Patient Preferences Research Articles

Evolving Standards of Care in the Management of Localized Colorectal Cancer.

The treatment of patients with localized rectal cancer is complex and requires input from a multidisciplinary team. Baseline local staging and mismatch repair protein testing are vital to develop individualized treatment plans. There are multiple options in terms of treatment modalities and sequencing, including transanal excision, short-course radiation, long-course chemoradiation, chemotherapy doublet or triplet, nonoperative management, and immune checkpoint blockade for patients with mismatch repair deficient tumors. While localized colon cancer is typically treated with surgical resection and consideration of adjuvant chemotherapy, emerging data suggest that neoadjuvant chemotherapy may be beneficial in patients with higher-risk disease. Quality-of-life considerations are imperative to prevent potential chronic effects on psychosocial health, neuropathy, fertility, and bowel, bladder, and sexual function. The omission of radiation or surgery can mitigate these toxicities without diminishing oncologic outcomes. The optimal treatment plan and sequence is not a one-size-fits-all approach but rather should be personalized to the patient's disease burden, tumor location, comorbidities, and preferences.

Stapedotomy Versus Cochlear Implantation for Far Advanced Otosclerosis: Insights From a Patient With Matched Preoperative and Postoperative Function.

To examine patient preference after stapedotomy versus cochlear implantation in a unique case of a patient with symmetrical profound mixed hearing loss and similar postoperative speech perception improvement. An adult patient with bilateral symmetrical far advanced otosclerosis, with profound mixed hearing loss. Stapedotomy in the left ear, cochlear implantation in the right ear. Performance on behavioral audiometry, and subjective report of hearing and intervention preference. A patient successfully underwent left stapedotomy and subsequent cochlear implantation on the right side, per patient preference. Preoperative audiometric characteristics were similar between ears (pure-tone average [PTA] [R: 114; L: 113 dB]; word recognition score [WRS]: 22%). Postprocedural audiometry demonstrated significant improvement after stapedotomy (PTA: 59 dB, WRS: 75%) and from cochlear implant (PTA: 20 dB, WRS: 60%). The patient subjectively reported a preference for the cochlear implant ear despite having substantial gains from stapedotomy. A nuanced discussion highlighting potentially overlooked benefits of cochlear implants in far advanced otosclerosis is conducted. In comparison with stapedotomy and hearing aids, cochlear implantation generally permits greater access to sound among patients with far advanced otosclerosis. Though the cochlear implant literature mainly focuses on speech perception outcomes, an underappreciated benefit of cochlear implantation is the high likelihood of achieving "normal" sound levels across the audiogram.

From hospital to home: Analyzing the market dynamics of home health and hospital-at-home care

The home health care industry in the United States is expected to develop at a compound annual growth rate (CAGR) of 6.89% from 2023 to 2032, and is expected to reach approximately $300 billion by 2028. The aging population, rising rates of chronic illnesses, the need for post-hospitalization care, and patient preferences for at-home care are some of the factors contributing to this growth. In addition to non-medical help with everyday life activities, home health care offers medical treatments such skilled nursing and physical therapy. Large providers with the greatest patient volume, such as AccentCare, Amedisys, and Enhabit Home Health & Hospice, dominate the industry. To guarantee patient safety and high-quality care, home health agencies are subject to regulatory scrutiny. Home health care can also be a valuable source of information and respite for family caregivers. The capabilities of home health care have been increased by technological developments in telehealth and remote monitoring, which allow medical professionals to keep an eye on patients' status and interact with them from a distance. All things considered, the home health care sector is changing to accommodate the expanding and varied requirements of patients who want to receive treatment in the convenience of their own homes, offering an affordable and individualized substitute for traditional hospital settings.

Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for Cardiovascular Disease.

Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships. Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC. We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations. This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.

Exploring Health Information-Seeking Behavior and Information Source Preferences Among a Diverse Sample of Cancer Survivors: Implications for Patient Education.

