Patient Reports Research Articles

Quality of Life in Patients With Breast Cancer: The Influence of Family Caregiver's Burden and the Mediation of Patient's Anxiety and Depression.

Previous research showed that family caregiver's perception of burden can influence patient's report on their quality of life (QoL). The present study investigated the relationship between the two variables by considering the role of patient's anxiety and depression. A total of 382 dyads of Chinese breast cancer patients and their family caregivers participated in this study. The results showed that the mediation model fitted the data well (χ = 49.859; df = 16; χ/df = 3.116; RMSEA = 0.05; TLI = 0.928; CFI = 0.959). It indicated that family caregiver's burden influenced patient's QoL negatively, and this relationship was partially mediated by patient's anxiety and depression.

Predicting Disease-Free Lung Cancer Survival Using Patient Reported Outcome (PRO) Measurements with Comparisons of Five Machine Learning Techniques (MLT).

The study was to develop the lung cancer patients' prediction model for predicting 5-year survival after completion of treatment by using Machine Learning Technology (MLT), adding patient reporting (PRO) measurements of lung cancer survivors to a variety of clinical parameters. Finally, the survival prediction models with the addition of lung cancer survivors' PRO measurements to the well-known clinical variables, based on diverse MLT, improved the predictive performance that explains 5-year disease-free lung cancer survival.

Risk of myocardial infarction associated with non-steroidal anti-inflammatory drugs: Impact of additional confounding control for variables collected from self-reported data.

SummaryWhat is known and objectiveImportant risk factors and over‐the‐counter (OTC) dispensing of non‐steroidal anti‐inflammatory drugs (NSAIDs) are often not routinely recorded in electronic health records. This study aimed to assess the impact of patient's reports on these factors on the risk of acute myocardial infarction (AMI) for NSAID use.MethodsA nested case‐control study was conducted among adults in the Utrecht Cardiovascular Pharmacogenetics study. Cases were patients with a first diagnosis of AMI as a hospital discharge diagnosis and controls were those without AMI. NSAID exposure was either current use of selective COX‐2 inhibitors or conventional NSAIDs. Information was collected from The Dutch PHARMO Database Network (pharmacy records of drug dispensing linked to hospitalization records) and the patient's questionnaire (lifestyle factors, body mass index and history of cardiovascular diseases). Unconditional logistic regression analysis was used to calculate odds ratios (ORs) and to control for confounding factors.ResultsWe identified 970 AMI cases and 2974 controls. Among cases, 11 (1.1%) and 185 (19.1%) were exposed to selective COX‐2 inhibitors and conventional NSAIDs, respectively. Compared to non‐use, none of these drug classes were associated with an increased risk of AMI (adjusted OR 1.07, 95% CI: 0.52‐2.18 and 0.93, 95% CI: 0.77‐1.12, respectively). Additional adjustment for potential confounders from patient's reports did not change the risk estimates (adjusted OR 1.08, 95% CI: 0.53‐2.22 and 0.89, 95% CI: 0.73‐1.09, respectively).What is new and conclusionAdditional confounding control for variables from self‐reported data or considering self‐reported OTC NSAID use did not change the risk estimates for the association between NSAIDs and AMI.

Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department.

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009-2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.

Unilateral hearing loss and the use of hearing aid: speech recognition, benefit, self-perception of functional performance and satisfaction

