Patient Self-report Research Articles

Psychological assessment and the role of the psychologist in early palliative care

BackgroundEarly palliative care (EPC) is a recommended model for improving the quality of life for patients with advanced cancer and their caregivers. However, limited research has focused on the role of psychological evaluation within EPC. The Veneto Institute of Oncology (IOV), a Comprehensive Cancer Centre, employs an interdisciplinary team to assess patients with advanced-stage disease. This study aims to assess the psychological needs of these patients, investigate any correlations between psychological symptoms (PSs) and factors such as awareness of diagnosis and prognosis, symptoms detected using the Edmonton Symptom Assessment System (ESAS), as well as the patient’s gender, age, social issues, and survival and to clarify the psychologist’s role within the interdisciplinary team.MethodsData were retrieved from a prospectively maintained database. From 1st January 2018 to 31st December 2021, 819 consecutive patients were evaluated during EPC consultations, with 753 participants enrolled in the study. The ESAS was administered to each patient before the consultation.ResultsMore than half of the patients (385, 57.1%) reported at least one PS, with an ESAS score of ≥4. Specifically, 34.9% reported depression, 28.7% reported anxiety, and 43.2% indicated feeling “not well.” Referring oncologists tended to overestimate the presence of PSs compared to patient self-reports (51.8% versus 41.3%). According to the psychologists’ assessment, 29.2% of participants were found to have depression, and 10.8% of participants had anxiety. Additionally, 31 patients (10.8%) with psychological disorders were diagnosed with an adaptation disorder related to a physical condition. The psychology service engaged 47% of patients, while 18.5% declined psychological support. Patients exhibiting other ESAS symptoms with scores of ≥4 had an increased odds ratio for reporting PSs of ≥4. However, multivariable analysis revealed no significant relationship between PSs and awareness of diagnosis and prognosis.ConclusionThe systematic use of self-assessment in EPC is essential for understanding patient’s experience, determining whether PSs stem from physical disorders, and prioritizing interventions. Awareness of prognosis does not correlate with increased anxiety and depression in patients. Therefore, EPC is an ideal opportunity to discuss prognosis and facilitate patients’ end-of-life choices early in their care journey.

EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases.

To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath-assisted flexible cystoscopy (eFC). EndoSheaths are single-use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time-consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced. All adult patients undergoing eFC over a 26-month period at a single institution were evaluated prospectively. Post-eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2-4 = mild, 5-7 = moderate, 8-10 = severe). The diagnosis of UTI was broad and based on any one of patient self-report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi-squared testing (P < 0.05, two-tailed). Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post-eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis. This large, prospective, unselected, real-world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.

Health-related quality of life among pediatric patients with acute lymphoblastic leukemia: An exploratory cross-sectional study.

Improved survival rates broadened the pediatric oncology focus to include health-related quality of life (HRQoL). This cross-sectional study aimed to examine HRQoL by treatment phase and disease risk level in pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL), including those in early survivorship. A subset of data from a larger prospective cohort study was analyzed. Data were collected from 73 patients (73 parent reports and 28 self-reports). Parent proxy and self-report PROMIS measures assessed HRQoL across treatment phases (early intensive, maintenance, and off treatment) and disease risk groups (standard vs high). Analyses assessed the relationship between parent proxy and patient self-reports and the differences in HRQoL among treatment phases and risk groups. Parent proxy reports generally indicated worse fatigue, pain interference, and mobility compared with patient self-reports. Self-reports in the early intensive treatment group suggested worse depressive symptoms, fatigue, mobility, and upper extremity function compared with those in later phases. Parent proxy reports showed worse fatigue and depressive symptoms in early intensive treatment group relative to those in later phases. Patient self-reports in the maintenance group demonstrated the best peer relationships scores. Parent proxy reports in the high-risk group reported significantly higher depressive symptoms and fatigue compared with the standard-risk group. Differences in HRQoL suggest targets for further assessment and intervention. The early treatment and immediate post-survivorship periods may represent particularly critical time points. Longitudinal studies with larger and diverse samples should further explore HRQoL trajectories in this population.

Headache trajectories in children and adolescents with new onset continuous headache.