This study examined health information-seeking behavior among cancer survivors, including informational sources used and the factors correlated with information-seeking across different racial/ethnic groups. We used data from the Health Information National Trends Survey (2017-2022). Adjusted logistic regression was conducted to identify the predictors of information-seeking by race/ethnicity. Predicting variables were organized into demographic (age, education, race, income, and comorbidity), enabling (having health insurance, having a regular provider, and frequency of care visits), predisposing (quality of care, self-efficacy, and confidence in one's ability to get information), and reinforcing (patient-centered communication, ease of getting information, and confusing information available) factors based on the PRECEDE-PROCEED Model. We included 4723 cancer survivors, of which 15.41% have breast cancer, 17.50% have skin cancer, and 11.11% have prostate cancer. A majority (75.08%) had sought health information. Healthcare providers were the most preferred sources of information across demographic groups, followed by the Internet. Health insurance, a regular provider, and frequent visits were enabling factors that positively influenced information-seeking behavior. Confidence in getting information when needed and self-efficacy were predisposing factors positively associated with the information-seeking behavior. Finally, reinforcing factors (ease of getting information and non-confusion of the information available) were also positively associated with information-seeking. Study findings suggest that one-fourth of cancer survivors had not sought cancer-related information. The results have implications for identifying patients at increased risk for unmet information needs. They also contribute to our understanding of critical racial differences and similarities. Further, findings can help guide interventions to assist in information seeking based on patient preferences.

Sleep effects of psychological therapies for menopausal symptoms in women with hot flashes and night sweats: A systematic review.

Sleep disturbance is frequently reported by women during the menopausal transition due to various physiological changes and environmental factors. Insomnia is a critical treatment target for its deleterious effects on daytime functioning and quality of life and increased risk of developing a depressive disorder. Due to medication side effects and patient preferences, there is increased interest in the use of psychological treatments that address the myriad of menopausal symptoms, including cognitive-behavioural therapy, clinical hypnosis and mindfulness-based therapies. The objective of this article is to review the effects of psychological treatments for menopausal symptoms on sleep disturbance in peri-/postmenopausal women. We conducted a systematic review of the literature using PubMed and reference lists from inception until May 2023, including 12 studies that evaluated sleep as a secondary outcome. Most studies found that group and self-help (guided and unguided) cognitive-behavioural therapies and clinical hypnosis for menopausal symptoms have positive effects on sleep among women with significant vasomotor symptoms. There was preliminary support for mindfulness-based stress reduction. Future research including more diverse samples and women with sleep disorders is needed. Evaluating the implementation of psychological therapies in clinics where menopausal women seek care is an important next step.

Patient preferences for breast cancer screening: a systematic review update to inform recommendations by the Canadian Task Force on Preventive Health Care

Patient preferences for breast cancer screening: a systematic review update to inform recommendations by the Canadian Task Force on Preventive Health Care

Is patient participation in hypertension care based on patients' preferences? - A cross-sectional study in primary healthcare.

The purpose of this study was to address the need to improve opportunities for patient participation in their health and health services. This paper reports if and how patients' preferences matched their experiences of participation in treatment for hypertension in primary healthcare, and what factors were linked with having had opportunities for participation that matched one's preferences. A total of 949 adult patients treated for hypertension completed the 4Ps (Patient Preferences for Patient Participation) tool, with which they ranked their preferences for and experiences of patient participation. Descriptive and comparative analyses of 4Ps data were performed to identify patient characteristics associated with preference-based participation.Approximately half of the participants experienced patient participation to the extent that they preferred. Women were more likely to have had less patient participation than their preference compared to men. Women were also more likely to prefer being more engaged in hypertension care than men. There were also marked associations between age and educational level with the extent of participation preferred and experienced, leaving patients younger than or with lower education than the mean in this study with more insufficient conditions for patient participation. There is a lack of concurrence between patients' preferences for, and experiences of, patient participation, especially for women. Further efforts to facilitate person-centred engagement are required, along with research on what strategies can overcome human and organisational barriers. The PERHIT- trial was registered with ClinicalTrials.gov: NCT03554382.

A Randomized Controlled Trial of the Implementation of BREASTChoice, a Multilevel Breast Reconstruction Decision Support Tool With Personalized Risk Predictiona.