ABSTRACT Purpose: to investigate speech recognition in silence and in noise in subjects with unilateral hearing loss with and without hearing aids, and to analyze the benefit, self-perception of functional performance, satisfaction and the use of hearing aids in these subjects. Methods: eleven adults with unilateral, mixed and sensorineural, mild to severe hearing loss participated in this study. Speech recognition was evaluated by the Brazilian Portuguese sentences lists test; functional performance of the hearing was assessed by using the Speech Spatial and Qualities of Hearing Scale questionnaire; satisfaction was assessed by the Satisfaction with Amplification in Daily Life questionnaire, both in Brazilian Portuguese; and to assess the use of hearing aids, the patient's report was analyzed. Results: the adaptation of hearing aids provided benefits in speech recognition in all positions evaluated, both in silence and in noise. The subjects did not report major limitations in communication activities with the use of hearing aids. They were satisfied with the use of sound amplification. Most of the subjects did not use hearing aids, effectively. The discontinuity of hearing aids use can be justified by the difficulty on perceiving participation’s restriction caused by hearing loss, as well as the benefit of the hearing aid, besides the concern with batteries’ costs and aesthetic aspects. Conclusion: although showing benefits in speech recognition, in silence and in noise, and satisfaction with sound amplification, most subjects with unilateral hearing loss do not effectively use hearing aids.

Oncologist recommendation matters!-Predictors of psycho-oncological service uptake in oncology outpatients.

Highly distressed cancer patients often do not use psycho-oncological services (POS). Research on predictors of POS uptake has mainly focused on patient-related variables and less on communication variables, so we examined the link between patient-oncologist communication (ie, talking about psychosocial distress, providing detailed information, and recommending POS) and POS uptake. We conducted a prospective, observational study in an Oncology Outpatient Clinic in Switzerland. Predictors (ie, patient-related variables and patient's reports of the patient-oncologist communication) were assessed via semistructured interviews, and information on outpatient POS uptake was assessed after 4 months. For statistical analysis, a multivariate logistic regression was performed. Of 333 participants (mean age 61years; 55% male; 54% distress thermometer ≥5), 77 (23%) had used POS during a 4-month period. Patients who reported an oncologist-recommended POS (odds ratio [OR]=6.27, 95% confidence interval [CI]=3.14-12.85) and those who were not sure if they had received a recommendation (OR=4.64, 95% CI=1.83-11.97) were more likely to attend POS than those who reported receiving no recommendation. Talking about psychosocial distress (OR=0.74, 95% CI=0.38-1.46) and providing detailed information about POS did not predict POS uptake (OR=1.06, 95% CI=0.46-2.38). Oncologists' expert recommendations to attend POS were strongly associated with patients' uptake of POS. The central role played by oncologists should be accounted for in stepped psycho-oncological care when POS referral pathways are defined.

Childbirth-specific patient-reported outcomes as predictors of hospital satisfaction

Under value-based payment programs, patient-reported experiences and outcomes can impact hospital and physician revenue. To enable obstetrical providers to improve the childbirth experience, a framework for understanding what women expect and desire during childbirth is needed. The purpose of this study was to identify key predictors of childbirth hospital satisfaction with the use of the Childbirth Experiences Survey. This study builds on a larger effort that used Patient-Reported Outcomes Management Information System methods to develop a childbirth-specific preliminary patient-reported experiences and outcomes item bank. These efforts led to the development of an antepartum and postpartum survey (Childbirth Experiences Survey Parts 1 and 2). All phases of the study were conducted with the participation of a community-based research team. We conducted a prospective observational study using national survey response panels that was organized through Nielsen to identify women's antepartum values and preferences for childbirth (Childbirth Experiences Survey Part 1). Eligible participants were pregnant women in the United States (English or Spanish speaking) who were ≥18 years old and ≥20 weeks pregnant. Women were recontacted and invited to participate in a postpartum follow-up survey to collect information about their childbirth patient-reported experiences and outcomes, which included childbirth satisfaction (Childbirth Experiences Survey Part 2). In bivariate analyses, we tested whether predisposing conditions (eg, patient characteristics or previous experiences), values and preferences, patient-reported experiences and outcomes, and the "gaps" between values and preferences and patient-reported experiences and outcomes were predictors of women's satisfaction with hospital childbirth services. Multivariable logistic regression models were fitted to examine the simultaneous effect of predictors on hospital satisfaction, which were adjusted for key predisposing conditions. From 500 women who anticipated a vaginal delivery at the time of the antepartum survey, who labored before delivery, and who answered the postpartum survey, key findings included the following responses: (1) the strongest predictors of women's satisfaction with hospital childbirth services were items in the domains of staff communication, compassion, empathy, and respect, and (2) 23 childbirth-specific patient-reported experiences and outcomes were identified. Examples of these patient-reported experiences and outcomes (such as being told about progress in labor and being involved in decisions regarding labor pain management) appeared especially relevant to women who experienced childbirth. A final model that predicted women's satisfaction with hospital childbirth services included a total of 8 items that could be optimized by doctors, midwives, and hospitals. These included the patient's report of how well she coped with labor pain, whether the hospital provided adequate space and food for their support person, and whether she received practical support for feeding the newborn infant. This study identified 23 childbirth-specific patient-reported experiences and outcomes that were predictors of childbirth hospital satisfaction. The implementation of the Childbirth Experiences Survey Parts 1 and 2 in a multihospital setting may lead to the development of childbirth hospital performance measures and strategies for improvement of the childbirth experience.