New daily persistent headache (NDPH) is a challenging and understudied primary headache disorder with no known effective treatment. Although the International Classification of Headache Disorders criteria require that the new onset continuous headache be present for at least three months before diagnosing NDPH, the biologic basis for when a new, continuous headache starts to behave as NDPH is unknown, and some pediatric headache experts consider that the minimum duration criterion could be shorter. In this retrospective study, we reviewed the intake questionnaires and medical records of 5-17 year-olds seen in neurology clinic for headache at the Children's Hospital of Philadelphia. Those with a new onset continuous headache of at least one month in duration were eligible. The patient's self-report and clinician's description both had to indicate that the headache was new, of abrupt onset, and continuous to be included, although patients were allowed to have a prior history of infrequent headaches. We compared headache outcomes at last follow-up and at one year after continuous headache onset between those who had a continuous headache duration of 1 to <3 months ("new onset headache", or NOH) at first visit vs. those with ≥3 months (NDPH). We used multivariate regression modeling to examine for predictors of headache outcomes. Of 472 patient records reviewed, 172 met the inclusion criteria for analysis. Of these, 84 had a headache duration of 1 to <3 months in duration and 88 had a duration of ≥3 months. Those with shorter duration continuous headache were younger (median (interquartile range) 13.5 (11.1-15.7) vs. 15.1 (12.3-16.5) years, and less likely to have previously received a prescription preventive for the continuous headache (n = 14 (17%) vs. 26 (30%), p = 0.046), but were otherwise similar to those with NDPH in terms of baseline clinical and demographic variables. Sixty-five (74%) of those with NDPH and 60 (71%) with NOH had follow-up data. At last clinic follow-up, 41/65 (63%) with NDPH and 43/60 (72%) with NOH had experienced any headache benefit (p = 0.307), although 39/65 (60%) with NDPH and 29/60 (48%) with NOH still had continuous headache (p = 0.191). Headache duration was not associated with outcomes in multivariate regression modeling. Headache outcomes of children and adolescents with new onset continuous headache, whether of 1 to <3 months (NOH) or ≥3 months in duration (NDPH) are suboptimal. More research is needed to improve treatment outcomes for this patient population.

Implementing a financial toxicity screening program.

275 Background: Financial toxicity (FT) is a well-documented negative side effect of cancer treatment. Routine screening can mitigate FT by proactively connecting at-risk patients to resources and counseling. Herein, we describe implementation of a FT screening quality improvement (QI) program. Methods: At a comprehensive cancer center, an interdisciplinary team explored options for implementation, with consideration for screening content, mechanism for delivery, and clinical workflow. Through consensus, the team agreed to use the 12-item COmprehensive Score for Financial Toxicity (COST) tool, a health-related social risk checklist, patient-self report of cost-related medication non-adherence, and a visual analog quality of life scale. Surveys were sent via portal every four months to patients on active treatment. The QI project was implemented on the breast, gastrointestinal, gynecologic, and thoracic services. COST scores ≤20 or any endorsed social risk (e.g., food, transportation) yielded a positive screen, and nurses placed a financial counseling referral, with counseling dispositions tracked. In March 2023, due to an influx of “unproductive” counseling dispositions (e.g., patient could not be contacted, patient no longer wanted help), machine learning models suggested reducing the screening threshold to COST scores ≤16 and limiting the social risk checklist to four items (food, transportation, medication, and housing insecurity). Results: From 06/2022-12/2023, 196,675 financial toxicity surveys were assigned to 78,289 unique patients: 38% (n=75,526) were completed by 45,003 patients. Of these, 56% have completed one survey, 26% have completed two surveys, and 18% have completed three or more. Since implementation, 9612 financial counseling referrals have been placed, yielding assistance with insurance selection and applications for assistance with co-payments, non-medical expenses, and out-of-pocket costs. During the QI project, several real-time workflow changes were made. On day 1, 519/1811 patients screened positive, yielding an overflow of counseling referrals: an additional question to allow patients to opt into referral, rather than generating an automatic referral, was then added: the following week, 136 referrals were generated. In September 2022, this opt-in was modified to allow patients to directly identify the areas in which they were seeking assistance (e.g., insurance counseling, out-of-pocket expenses). In 2024, the screening was reduced to two COST questions that had a 0.92 correlation with the full-tool. Conclusions: Routine FT screening is feasible during active treatment, although attention is needed to clinical workflows to ensure patients have access to the screening, nurses and other clinical staff are involved in the implementation, and referrals to resources are available for patients who screen positive. Future work will address cadence of delivery and outcomes of interventions.