To implement the BREASTChoice decision tool into the electronic health record and evaluate its effectiveness. BREASTChoice, is a multilevel decision tool that: 1) educates patients about breast reconstruction; 2) estimates personalized risk of complications; 3) clarifies patient preferences; and 4) informs clinicians about patients' risk and preferences. A multisite randomized controlled trial enrolled adult women with stage 0-III breast malignancy undergoing mastectomy. Participants were randomized to BREASTChoice or a control website. A survey assessed knowledge, preferences, decisional conflict, shared decision-making, preferred treatment, and usability. We conducted intent-to-treat (ITT), per-protocol (PP) analyses (those randomized to BREASTChoice who accessed the tool), and stratified analyses. 23/25 eligible clinicians enrolled. 369/761 (48%) contacted patients enrolled and were randomized. Patients' average age was 51 years; 15% were older than 65. BREASTChoice participants had higher knowledge than control participants (ITT: mean 70.6 vs. 67.4, P=0.08; PP: mean 71.4 vs. 67.4, P=0.03), especially when stratified by site (ITT: P=0.04, PP: P=0.01), age (ITT: P=0.04, PP: P=0.02), and race (ITT: P=0.04, PP: P=0.01). BREASTChoice did not improve decisional conflict, match between preferences and treatment, or shared decision-making. In PP analyses, fewer high-risk patients using BREASTChoice chose reconstruction. BREASTChoice had high usability. BREASTChoice is a novel decision tool incorporating risk prediction, patient education, and clinician engagement. Patients using BREASTChoice had higher knowledge; older adults and those from racially minoritized backgrounds especially benefitted. There was no impact on other decision outcomes. Future studies should overcome implementation barriers and specifically examine decision outcomes among high-risk patients.

ASO Visual Abstract: Patient Preference for Surgical Methods for Ipsilateral Breast Tumor Recurrence.

ASO Visual Abstract: Patient Preference for Surgical Methods for Ipsilateral Breast Tumor Recurrence.

Ablation of anomalous mitral annular pathways via transradial access: early hospital discharge due to the covid-19 pandemic

Abstract Introduction Wolff-Parkinson-White (WPW) syndrome arises from the conduction through accessory pathways (AP) connecting the atria and ventricles, bypassing the atrioventricular node. Radiofrequency catheter ablation of AP is the recommended treatment, often performed via transradial access. This approach is widely utilized in percutaneous coronary intervention due to its safety, effectiveness, patient preference, cost-effectiveness, and simplicity. Our study aims to present the results of AP ablation in the mitral annulus through transradial access amid the Covid-19 pandemic, marked by hospital bed scarcity and the need for early discharge. Materials and Methods Between May 2020 and December 2021, eight cases of transradial AP ablation in the mitral annulus were conducted. The service had previously achieved success in 16 transradial ablation cases. Among the eight cases during the pandemic, 62.5% were male, aged 24 to 56 years, all experiencing tachycardic palpitations and pre-syncope with a history of hospitalization. In 25% of cases, syncope episodes occurred. Patients were on propafenone, with no structural heart disease. Covid-19 tests were negative. Radial and ulnar artery perfusion integrity was assessed using the Allen maneuver and arterial Doppler. The right radial artery was used in 100% of cases. Sixty-two point five percent of accessory pathways were in anterolateral positions, and 37.5% were left posteroseptal. The approach was through the right radial artery, under local anesthesia, with venous sedation, using a 7Fr introducer sheath and positioning of the explorer catheter. Mapping was conducted during sinus rhythm, and adenosine IV tests followed ablation. The catheter was removed, and a pneumatic local dressing was applied for 2 hours, followed by a conventional dressing change for 24 hours. Results Ablation was successful in all eight patients. The procedure time ranged from 40 to 80 minutes, with an average of 55 minutes. Two to four radiofrequency applications were applied for a total of 2 minutes, using 55 W energy and a temperature of 55 to 60°C. No complications occurred during or after the procedure. Patients were discharged three hours post-intervention. Follow-up included reviews every four months, ECGs without ventricular pre-excitation, asymptomatic patients without antiarrhythmic medication, and no complications at the puncture site one year post-procedure. Conclusion Although based on a small sample of eight cases, and acknowledging the need for a larger sample to establish the procedure as an alternative, considering possible operator experience influence, we conclude that radial access proved effective and safe in this patient group. Its usage was exceptional, specifically in the context of a pandemic with crowded hospitals. Selection criteria and comparisons with other alternatives should be adopted for analyzing its potential future use.Transradial approachAblation catheter in the mitral plane