Self-care treatment on patients with wakefulness bruxism

Objective: To evaluate self-care efficacy on reduction of pain and wakefulness bruxism before the treatment with the stabilization splint. Methods: Sixty patients were divided into two groups: 30 belonging to the group that received the self-care guide (G1) and 30 belonging to the control group (G2) who were advised to wait for the beginning of the treatment with the stabilization splint. G1 received a self-care guide for immediate application before any intervention for bruxism treatment. The instructions were given as tips to follow every day for 1 month. Before being given to the patient, the guide was read aloud and clearly by the researcher and clarifying any patients doubts or questions. To evaluate the evolution of each group, the evaluation of physical symptoms occurred at 2 times (M1 and M2). G1 the efficacy of the self-care guide was tested through patient's report of pain sensation before and after the use of the guide. The control group (G2) was evaluated at M1 and M2, in order to obtain a parameter of pain evaluation in patients not previously subjected to the treatment. Results: The Self-care group presented statistical significance in relation to the group that did not receive self-care. Conclusion: According to the results obtained it can be verified that the patient's awareness about this problem and the application of a conservative therapy based on self-care was effective reducing the pain level of patients with wakefulness bruxism.

ADULT-ONSET WHEAT ANAPHYLAXIS IN THE POSTPARTUM PERIOD

Introduction Although most food allergies present in childhood, food allergies can develop at any age. The lay press suggests the occurrence of new allergy following parturition, but this has not been well-documented in the literature. Case Description 37-year old female without prior food allergies presented with sudden-onset urticaria, one week postpartum, which resolved with epinephrine. Over the subsequent two weeks, she had two episodes of anaphylaxis, during walks preceded by wheat ingestion. Per the patient's report, ingestion of wheat without exercise did not provoke symptoms. Skin testing shortly thereafter to a panel of aeroallergens and food allergens was negative. Serum specific IgE testing and component-resolved diagnostics were significant only for wheat omega-5 gliadin (5.3 ISU-E). An open challenge to wheat was positive with urticaria. We recommended strict avoidance of wheat. On follow up in 4 years, she had had no further allergic reactions and continued to avoid wheat. Omega-5 gliadin sensitization has declined slightly over these four years, to 2.1 ISU-E. She has not been re-challenged to wheat. Discussion Recent anaphylaxis may yield falsely-negative skin test results. This patient's initial history was suggestive of food-dependent, exercise-induced anaphylaxis (FDEIA). Wheat sensitization, specifically omega-5 gliadin, is the most commonly reported sensitization and trigger in FDEIA. Although exercise was a previously required component of her reactions, our patient developed subsequently a reaction during the open challenge, which was at rest. Striking in this case was the development of new food allergy closely associated with parturition. Pregnancy could modify food allergy risk.