Reliability Of E-Health Records and The Importance of Patient Self-Reporting in International Health Information Sharing

Reliability Of E-Health Records and The Importance of Patient Self-Reporting in International Health Information Sharing

When sexual distress shares the bed: the role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress in sex therapy patients.

Sexual distress (eg, feeling distressed, unhappy, frustrated, stressed, dissatisfied, or bothered about their sexuality) is a central concern reported by patients seeking sex therapy, and might be related to sexual self-esteem and mindfulness disposition, yet research is needed to examine the links among those variables within the specific population of patients seeking therapy. This study aimed to examine the indirect role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress. The study was conducted among 696 patients undergoing sexual therapy (mean age 34.19 ± 11.21 years, age range 18-78years). Participants identified as women (57.3%), men (38.5%), or nonbinary (4.2%). They completed self-report questionnaires assessing dispositional mindfulness (Five Facet Mindfulness Questionnaire), sexual self-esteem (Multidimensional Sexuality Questionnaire), and sexual distress (Sexual Distress Scale-Revised), during their first few sessions (ie, first to third sessions [the assessment phase]). Sexual distress was the main outcome, as measured with the Sexual Distress Scale-Revised. Results indicated that 54% (n = 376) of patients reported elevated sexual distress based on the questionnaire threshold score. Path analyses indicated an indirect effect in which higher dispositional mindfulness was associated with higher levels of sexual self-esteem, which in turn was associated with lower sexual distress. Results also highlighted that specific facets of mindfulness were related to higher sexual self-esteem (ie, describing, and nonreacting) and lower sexual distress (ie, nonjudgment and acting with awareness). The integrative model explained 23% of the variance of sexual distress scores. Findings suggest that addressing specifically sexual self-esteem and mindfulness may represent relevant clinical avenues to reduce sexual distress among sex therapy patients. Strengths of this study include the novel examination of the role of sexual self-esteem in the link between mindfulness disposition and sexual distress in a large clinical sample of patients seeking sex therapy. Limitations includes reliance on patient self-report and a cross-sectional design that limit conclusion regarding causality. This study makes a valuable contribution to the existing body of research highlighting the pivotal roles of sexual self-esteem in the link between dispositional mindfulness and reduced sexual distress among adults undergoing sex therapy, allowing us to identify potential targets of intervention.

Model-agnostic confidence measurement for aggregating multimodal ensemble models in automatic diagnostic systems

Automatic diagnostic systems (ADSs) have been garnering increased attention because they can alleviate the workload of clinicians by assisting in diagnosis and offering low-cost access to healthcare for people in medically underserved areas. ADS can suggest potential diseases by analyzing a patient's self-report. Previous research on ADS has leveraged diagnostic case data from various patients and medical knowledge to diagnose diseases, with multimodal ensemble methods proving particularly effective. However, the existing multimodal ensemble method combines the probabilities of different models in the aggregating process, which can not properly combine the probabilities that are produced by different criteria. To address these issues, we propose an effective aggregation framework for multimodal ensembles that can properly aggregate model-agnostic confidence scores and predictions from each model. Our framework transforms probability scores from different criteria into unified aggregation rule-based scores and reflects the gap between the probabilities that may be blurred in the aggregation process through the confidence score. In particular, The proposed confidence measurement method employs a post-analysis approach with the developed model or algorithm, making it adaptable in a model-agnostic manner and suitable for multimodal ensemble learning that utilizes heterogeneous prediction results. Our experimental results demonstrate that our framework outperforms existing approaches by more effectively leveraging the strengths of each ensemble member.