P.028 Exploring young adult stroke patients’ lived experience, healthy lifestyle habits, and recommendations for designing innovative brain care-related initiatives

Background: Over the past decade, worldwide stroke incidence has been increasing among young adults (≤65years), which has implications during the most dynamic period of their life. There is a dearth of research exploring young adults stroke patients’ experiences, healthy lifestyle habits, preferences, and recommendations for brain care-related initiatives. The study aimed to gain knowledge and a deeper understanding of young adult stroke patients’ experiences, lifestyle habits, and support needs for brain care-related education and interventions. Methods: A descriptive qualitative study was used. Participants who took part in the quantitative phase of a larger mixed methods study (n=103 that expressed an interest in the qualitative phase, were invited to take part in semi-structured focus groups. Simultaneous data collection and analysis are being conducted. Data are being analyzed using inductive thematic analysis outlined by Braun and Clarke (2006). Results: Findings will be available by May 20, 2024. Conclusions: Study findings will be essential to 1) mobilize an understanding of young adult stroke patients’ lived experience; 2) reconceptualize the current model of stroke care and services that is traditionally geared towards older adults; and 3) inform the development of brain care-related education and interventions to meet the unique needs, priorities, and preferences of young adult stroke patients.

Electronic 1 year follow up after ablation

Abstract Background Several studies have shown that phone calls are an effective but resource intensive Follow-up (FU) method to collect patient reported data (PROM) after discharge from hospital. Regarding patient preference for FU, who has been ablated for atrial fibrillation (AF), most of the AF patients favoured a questionnaire with a stamped return envelope. In 2019 the National registry for ablation and electrophysiology in Norway (AblaNor) was established. All patients who have been in an EP lab receive an electronic FU questionnaire (ePROM) 1 year after the date of ablation. In Norway, it has been developed a technical solution which allows data submitted from the patient to be registered in the Health Network,"ePROM engine". Little is known about the functionality and response rate of electronic solutions. Purpose The aim of our study was to investigate an electronic FU approach in general and in different patient subgroups from AblaNor. Method We used data from the National register of ablation and electrophysiologi in Norway, Ablanor. The data are FU questionnaire who all patients received 1 year after ablation. All questionares are the same, independent diagnosis group. The patients received the FU questionnaires electronically via Helse Norge.no. The data is based on registrations from 2020-21. Results The data shows that amongst the 7169 selected procedures in 2020 and 2021, 5235 completed the ePROM form . There is a difference in response rates for both age and sex alone. Younger women have a higher response rate than men of same age, whereas in older age groups,men have higher response rates than women . Patients who have been ablated for AF have a higher respons rate than other procedures. Patients who have only undergone an electrophysiological examination (EP) have the lowest response rate. Conclusion Mandatory follow-up 1 year after completion of the procedure takes place in electronic form and contains simple registration of PROMS. The response rate among patients is 78% over the two years. This indicates an extremely high level of digital competence and motivation among patients to provide feedback for completed treatment. This shows that there is a discrepancy for FU regarding patient who has been ablated for atrial fibrillation (AF) . Abbreviations RFA: Radiofrequency Ablation; FU: Follow-up; AF: Atrial fibrillation; PROM: Patient reported outcome Measurement

Do Shared Decision-Making and Patient Decision Aids Take Patient's Preferences Seriously?

Most clinical guidelines for the assessment and management of atrial fibrillation emphasize the importance of decision support provided by Patients Decision Aids, but they are to be used and evaluated only in the context of Shared Decision-Making. Detailed examination of 10 clinical decision support tools reveals that many do not engage with patient's preferences at all. Only two take them seriously in terms of their formation, elicitation and processing, aimed at identifying the optimal personalised decision for the patient. This failure is traced to a reluctance to accept the ontological nature of preferences, as instantiations of comparative magnitudes, and to set them in an analytical framework that facilitates their transparent integration with individualised evidence.

