.4%, 81 of 102) but not with risky RRDs. Predictive factors of inpatient management were critical finding (odds ratio [OR], 5.60; p < 0.001), CT examination (OR, 3.93; p = 0.01), digestive diseases (OR, 2.54; p < 0.001), and late finalized report (OR, 1.65; p = 0.02). Digestive diseases (OR, 6.14; p = 0.006) were identified as the only significant predictor of adverse outcomes.ConclusionsRisky RRDs were associated with several factors, including CT examination, digestive diseases, and late finalized reports, as well as critical image findings. This knowledge could aid in determining the priority of discrepancies for the appropriate management of RRDs.

Development of posttraumatic stress disorder symptoms after intensive care - how to prevent it?

IntroductionOver the last decade, there has been identified that critical illness survivors have high rates of psychiatric disorders such as posttraumatic stress disorder (PTSD). The experience of admission to intensive care units (ICU) and illusory memories may cause short and long-term psychological disorders.ObjectivesTo evaluate psychiatric disorders, such as PTSD, after ICU discharge, and determine the prevalence, risk factors, and prevention strategies for PTSD in these patients.Methods Non-systematic review through research in PubMed. Addicionally, a case report will be exposed, after the patient was diagnosed with SARS‑CoV‑2 and stayed in ICU for more than 30 days.Results The development of PTSD has been related to the number of adverse memories patients recall from their ICU experience. Some studies have shown that approximately 47% of patients remember real facts and 34% have illusory memories relative to their stays in the ICU. There were identified some risk factor associated to the increased risk of post-ICU PTSD, such as early post-ICU memories or psychotic experiences, pre-ICU psychopathology, benzodiazepine sedation during ICU and substantial acute stress symptoms occurring &lt; 1 month after exposure to a traumatic stressor.ConclusionsHigh levels of anxiety and the development by patients of PTSD are being recognized as significant problems occurring after a stay in an ICU. The results of this study highlight the need to recognise the risk factors and to establish a early follow-up after ICU stay. This way is possible to identify patients who are at risk of developing acute PTSD-related symptoms, and early intervention can be institued.DisclosureNo significant relationships.

Supporting Human Memory by Reconstructing Personal Episodic Narratives from Digital Traces

Numerous applications capture in digital form aspects of people’s lives. The resulting data, which we call Personal Digital Traces - PDTs, can be used to help reconstruct people’s episodic memories and connect to their past personal events. This may have several applications, from helping the recall of patients with neurodegenerative diseases to gathering clues from multiple sources to identify recent contacts and places visited – a critical new application for the recent health crisis. This paper takes steps towards integrating, connecting and summarizing the heterogeneous collection of data into episodic narratives using scripts – prototypical plans for everyday activities. Specifically, we propose a matching algorithm that groups PDTs from many different sources into script instances (episodes), and we provide a technique for ranking the likelihood of candidate episodes. We report on the results of a study based on the personal data of real users, which gives evidence that our episode reconstruction 1) integrates well PDTs from different sources into coherent episodes, and 2) augments users’ memory of their past actions.

Icatibant use in Brazilian patients with hereditary angioedema (HAE) type 1 or 2 and HAE with normal C1-INH levels: findings from the Icatibant Outcome Survey Registry Study

BackgroundHereditary angioedema can be caused by C1-Inhibitor (C1-INH) deficiency and/or dysfunction (HAE-1/2) or can occur in patients with normal C1-INH (HAE nC1-INH). MethodsThe Icatibant Outcome Survey (IOS; NCT01034969) registry monitors the safety and effectiveness of icatibant for treating acute angioedema. ObjectivePresent findings from Brazilian patients with HAE-1/2 and HAE nC1-INH participating in IOS. Results42 patients were enrolled (HAE-1/2, n = 26; HAE nC1-INH, n = 16). Median age at symptom onset was significantly lower with HAE-1/2 vs. HAE nC1-INH (10.0 vs. 16.5y, respectively; p = 0.0105), whereas median age at diagnosis (31.1 vs. 40.9y; p = 0.1276) and the median time between symptom onset and diagnosis (15.0 vs. 23.8y; p = 0.6680) were numerically lower vs. HAE nC1-INH, respectively. One icatibant dose was used for > 95% of HAE attacks. Median (range) time-to-event outcomes were shorter for patients with HAE nC1-INH vs. HAE-1/2, including time to first administration (0.5 [0–96.0] vs. 1.0 [0–94.0]h, respectively), time from first administration to complete resolution (1.0 [0–88.0] vs. 5.5 [0–96.0]h, respectively), and total attack duration (7.0 [0.3–99.0] vs. 18.5 [0.1–100.0]h, respectively). Mean (SD) time from attack onset to resolution was significantly shorter for patients with HAE nC1-INH vs. HAE-1/2 (9.8 [18.7] vs. 19.6 [24.0]h, respectively; p = 0.0174). 83 adverse events (AEs) in 42 patients were reported; most were mild (66.3%) or moderate (13.3%) and non-serious (75.9%). The most common icatibant-related AE was injection site erythema (HAE-1/2, 34.6%; HAE nC1-INH, 18.8%). Study limitationsThis was an observational study without a treatment comparator and that relied on patient recall. ConclusionsFindings demonstrate effectiveness and tolerability of icatibant in Brazilian HAE patients.

Promoting the Importance of Recall Visits Among Dental Patients in India Using a Semi-Autonomous AI System.