Abstract A130: Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic

Abstract Intro: There is evidence to suggest that preventive services, such as breast cancer screening, were impacted during the SARS-CoV-2 pandemic with interruption in screening mammogram services during March-July 2020. Federally Qualified Health Centers (FQHCs) are a critical health system to help better understand pandemic sequelae among diverse patient populations so teams can better prepare for a future pandemic. US Preventive Services Task Force (USPSTF) recommends average-risk patients aged 50-74 screen for breast cancer biyearly. Based on USPSTF recommendations in 2021, 76% of non-Hispanic White women and 74 % of Latina women were up-to-date on mammography screening. Our study, RESTORE, focuses on understanding patient barriers and facilitators to completing breast cancer screening at one large urban FQHC during the pandemic. Here, we compare FQHC patient self-reported completion of breast cancer screening to documented breast cancer screening found in the electric health record (EHR). Methods: Patients (n=20) were interviewed between July 2023 and February 2024 about their healthcare utilization, breast cancer screening (including medical site), and health literacy throughout the COVID period (2018-2022). When a screening date was documented in the EHR, interviewers mentioned the screening date to participants during the interview. Interviews were audio recorded and transcribed. A preliminary review of these interviews was conducted to collect self-reported breast cancer screening date and compare it to the date in the EHR. Results: Interviewees’ average age was 65.1 years; 70 % were Spanish-speaking; 60% were Latino, and 95% were female. Of the Spanish-speakers, 8 out of 14 patients self-reported completing a mammogram between 2018-2022, with 2 of 8 reporting having completed it with an onsite vendor. Only 3 of these 8 mammograms were captured in the EHR. Of these three, 2 patients were prompted with the EHR date during the interview: one patient agreed with the date while the other rejected the date. Among the English-speaking patients, 4 out of 6 patients self-reported completing a mammogram between years 2018-2022, all of these 4 self-reported dates were captured in the EHR. Of these 4 patients, all were prompted with the EHR date, 3 agreed to the date and one rejected the date, with 3 of 4 reporting having completed it with an onsite vendor.Conclusion: Throughout COVID, FQHC patients sought mammogram screening; however, gaps in data systems limited completeness of the health system’s mammogram EHR data. Time delays between patient experience and interview dates, complicated our understanding of patients’ COVID experiences. The inconsistency between self-reported dates and EHR dates also creates challenges educating and convincing patients to stay up-to-date on screenings based on recommended intervals. Missing EHR data could have also impacted staff not accurately following-up for mammograms or referrals. Additional work is needed to understand the opportunities to better integrate FQHC EHR with mammogram vendor data systems. Citation Format: Anne Escaron, Crystal Gomez, Jennifer Schneider, Jennifer Rivelli, Fabian Hidalgo, Gloria Coronado. Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A130.

Side Effect Profile of Arimidex vs. Femara: A Comparison Study

Background: Background: Aromatase inhibitors, Arimidex (anastrozole) and Femara (letrozole), are commonly used in the treatment of hormone receptor-positive (HR+) breast cancer in postmenopausal women. Despite similar efficacy, these drugs have different side effect profiles that impact patient compliance and quality of life.Objective: To compare the incidence and severity of side effects between Arimidex and Femara in postmenopausal women with HR+ breast cancer.Methods: A retrospective cohort study was conducted involving 1,000 postmenopausal women with HR+ breast cancer from multiple oncology centers. Participants were divided into two groups: Arimidex (n=500) and Femara (n=500). Side effects were assessed via patient self-reports, clinical evaluations, and standardized questionnaires. Data were analyzed using chi-square tests, t-tests, and logistic regression models, with p-values &lt;0.05 considered significant.Results: Arimidex was associated with higher rates of joint pain (45% vs. 30%, p&lt;0.001) and muscle pain (38% vs. 25%, p&lt;0.01). Femara showed increased rates of hypertension (28% vs. 20%, p&lt;0.05) and significant bone density loss (18% vs. 12%, p&lt;0.05).Conclusion: Arimidex and Femara exhibit distinct side effect profiles, suggesting the need for personalized treatment approaches based on patient risk factors.

Statistical characteristics of large-scale objective tonic-clonic seizure records from medical smartwatches used in daily life.