#1222 Crovalimab: patient preferences and ongoing phase III COMMUTE trials in acute haemolytic uraemic syndrome (aHUS)

Abstract Background and Aims aHUS is a rare, life-threatening, complement-mediated disease characterised by thrombotic microangiopathies (TMAs). Existing C5 inhibitor (C5i) therapies, such as eculizumab (ecu) and ravulizumab (ravu), are effective for aHUS management but can be burdensome in both adults and children, typically requiring regular intravenous (IV) infusions every 2 weeks (Q2W, ecu) or every 8 weeks (ravu). Crovalimab (crova), a novel C5i with low-volume, subcutaneous (SC) administration every 4 weeks (Q4W), allows for convenient self-administration outside of a healthcare setting. Crova is currently being evaluated in two ongoing global, Phase III, single-arm trials in aHUS: COMMUTE-a (NCT04861259) and COMMUTE-p (NCT04958265). The efficacy and safety of crova have also been evaluated in patients (pts) with paroxysmal nocturnal haemoglobinuria (PNH), another complement-mediated rare blood disorder, in the global, randomised, Phase III COMMODORE 1 (NCT04432584) and COMMODORE 2 (NCT04434092) trials (Röth EHA 2023; #S181, Scheinberg EHA 2023; #S183). Here, we report pt preference data from COMMODORE 1 and 2. Method COMMODORE 1 and 2 enrolled C5i-experienced and C5i-naive pts with PNH, respectively. Pts were randomised 1:1 in COMMODORE 1 and 2:1 in COMMODORE 2 to receive crova (weight-based tiered dosing regimen consisting of loading doses followed by SC Q4W maintenance) or ecu (900 mg IV Q2W) over a 24-week primary treatment period. After completing 24 weeks of treatment, all pts received crova if continuing the trial. Treatment preference was assessed in adult pts using the validated Patient Preference Questionnaire (PPQ) after 17 weeks of crova treatment in C5i-experienced pts randomised to crova in COMMODORE 1 and in pts initially randomised to ecu who switched to crova at Week 25 in both COMMODORE 1 and 2. COMMUTE-a is enrolling pts with aHUS aged ≥12 years and weighing ≥40 kg (N ≈ 80), while COMMUTE-p is enrolling pts with aHUS aged ≥28 days to <18 years and weighing ≥5 kg (N ≈ 45). Both studies are enrolling 3 cohorts (Fig. 1): (1) Naive: pts not previously treated with a C5i (n ≈ 40 in COMMUTE-a; n ≈ 20 in COMMUTE-p), (2) Switch: pts switching from ecu or ravu (n≈40 in COMMUTE-a; n ≥ 20 in COMMUTE-p), (3) C5 polymorphism cohort in COMMUTE-a: pts with known C5 polymorphisms (n ≤ 5); pretreated cohort in COMMUTE-p: pts previously treated with and discontinued ecu or ravu (n ≤ 10). In both COMMUTE studies, pts will receive weight-based tiered crova dosing consisting of loading doses (IV and SC) followed by SC Q4W maintenance (or Q2W if <20 kg) from Week 5 onward. The primary efficacy objective of both studies is to assess the proportion of C5i-naive pts with complete TMA response from baseline to Week 25. Secondary efficacy endpoints include change from baseline in dialysis requirement status and estimated glomerular filtration rate. Safety, pharmacokinetics, immunogenicity, biomarkers, and pt-reported fatigue will also be assessed. Treatment preference will be assessed using the PPQ in pts ≥12 years old and in caregivers of children <12 years old. Results 89 pts were randomised in COMMODORE 1 (crova: n = 45; ecu: n = 44) and 204 in COMMODORE 2 (crova: n = 135; ecu: n = 69). Of pts randomised to crova in COMMODORE 1, 33 (85%) of 39 pts assessed at Week 17 preferred crova over ecu. Of pts randomised to ecu who switched to crova after the primary treatment period, 27 (96%) of 28 pts who answered the questionnaire in COMMODORE 1 and 32 (84%) of 38 in COMMODORE 2 preferred crova (Fig. 2). The top reasons selected for crova preference over ecu were that the treatment required fewer hospital visits, was easier to administer, took less time to administer, and provided better quality of life (Kulasekararaj ASH 2023; #5628). COMMUTE-a and COMMUTE-p are currently open for recruitment in 17 and 14 countries, respectively. Conclusion Crova was preferred to ecu by most C5i-naive and switch pts with PNH in COMMODORE 1 and 2, largely due to faster, easier administration. Crova, with SC Q4W (or Q2W in pts <20 kg with aHUS) self-administration, can potentially reduce treatment burden vs currently approved C5 is in aHUS. The COMMUTE-a and COMMUTE-p trials evaluating crova in aHUS are currently enrolling.