Definitive HDR Brachytherapy for Non-Melanomatous Skin Cancers: an Effective and Efficient Cure

Non-melanomatous skin cancer (NMSC) is the most common malignancy with high cure rates using surgery or radiation. In certain patients/anatomical sites, surgery can lead to suboptimal cosmesis or concerns of wound healing. External beam radiation (EBRT) can be time intensive and has dosimetric limitations when treating irregular surfaces. Surface HDR brachytherapy (BT) offers dosimetric advantages over EBRT and a more timely and cost effective treatment, although there are limited data on its utility. We report on our institutions’ experience treating patients’ NMSC lesions with HDR BT, reporting disease outcomes, toxicities, and cosmesis. Eighty-one NMSCs in 60 patients (median age 83) have been treated since 2015 with HDR BT, mostly using a Freiburg flap surface applicator. Most common prescription dose was 32-40 Gy in 8-10 fractions twice weekly to the lesion with margin at 3-5mm depth. Patient and treatment data were recorded in a prospectively maintained database. Physician graded (PG) toxicities (CTCAE v4.03) were recorded during treatment and at early (within 3 mo of treatment) and late (>3 mo) follow-up (FU) visits, as was PG and patient reported (PR) skin cosmesis. Univariable generalized linear mixed effects models were used to estimate the odds of have suboptimal cosmesis (fair-poor vs good-excellent) with certain patient/disease risk factors. Lesions were mostly squamous cell carcinoma (CA) (35%) and basal cell CA (52%), with 13% other histologies. Lesion sites included scalp (20%), head/neck (40%), extremities (35%) and trunk (5%). 51% of patients had vascular disease, 26% were smokers, and 20% had autoimmune conditions. Lesion size ranged from 4 mm to >5 cm (median 1.1-2cm). BT was definitive in 92% and adjuvant in 8% of lesion treatments. At a median FU of 12 months, local disease control was 97.3% (74/76 patients with at least 3 mo FU). One failure was in a previously irradiated, recurrent squamous cell CA of the eyelid. Early Grade (G) 2 and G3 PG skin toxicities were 5.6% and 2.8% and late G2 and G3 toxicities were 1.3% and 0%, respectively, with no G4 toxicities. PR cosmesis was reported as good to excellent in 92% and 96% at early and late FU, respectively. PG cosmesis was good to excellent in 86% and 98% at early and late FU, respectively. This included patients with advanced vascular disease (51%), lesions on lower extremities (26%), difficult location lesions on the nose/ear (26%), and immunocompromised patients (20%). The odds of less than good cosmetic outcome at early FU were slightly higher for smokers (OR 4.72 (0.82-27.2 CI), p=.08), approaching significance. No other tested lesion or patient characteristic was associated with poorer cosmesis. Organ preservation, where applicable (i.e. nose, ear) was 100%. HDR BT is a good treatment option for NMSC with excellent local control, low toxicity, and overall great PR and PG cosmesis. Longer followup is awaited. Further studies comparing HDR BT to surgery and EBRT are underway at our institution.

Liver transplantation and the use of KAVA: Case report

BackgroundSelf-medication and the belief that herbal products are free of health risks are common in Brazil. The kava (Piper methysticum), known for its anxiolytic action, has a widespread popular use. Hepatotoxicity of kava is reported, including cases of liver transplantation and death. The kava had its use prohibited or restricted in countries like Germany, France, among others. Toxicity may be related to overdosage; however, factors such as botanical characteristics of the plant, the harvesting, storage, and production process may be associated with the development of hepatotoxic substances, such as triggering idiosyncratic reactions. HypothesisIn this case, there is a suspicion that the toxicide is intrinsic to the drug; however, the possibility of adulterants and contaminants must be ruled out. Study designThis study reports the case of a patient who, after using the herbal kava for 52 days, evolved into acute liver failure and liver transplantation. MethodsThe data were collected directly with the patient and compared with their clinical records. Causality was determined through the RUCAM algorithm. In addition, a phytochemical analysis of the drug used was performed. ResultsAccording to the patient's report, there is no evidence of overdosage. Results from RUCAM algorithm infer causality between liver damage and the use of kava. The analysis chemical constituents did not find any possible contaminants and major changes in the active compounds. Seven months after transplantation, the patient is well and continues to be followed up by a medical team. ConclusionOur investigation indicates that there was kava-induced hepatotoxicity at standard dosages. In Brazil, self-medication by herbal medicines is frequent and many patients and health professionals do not know the risks associated with their use. Diagnosing and notifying cases in which plants and herbal medicine induce liver damage is of paramount importance to increase the knowledge about DILI and to prevent or treat similar cases quickly.