This study aimed to assess whether population-level patterns in seizure occurrence previously observed in self-reported diaries, medical records, and electroencephalographic recordings were also present in tonic-clonic seizure (TCS) diaries produced via the combined input of a US Food and Drug Administration-cleared wristband with an artificial intelligence detection algorithm and patient self-reports. We also investigated the characteristics of patient interactions with wearable seizure alerts. We analyzed wristband data from patients with TCSs who had at least three reported TCSs over a minimum of 90 days. We quantified TCS frequency and cycles, and the relationship between the mean and variability of monthly TCS counts. We also assessed interaction metrics such as false alarm dismissal and seizure confirmation rates. Applying strict criteria for usable data, we reviewed 137 490 TCSs from 3012 patients, with a median length of TCS alert records of 445 days (range = 90-1806). Analyses showed consistency between prior diary studies and the present data concerning (1) the distribution of monthly TCS frequency (median = 3.1, range = .08-26); (2) the linear relationship (slope = .79, R2 = .83) between the logarithm of the mean and the logarithm of the SD of monthly TCS frequency (L-relationship); and (iii) the prevalence of multiple coexisting seizure cycles, including circadian (84.0%), weekly (24.6%), and long-term cycles (31.1%). Key population-level patterns in seizure occurrence are recapitulated in wrist-worn device recordings, supporting their validity for tracking TCS burden. Compared to other approaches, wearables can provide noninvasive, objective, long-term data, revealing cycles in seizure risk. However, improved patient engagement with wristband alerts and further validation of detection accuracy in ambulatory settings are needed. Together, these findings suggest that data from smart wristbands may be used to derive features of TCS records and, ultimately, facilitate remote monitoring and the development of personalized forecasting tools for TCS management. Our findings may not generalize to other types of seizures.

B - 80 The Long-Term Memory Sign in Adults Referred for Neuropsychological Evaluation

Abstract Objective We investigated the clinical utility of the newly described long-term memory (LTM) sign in adults referred for neuropsychological evaluation. Individuals with dementia often report short-term episodic memory decline or no memory decline, but rarely report long-term episodic memory decline. The LTM sign refers to patient self-report of long-term episodic memory decline, that is equivalent to/or greater than, subjective short-term episodic memory decline. Method The LTM sign was endorsed on a pre-visit intake form and established during clinical interview in 568 patients (M age = 63, SD = 14.3) referred for neuropsychological evaluation at a large medical center in the Northwest United States. Results In our sample of 568 patients, 79 (14%) reported the LTM sign. In 79 patients with the LTM sign, 45 were diagnosed with a primary psychiatric disorder (57%), 23 were diagnosed with mild neurocognitive disorder (29%), seven had no cognitive or psychiatric diagnosis (9%), and four had dementia (5%). The LTM sign was most common in those with a history of trauma in childhood or adolescence (52/79, 66%) and substance use disorders (50/79, 63%). Conclusions The LTM sign was rare in dementia, but common in those with a current psychiatric diagnosis. These findings support the literature on episodic memory decline in dementia populations and suggests that encoding of early memories and/or retrieval of old memories is negatively impacted by a current psychiatric disorder, traumatic events in childhood and adolescence, and lifetime history of substance use disorder. The LTM sign is a valuable addition to the clinical interview of neuropsychological patients.

Limbic Network Derangement Mediates Unawareness of Apathy in Mild Cognitive Impairment due to Alzheimer's Disease: Clues from [18F]FDG PET Voxel-Wise Analysis.

Discrepancy between caregiver and patient assessments of apathy in mild cognitive impairment (MCI) is considered an index of apathy unawareness, independently predicting progression to AD dementia. However, its neural underpinning are uninvestigated. To explore the [18F]FDG PET-based metabolic correlates of apathy unawareness measured through the discrepancy between caregiver and patient self-report, in patients diagnosed with MCI. We retrospectively studied 28 patients with an intermediate or high likelihood of MCI-AD, progressed to dementia over an average of two years, whose degree of apathy was evaluated by means of the Apathy Evaluation Scale (AES) for both patients (PT-AES) and caregivers (CG-AES). Voxel-based analysis at baseline was used to obtain distinct volumes of interest (VOIs) correlated with PT-AES, CG-AES, or their absolute difference (DISCR-AES). The resulting DISCR-AES VOI count densities were used as covariates in an inter-regional correlation analysis (IRCA) in MCI-AD patients and a group of matched healthy controls (HC). DISCR-AES negatively correlated with metabolism in bilateral parahippocampal gyrus, posterior cingulate cortex, and thalamus, PT-AES score with frontal and anterior cingulate areas, while there was no significant correlation between CG-AES and brain metabolism. IRCA revealed that MCI-AD patients exhibited reduced metabolic/functional correlations of the DISCR-AES VOI with the right cingulate gyrus and its anterior projections compared to HC. Apathy unawareness entails early disruption of the limbic circuitry rather than the classical frontal-subcortical pathways typically associated with apathy. This reaffirms apathy unawareness as an early and independent measure in MCI-AD, marked by distinct pathophysiological alterations.