Patient preference and acceptability of self-sampling for cervical screening in colposcopy clinic attenders: A cross-sectional semi-structured survey.

Low vaginal self-sampling has been pioneered as an important development to improve uptake of cervical screening globally. Limited research is available in specific patient groups in the UK exploring views around self-sampling to detect high-risk human papillomavirus (hrHPV) DNA. Therefore, we explored patient views to support development of a novel point-of-care self-sampling cervical cancer screening device, by undertaking a cross-sectional semi-structured questionnaire survey to explore preferences, acceptability, barriers and facilitators around self-sampling. Patients attending a colposcopy clinic, 25-64 years old, were invited to participate after having carried out a low vaginal self-sample using a regular flocked swab. Participants self-completed an anonymous 12-point questionnaire. Quantitative data were analysed in MS Excel and Graphpad Prism, and qualitative data with Nvivo. We recruited 274 patients with a questionnaire response rate of 76%. Acceptability of self-sampling was high (95%, n = 187/197; Cronbachs-α = 0.778). Participants were asked their choice of future screening method: a) low vaginal self-sampling, b) healthcare professional collected vaginal swab, c) cervical brush sample with healthcare professional speculum examination, or d) no preference. Preferences were: a) 37% (n = 74/198), b) 19% (n = 37/198); c) 9% (n = 17/198), and d) 35% (n = 70/198), showing no single option as a strong preference. Key motivators were: Test simplicity (90%, n = 170/190), speed (81%, n = 153/190) and less pain (65%, n = 123/190). Barriers included lack of confidence taking the sample (53%, n = 10/19), resulting in preference for a healthcare professional sample (47%, n = 9/19). Whilst self-sampling showed high acceptability, lack of strong preference for screening method may reflect that respondents attending colposcopy are already engaged with screening and have differing perception of cervical cancer risk. This group appear less likely to 'switch' to self-sampling, and it may be better targeted within primary and community care, focusing on under-screened populations. Any shift in this paradigm in the UK requires comprehensive education and support for patients and providers.

Pregnancy Outcomes of Nifedipine Compared With Labetalol for Oral Treatment of Mild Chronic Hypertension

OBJECTIVE: To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial. METHODS: We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140–159/90–104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment: labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine. Although active compared with standard care groups were randomized, medication assignment within the active treatment group was not random but based on clinician or patient preference. The primary outcome was the occurrence of superimposed preeclampsia with severe features, preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The key secondary outcome was small for gestational age (SGA) neonates. We also compared medication adverse effects between groups. Relative risks (RRs) and 95% CIs were estimated with log binomial regression to adjust for confounding. RESULTS: Of 2,292 participants analyzed, 720 (31.4%) received labetalol, 417 (18.2%) received nifedipine, and 1,155 (50.4%) received no treatment. The mean gestational age at enrollment was 10.5±3.7 weeks; nearly half of participants (47.5%) identified as non-Hispanic Black; and 44.5% used aspirin. The primary outcome occurred in 217 (30.1%), 130 (31.2%), and 427 (37.0%) in the labetalol, nifedipine, and standard care groups, respectively. Risk of the primary outcome was lower among those receiving treatment (labetalol use vs standard adjusted RR 0.82, 95% CI, 0.72–0.94; nifedipine use vs standard adjusted RR 0.84, 95% CI, 0.71–0.99), but there was no significant difference in risk when labetalol was compared with nifedipine (adjusted RR 0.98, 95% CI, 0.82–1.18). There were no significant differences in SGA or serious adverse events between participants receiving labetalol and those receiving nifedipine. CONCLUSION: No significant differences in predetermined maternal or neonatal outcomes were detected on the basis of the use of labetalol or nifedipine for treatment of chronic hypertension in pregnancy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02299414.