In many developing countries like India, there is a widespread lack of general awareness about the importance of good oral health, which causes dental patients to neglect their oral hygiene, thus precipitating many long-term ailments. We developed an application that promotes the significance of regular dental checkups and oral health care by explaining to patients how these are intrinsic to overall health. Our application, in essence, extracts relevant health information from published scientific studies according to a patient's medical history and shares it with the patient at the discretion of the supervising dentist, thereby empowering patients to make more informed decisions. We present a detailed overview of our semi- autonomous machine learning-based solution, along with the complex challenges involved in the design, development, and real-world deployment of our application. Finally, we conducted a randomized parallel-group study in India with 224 dental patients over two years to assess the utility of our proposed solution. Results show our application improved the patient recall rate from 21.1% to 37.8% (p-value = 0.024).

Patient and Proxy Recall After Providing Written or Oral Informed Consent to Participate in an Interventional Trial

Patient and Proxy Recall After Providing Written or Oral Informed Consent to Participate in an Interventional Trial

Pre-pperative low intensity vestibular shockwave therapy (LiSWT) decreases opioid use post-vestibulectomy: A pilot study

ABSTRACT Introduction Surgeons performing complete vestibulectomy with vaginal advancement flap reconstruction for suspected neuroproliferative vestibulodynia (NPV) take into consideration the need for acute pain relief in the early postoperative period as well as risks for persistent post-operative opioid use. Post-operative acute pain has traditionally been managed with narcotics which are effective but are highly addictive and can cause unwanted side effects including nausea/vomiting, impaired mental function, and severe constipation/obstipation. We serendipitously observed that one patient who tried to avoid surgery by undergoing numerous vestibular low intensity shockwave therapy (LiWST) treatments used very few narcotics post vestibulectomy. LiWST is FDA-cleared for pain amelioration. It has been hypothesized that LiSWT downregulates inflammatory cytokines, promotes enhancement of blood flow and angiogenesis through expression of vascular endothelial growth factor and nitric oxide synthesis. Objective We performed a pilot study using pre-operative LiSWT to determine whether or not it might decrease post-operative opioid use (oxycodone/acetaminophen tablets; 5mg/325mg) for acute pain management in patients undergoing complete vestibulectomy with vaginal advancement flap for suspected NPV. Method We studied the post-op opioid use of women who underwent complete vestibulectomy at our facility during the period January 1, 2019 through June 30, 2021. We assessed opioid use based on the patient's recall of the total oxycodone/acetaminophen tablets required in the first 30 days post-vestibulectomy. When possible, patients confirmed the use by counting tablets left in the pill container. Women scheduled to undergo vestibulectomy for suspected NPV were placed in the LiSWT study group if they agreed to undergo vestibular LiSWT treatment daily for the three business days immediately pre-operatively. Using the Urogold 100™MTS, LiSWT involved delivery of 1800 shocks to the vestibule per session, energy flux density 0.05-0.1 mJ/mm2, 3 Hz, membrane pressure 3. We compared the post-op opioid use by women in the LiSWT study group to the use by women who did not undergo pre-op LiSWT. Results Forty-five women (mean age 28 years; range 17 - 57) underwent complete vestibulectomy for suspected NPV during the 30 month period. Twenty women (mean age 27 +/- 9 years) agreed to undergo pre-op LiSWT and post-op opioid use was obtained in all. Twenty-five women (mean age 29 +/- 11 years) did not undergo pre-op LiSWT and opioid use was obtained in 19/25 (76%). Mean post-operative opioid use was 47 +/- 13 (range 25 - 90) tablets in those vestibulectomy patients who did not undergo pre-op vestibular LiSWT; opioid side effects included constipation, nausea, fainting, drowsiness, fatigue, and blurred vision. Mean post-op opioid use was 22 +/- 10 (range 1 - 26) tablets in the 20 vestibulectomy patients who did undergo pre-op vestibular LISWT sessions; opioid side effects were restricted to constipation, sleepiness, and nausea. Conclusion In this pilot study, pre-operative low intensity shockwave therapy decreased post-operative opioid use after complete vestibulectomy with vaginal advancement flap. While encouraging, more research is needed. Disclosure Work supported by industry: no.

Use of the Japanese Version of the Montreal Cognitive Assessment to Estimate Cognitive Decline in Patients Aged 75 Years or Older with and without Type 2 Diabetes Mellitus.

The number of people diagnosed with dementia worldwide is set to increase significantly. Patients with dementia often have comorbidities, particularly diabetes, and patients with type 2 diabetes mellitus (T2DM) have a high risk of cognitive decline. This study investigated whether older people with T2DM have disease-specific cognitive deficits. The Montreal Cognitive Assessment is a well-known tool for examining mild cognitive impairment, and the modified Japanese version (MoCA-J) has been confirmed as effective. Using the MoCA-J, we assessed the cognitive function of Japanese adults aged ≥75 years with and without T2DM and analyzed the results. Thirty-three patients with T2DM and 23 non-DM patients completed the examination, and MoCA-J total scores differed between these groups (T2DM mean, 21.4 ± 3.5; non-DM mean, 23.5 ± 3.6). Only 9% of patients with T2DM and 39% of those with non-DM had scores ≥26, which is the cutoff point for mild cognitive impairment, although all patients were capable of self-care. Additionally, delayed recall scores were significantly lower for the older patients with T2DM had for the non-DM group. Patients aged ≥75 years with T2DM might have worse cognition than those without T2DM; the inability to perform delayed recall in T2DM patients suggests a decline in cognitive function. Therefore, patients aged ≥75 years with T2DM should receive explanations of their care that are individualized in relation to their cognitive status.