Dose Deintensified 3-Day Photon, Proton, or Brachytherapy: A Nonrandomized Controlled Partial Breast Irradiation Trial

BackgroundThe optimal approach for partial breast irradiation (PBI) is unknown. We investigated a novel de-intensified 3-fraction PBI regimen for photons, protons, and brachytherapy. MethodsA multicenter nonrandomized controlled trial with primary outcome of adverse cosmesis at 3 years versus pre-PBI. Eligibility criteria were ≥ age 50 years treated with breast-conserving surgery for node-negative estrogen receptor positive (ER+) invasive breast cancer or any ductal carcinoma in-situ (DCIS) measuring ≤ 2.5 cm. Photon and proton PBI were prescribed 21.9 Gy (RBE) and brachytherapy 21 Gy in 3 fractions. Radiotherapy technique and use of adjuvant endocrine therapy was selected at physician and patient discretion. ResultsBetween June 17, 2015 and July 13, 2017, 161 eligible patients were treated with photons (56), protons (49), or brachytherapy (56). Median patient age was 66.8 years. 126 (78.3%) had invasive breast cancer (all ER+) and 35 (21.7%) had DCIS (88.6% ER+). 54.0% of patients with invasive breast cancer and 25.8% of patients with ER+ DCIS initiated and adhered to prescribed endocrine therapy. The proportion of patients with adverse cosmesis (by trained nurse assessment) was 14.5% at baseline, 2.3% at 3 years (difference -12.2%, 95% CI (-100%, -6.4%)). Adverse cosmesis at last-follow-up, with median follow-up 5 years, was 5.7% by nurse assessment, 5.6% by panel assessment of digital photographs, and 5.2% by patient self-report. There were no observed clinically meaningful changes in other patient reported outcomes, and just two grade 2 or higher adverse events, both grade 2, in the brachytherapy cohort. 5-year local recurrence-free and progression-free survival were 98.0% and 95.5%, respectively. There were no local recurrences amongst 60 patients with invasive breast cancer and Ki67 ≤ 13.25%. ConclusionsDe-intensified 3-day PBI provided favorable disease control, tolerability, and cosmetic outcomes, meeting the pre-specified criteria for acceptability. This approach is an attractive option for small node-negative ER+ BC and DCIS patients. Trial registrationClinicalTrials.gov identifier NCT02453737

Case series of patients with early psychosis presenting hypoperfusion in angular gyrus and self-disturbance: Implication for the sense of agency and schizophrenia.

Self-disturbance has been considered as a core symptomatology of schizophrenia and its emergence from the prodromal phase makes it a crucial target for early detection and intervention in schizophrenia. Currently, the clinical assessment of self-disturbance relies on the self-report of patients, and clinicians have no diagnostic tools in clinical practice. Identifying the neural substrate of self-disturbance would be of great clinical value by shedding light on the core dimension of schizophrenia. We first introduce an adolescent patient who initially presented self-disturbance, and clinically detectable hypoperfusion in angular gyrus (AG) was observed when early psychosis was suspected. Interestingly, the hypoperfusion in AG may correspond to improvement and exacerbation of self-disturbance. This clinical observation led us to pursue the relationship between the decreased blood flow in the AG and self-disturbance. Among 15 cases with suspected early psychosis in which single photon emission computed tomography was performed to exclude organic factors, we found additional 5 cases, including one prodromal patient, showing hypoperfusion in the AG and self-disturbance with significant correlation (r = 0.79, p = 0.00025). The self-disturbance has been interpreted as a reflection of disturbance of the "Sense of Agency", the ability to attribute their action and/or thoughts to themselves. AG has been shown to play a pivotal role in the sense of agency. These cases suggest that the hypoperfusion in AG associated with the disruption in the sense of agency would be an early clinical sign of schizophrenia. Further longitudinal studies are needed to test this hypothesis.