653 Long-term surgical, functional and patients’ reported outcomes of the turin's corporoplasty: results from a tertiary referral center experience

In 2005, we proposed an effective modification of Nesbit’s corporoplasty. To report long-term surgical, functional and patients’ reported (PROs) outcomes of Turin’s corporoplasty. From May 2005 to May 2016, 145 consecutive patients underwent Turin’s corporoplasty for a penile deformation. Clinical records were retrospectively reviewed. 87 patients, presenting full intraoperative and postoperative information were included in the present study. Etiology was congenital curvature (A) in 61 patients and Peyronie’s disease (PD) (B) in the remainders. The intraoperative complications, the hospital stay and the postoperative complications were selected as variables for the surgical outcomes. Validated questionnaires (IIEF and SEP 2,3) were administered preoperatively and 12 months after surgery. Finally, an “ad-hoc” questionnaire was submitted to assess long-term PROs. Patients’ features are summarized in table 1. The average follow-up time was 97 months. No major intraoperative complications were reported. The median hospital stay was 2 days for both group. The postoperative haematomas were graded through a haematoma scale (range 1-5) and they showed to be more frequent (p=0.003) in the group A (median score of 2, IQR 1-2) when compared to the group B (median score 1, IQR 1-2). Postoperative complications, in terms of bleeding, infection or unaesthetic scarring, resulted a rare event (13.6%) without a significant difference in-between groups. A recurrent curvature was observed in 9.9% of cases. A minor residual curvature (< 20°) was detected in 14.8% of patients. Functional outcomes are summarized in table 2. The IIEF score improved in both groups as well as the SEP 2,3. Long-term postoperative erectile dysfunction (ED) was observed in 3.2% of case in group A and in 43.5% in group B (p=0.001). Long-term PROs (table 3) demonstrated a higher incidence of dissatisfaction for penile length loss in group B compared to group A (p=0.001). Nevertheless, a sharply higher improvement of quality of both everyday life and sexual life was observed in group A compared to group B (p=0.01; p=0.004). Finally, the multivariate statistical analysis evidenced as independent risk factors for the development of postoperative ED the etiology (PD), the age (> 35) and the incidence of postoperative complications (table 4).

Development of a National Minimal Set of Patient-Important Outcome Domains for Value-Based Diabetes Care in Denmark

Aim: To identify a minimal set of patient-reported (PRO) domains for use in value-based diabetes care in Denmark. Methodology: A structured mixed-methods research protocol was applied to ensure an evidence-based approach to involvement of people with diabetes in the identification of patient-centered outcome domains. 20 people with diabetes and 4 caregivers of people with diabetes selected for representativeness in age, gender, type of therapy, duration of diabetes, type of diabetes, and disease burden were recruited for qualitative research and co-creation to examine 1) psychological, physical and social impacts of diabetes and desired outcomes of treatment, 2) dis-utilities of therapy and 3) factors enabling sustainability in line with the value based care model. Qualitative research based on interviews, structured focus group and co-creation workshop sessions together with desk research on patient, clinical, health economic, and societal relevance of identified domains informed the final identification of domains by a multi-disciplinary and multi-sector working group using strict criteria of patient importance, clinical relevance and applicability, measurability and mutability. Results: The following PRO domains were selected to complement the clinical outcome domains: Self-reported health, psychological well-being, symptom burden (e.g., sleep, sexual dysfunction, complications), multi-faceted impact of diabetes on life including diabetes distress, treatment burden and impacts of hypoglycemia, and specific indicators of care confidence, quality and diabetes self-care ability. Conclusions: The assessment of patient-important outcomes for value based diabetes care in Denmark require the implementation of PRO questionnaires in standard diabetes care. Disclosure S.E. Skovlund: None. L. Troelsen: None. M. Dømgaard: None. P.O. Jakobsen: None. N. Ejskjaer: None.