Agreement between patient- and proxy-reported outcome measures in adult musculoskeletal trauma and injury: a scoping review.

Patient-reported outcome measures (PROMs) are widely used in medicine. As older adults, who may rely on a proxy caregiver for answers due to cognitive impairment, are representing an increasing share of the traumatically injured patient population, proxy-reported outcome measures (proxROMs) offer a valuable alternative source of patient-centered information although its association with PROMs is unclear. The objective of this scoping review is to discuss all available literature comparing PROM and proxROMs in adult patients with musculoskeletal trauma to guide future research in this field. The PRISMA extension for Scoping Reviews was used to guide this review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched without date limit for articles comparing PROM and proxROMs in setting of musculoskeletal trauma. Abstract and full-text screening were performed by two independent reviewers. Variables included study details, patient and proxy characteristics, and reported findings on agreement between PROMs and proxROMs. Of 574 unique records screened, 13 were included. Patient and proxy characteristics varied greatly, while patients' cognitive status and type of proxy perspective were poorly addressed. 18 different PROMs were evaluated, mostly reporting on physical functioning and disability (nine, 50%) or quality of life (six, 33%). Injury- and proxy-specific tools were rare, and psychometric properties of PROMs were often not described. Studies reported moderate to good agreement between PROMs and proxROMs. There is less agreement on subjective outcome measures (e.g., depression score) compared to observable items, and proxy bias results in in worse outcomes compared to patient self-reports. Current literature, though limited, demonstrates moderate to good agreement between injured patients' self- and proxy-reports. Future studies should be mindful of current guidelines on proxy reporting when developing their studies and consider including neglected populations such as cognitively impaired patients to improve clinical validity.

Quality of Life in Children with Neurofibromatosis Type 1: Agreement between Parents and Patients, and the Role of Disease Severity and Visibility.

Neurofibromatosis type 1 (NF1) is a genetic disorder that affects multiple systems in the body, often leading to physical disfigurements and a wide range of clinical symptoms. This study aims to investigate the relationship between NF1 severity and visibility and the quality of life (QoL) in children. The Pediatric Quality of Life Inventory (PedsQL) and a modified version of the Ablon scale were used to assess QoL and NF1 severity and visibility, respectively. Self-reported and parent-reported QoL scores were compared, and the associations between NF1 severity/visibility and QoL were explored. Thirty-eight pediatric NF1 patients and their parents were enrolled. QoL scores did not differ significantly between patient self-reports and parent reports. However, correlational analyses revealed that higher NF1 severity was associated with lower physical QoL in patients, and greater NF1 visibility was linked to lower physical and social QoL. For parents, higher NF1 severity correlated with lower school functioning, whereas NF1 visibility did not show a significant correlation with QoL. The severity and visibility of NF1 have distinct impacts on various aspects of QoL in children, highlighting the need for tailored interventions that address both physical and psychological challenges. These findings underscore the importance of comprehensive care approaches in managing NF1 in pediatric populations.

The patient-perceived intravaginal ejaculation latency time cut-off for lifelong premature ejaculation.

The current cutoff values of intravaginal ejaculation latency time for diagnosing lifelong premature ejaculation do not always match clinical practice, and the inconsistency in the cutoff values of intravaginal ejaculation latency time among different definitions has also posed challenges to both clinical management and research of premature ejaculation. To re-evaluate the intravaginal ejaculation latency time and to find evidence-based cut-off values for diagnosing lifelong premature ejaculation that can be widely accepted and match clinical practice. We addressed the flaws of previous studies. Lifelong premature ejaculation was diagnosed based on both patient self-report of premature ejaculation status and scores on the Premature Ejaculation Diagnostic Tool, with a control group consisting of non-premature ejaculation individuals included for comparison. Utilizing receiver operating characteristic curve analysis, the optimal self-estimated cutoff value for intravaginal ejaculation latency time in diagnosing lifelong premature ejaculation was determined. A total of 307 heterosexual participants (mean age=30.7±6.4) were included, comprising 187 lifelong premature ejaculation patients (mean age=28.0±4.6) and 120 non-premature ejaculation individuals (mean age=35.0±6.5). 2.7% of lifelong premature ejaculation patients experienced anteportal ejaculation. 59.9%, 92%, and 97.9% of lifelong premature ejaculation patients displayed intravaginal ejaculation latency times within 1, 2, and 3 min, respectively. The receiver-operating characteristic curve's area under the curve was 0.996 with a 95% confidence interval of 0.991-1.000 (p<0.0001). The perceived intravaginal ejaculation latency time cut-off at 3.5 (sensitivity=97.9%, specificity=99.2%) showed the highest Youden index compared with other options. Although we found that 92.0% of lifelong premature ejaculation patients had a perceived intravaginal ejaculation latency time within 2 min, a perceived intravaginal ejaculation latency time cutoff value of less than 3.5 min for diagnosing lifelong premature ejaculation could encompass a larger proportion (97.9%) of patients seeking medical help for complaints of PE, and increasing the perceived intravaginal ejaculation latency time cutoff value to 3.5 min would not significantly increase the false-positive rate. The perceived intravaginal ejaculation latency time cutoff value for diagnosing lifelong premature ejaculation within a clinical practice context is 3.5 min.

Application Progress of Wearable Devices in the Field of Depression Monitoring and Intervention

Depression's high recurrence rate and severe consequences pose significant challenges to public health. To address this issue effectively, this review explores the innovative application of wearable devices in monitoring and intervening in depression, surpassing the limitations of traditional subjective assessments and patient self-reports. The paper systematically analyzes recent studies utilizing wearable devices to monitor physiological and behavioral indicators of depression, categorizing them by different technological types and evaluating their practical effectiveness in early diagnosis and intervention. The findings indicate that wearable devices can continuously monitor physiological indicators and behavioral patterns related to depression, potentially enabling early detection of depressive episodes and supporting timely interventions. Despite challenges such as data privacy and user acceptance, wearable technology holds immense potential in enhancing clinical outcomes in depression treatment.

Building a composite score for patient self-report of flare in osteoarthritis: a comparison of methods with the Flare-OA-16 questionnaire

ObjectivesThis study aims to compare methods of constructing a composite score for the Flare-OA-16 self-reported questionnaire. MethodsParticipants with knee and hip osteoarthritis (OA) completed a validated 16-item questionnaire assessing five domains of flare. Three estimation methods were compared: (i) second-order confirmatory factor analysis (CFA); (ii) logistic regression, according to the participant's self-report of flare (yes/no); and (iii) Rasch method, with weighted scores in each dimension. The distribution (floor effect [FF] and ceiling effect [CF]) were described and the known-group validity (by self-reported flare) tested by Wilcoxon rank-sum test. Similarity between the scores was analyzed by intraclass correlation coefficient (ICC) and their performance against self-report compared by areas under ROC curves (AUC). Intrascore test-retest reliability at 14 days was assessed by ICC. ResultsIn a sample of 381 participants, 247 reported having a flare. CFA showed fit indices (comparative fit index [CFI] = 0.95; root mean square error of approximation [RMSEA] = 0.08) and estimated composite mean score = 4.33(SD = 2.85) (FF = 14.9%, CF = 0%). For the logistic regression estimation, the mean composite score was 6.48 (SD = 3.13) (FF = 0%; CF = 0%). With Rasch model, the mean composite score was 4.35 (SD = 2.60) (FF = 14.9%; CF = 0%). Similarity analysis indicated a greater concordance between CFA and Rasch scores (ICC = 0.98) than between logistic regression score and the two others (ICC = 0.88 with Rasch score and 0.90 with CFA score). The AUC indicated similar performance of all methods: logistic model (AUC = 0.89 [0.85–0.92]), CFA, and Rasch model (AUC = 0.86 [0.82–0.90]). The difference between groups was significant (P < .05) for scores estimated by CFA (3.98), Rasch model (4.95), and logistic regression (4.30). The reproducibility was ICC = 0.84 (0.75–0.90) for Rasch and CFA scores and ICC = 0.78(0.66–86) for logistic model. ConclusionThree alternatives explored to build a composite score showed similar construct validity. Some metric superiority (better score distribution and reproducibility) of the Rasch model is promising for the detection of occurrence and assessment of severity of a flare in OA.