Health utility scores from EQ-5D and health-related quality of life in patients with esophageal cancer: a real-world cross-sectional study.

Esophageal cancer and its treatment can cause serious morbidity/toxicity. These effects on health-related quality of life (HRQOL) can be measured using disease-specific scales such as FACT-E, generic scales such as EQ-5D-3L, or through symptoms. In a two-year cross-sectional study, we compared HRQOL across esophageal cancer patients treated in an ambulatory clinic and across multiple disease states, among patients with all stages of esophageal cancer. Consenting patients completed FACT-E, EQ-5D, a visual analog scale, and patient reported (PR)-ECOG. Symptom complexes were constructed from FACT-E domains. Responses were categorized by disease state: pre-, during, and post-treatment, surveillance, progression, and palliative chemotherapy. Spearman correlation and multivariable linear regression characterized these associations. In total, 199 patients completed 317 questionnaires. Mean FACT-E and subscale scores dropped from baseline through treatment and recovered during post-treatment surveillance (P<0.001); EQ-5D health utility scores (HUS) displayed a similar pattern but with smaller differences (P=0.07), and with evidence of ceiling effect. Among patients with stage II/III esophageal cancer, mean EQ-5D HUS varied across disease states (P<0.001), along with FACT-E and subscales (P<0.001). Among patients with advanced disease, there was no significant difference between baseline and on-treatment total scores, but improved esophageal cancer-specific scales were noted (P=0.003). Strong correlation was observed between EQ-5D and FACT-E (R=0.73), along with physical and functional subscales. In addition, the association between FACT-E and EQ-5D HUS was maintained in a multivariable model (P<0.001). We interpret these results to suggest that in a real-world clinic setting, FACT-E, EQ-5D HUS, and symptoms were strongly correlated. Most HRQOL and symptom parameters suggested that patients had worse HRQOL and symptoms during curative therapy, but recovered well afterwards. In contrast, palliative chemotherapy had a neutral to positive impact on HRQOL/symptoms when compared to their baseline pre-treatment state.

Mining Patients' Narratives in Social Media for Pharmacovigilance: Adverse Effects and Misuse of Methylphenidate.

Background: The Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) have recognized social media as a new data source to strengthen their activities regarding drug safety.Objective: Our objective in the ADR-PRISM project was to provide text mining and visualization tools to explore a corpus of posts extracted from social media. We evaluated this approach on a corpus of 21 million posts from five patient forums, and conducted a qualitative analysis of the data available on methylphenidate in this corpus.Methods: We applied text mining methods based on named entity recognition and relation extraction in the corpus, followed by signal detection using proportional reporting ratio (PRR). We also used topic modeling based on the Correlated Topic Model to obtain the list of the matics in the corpus and classify the messages based on their topics.Results: We automatically identified 3443 posts about methylphenidate published between 2007 and 2016, among which 61 adverse drug reactions (ADR) were automatically detected. Two pharmacovigilance experts evaluated manually the quality of automatic identification, and a f-measure of 0.57 was reached. Patient's reports were mainly neuro-psychiatric effects. Applying PRR, 67% of the ADRs were signals, including most of the neuro-psychiatric symptoms but also palpitations. Topic modeling showed that the most represented topics were related to Childhood and Treatment initiation, but also Side effects. Cases of misuse were also identified in this corpus, including recreational use and abuse.Conclusion: Named entity recognition combined with signal detection and topic modeling have demonstrated their complementarity in mining social media data. An in-depth analysis focused on methylphenidate showed that this approach was able to detect potential signals and to provide better understanding of patients' behaviors regarding drugs, including misuse.

Deep learning in the field of disease diagnosis

A good treatment is dependent on the accuracy of the diagnosis. The cure for the disease starts with the process of diagnosis. All these years, the grade and standard of the medical field has been increasing exponentially, yet there has been no significant downfall in the rate of unintentional medical errors. These errors can be avoided using Deep learning algorithm to predict the disease. The Deep Learning algorithm scans analyses and compares the patient's report with its dataset and predicts the nature and severity of the disease. The test results from the patient’s report are extracted by using PDF processing. More the medical reports analyzed, more will be the intelligence gained by the algorithm. This will be of great assistance to the doctors as they can interpret their diagnosis with the results predicted by the algorithm.

PGI27 - Concepts and Instruments for Patient-Reported (PRO) Assessment in Celiac Disease: Literature Review and Stakeholder Perspectives

PGI27 - Concepts and Instruments for Patient-Reported (PRO) Assessment in Celiac Disease: Literature Review and Stakeholder Perspectives

A rare case report of long-standing foreign body in the abdomen; forgotten scalpel blade in a multipara

The unintended retention of foreign objects (URFOs) after invasive procedures can cause morbidity and in some cases mortality. There may be an extended period between occurrence and detection of an URFO. Retained foreign objects are most commonly detected immediately postprocedure by X-ray, during routine follow-up visits, or from the patient's report of pain or discomfort. This is a case report of a 46-year-old lady Para 3+04 alive who presented to the gynecological clinic following an incidental radiological finding of a size 22 scalpel blade while being evaluated for low back pain. She had an exploratory laparotomy and retrieval of the blade. She did well and was discharged home in good condition on postoperative day 7.

Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients

The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Eighty-six percent of patients received an opioid at 1 or more clinic encounters. Regression analysis revealed that male sex or being younger (65 years of age or younger) was associated with a greater likelihood of an opioid ordered. Male sex nearly doubled the likelihood of a higher dose being ordered than female sex. Bivariate analysis found that patients receiving opioids reported significantly more pain relief than no-opioid patients. However, patients receiving opioids had higher pain interference scores, lower index of health state, and more physical distress than no-opioid patients Our results identify the need to consider opioid use and dosage when attempting to understand patient-reported outcomes (PROs) and factors affecting pain management. PerspectiveThis report describes the results of the analyses of PROs and patient-related electronic health record data collected under standard of care from cancer patients at outpatient pain management clinics of Anesthesiology and Palliative Care at the Memorial Sloan Kettering Cancer Center. Consideration of sex and age as predictors of opioid use is critical in attempting to understand PROs and their relationship to pain management.

SOME CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF THE MAXILLOFACIAL AREA PHLEGMONS

Introduction. It is known that the number of patients with phlegmons does not tend to decrease, which can be due to both disease pathomorphosis and changes in the epidemiological features of this pathology. In addition, a significant contribution to the development of the disease makes the characteristics of the comorbidity background. The aim of the study was to assess the clinical and epidemiological aspects of the morbidity of the Perm city population with the maxillofacial area phlegmons. Materials and methods. A retrospective analysis of 137 case reports ofpatients with facial phlegmon was carried out. Results. It is shown that young and middle-aged patients dominated in the age structure of the disease. Phlegmons often localized in 1-2 spaces. In more than half the cases, the phlegmons was in the submandibular space. Among the etiological factors of the disease, the leading place is occupied by gram-positive cocci and their associations. An essential role of anaerobic microflora in the pathogenesis of phlegmons has been established. Microorganisms of the Enterobacteriaceae family play a significant role in the formation of inter-microbial associations in the development of this pathology. Often phlegmons of the maxillofacial region are found in patients with concomitant somatic pathology. With a comorbid component, more frequent detection of microorganism associations is indicated. In addition, such patients enter the hospital much later. Conclusion. Thus, when assessing clinical and epidemiological data, it is shown that the phlegmons of the maxillofacial region occur, as a rule, in young and middle age, and also in the presence of comorbid pathology. A significant contribution to the development of the disease is made by associations of microorganisms, which may include a change in the severity ofpathogenicity factors.