#596 The Borg Scale—efficient and safe for exercise prescription in self-administered balance and strength exercise in patients with CKD

Abstract Background and Aims With the continued rise in chronic kidney disease (CKD), there is a critical need for sustainable, home-based exercise interventions. While supervised, centre-based exercise improves physical performance in CKD patients, unsupervised, self-administered exercise poses challenges in ensuring adherence, safety, and efficacy. This study investigates the Borg Rating of Perceived Exertion (RPE) scale, a subjective measure of exertion, as a method for prescribing and monitoring the intensity of balance and strength exercise in non-dialysis dependent CKD patients. The aims of this study were: Method This sub study of the RENEXC-trial included 148 patients with CKD stages 3-5, with a mean age of 66 ± 14 years and mean measured GFR of 22 ± 8 ml/min/1.73 m2. Patients were prescribed 90 minutes/week of balance or strength exercise at a Borg RPE of 13-17 (corresponding to an exercise intensity of somewhat hard to very hard), along with 60 minutes/week of endurance exercise. Exercise programs were individually prescribed by a physiotherapist according to randomization and each patient's baseline performance and were performed at home or in a gym according to the patient's preference. Duration and RPE of the performed exercise were reported in an exercise diary. Progress was monitored by the physiotherapist through phone contact, every week for the first three months of the study and every other week for the rest of the study year. The continuous follow up provided motivation and enabled adjustments of the exercise program to maintain the goal RPE, adapt intensity and the weekly duration of exercise. Outcome measures included the Berg Balance Scale (BBS) and Functional Reach Test (FRT), the 30-second sit-to-stand test (30STS) and isometric quadriceps strength (IQS). Balance and strength measures were evaluated at baseline and after 12 months of exercise. Previous publications of the RENEXC-trial showed no difference between patients who performed balance exercise and patients who performed strength exercise; therefore, this sub-study analysed all included patients as one group. Results Of 148 participants, 112 completed the study. At 12 months, 79% reported performed exercise, with 86% of these patients adhering to the prescribed intensity. The median (25th-75th percentile) exercise intensity was a RPE of 14 (13-15) on the Borg scale, and the median (min-max) exercise duration was 48 (0-241) minutes/week. Only 18% of the patients reached the 90-minute/week target. No exercise-related incidents were reported. Significant improvements were noted in BBS (p = 0.0464), FRT (p = 0.009), 30STS (p = 0.047), and IQS (right/left p = 0.022 / p = 0.049). Conclusion The Borg RPE scale is an effective and safe method for prescribing and monitoring self-administered balance and strength exercise in patients with CKD. Using the Borg scale for prescribing and monitoring exercise intensity during balance and strength exercise resulted in a good level of adherence to the 12-months exercise program and the prescribed exercise intensity. As no exercise related incidents were reported, we conclude that the self-administered exercise was safe to perform. Significant improvements in balance and strength were observed with a moderate to high exercise intensity prescription within a wide range of performed weekly duration of exercise, suggesting the Borg scale's value in exercise prescription in both well- and deconditioned patients with CKD. These findings show that the integration of the Borg scale into routine exercise prescription in people with CKD can promote patient autonomy and efficient resource utilization in healthcare.

Nabilone for Chronic Non-Cancer Pain

What Is the Issue? Chronic pain is pain that lasts beyond 3 months. Chronic non-cancer pain conditions include osteoarthritis, low back pain, musculoskeletal pain, fibromyalgia, and neuropathic pain. Approximately 1 in 5 people in Canada live with chronic pain. Nabilone (a cannabinoid) is indicated for the management of severe nausea and vomiting associated with cancer chemotherapy. Nabilone is also used in the management of chronic non-cancer pain. It is important to understand the potential benefits and harms of nabilone in people living with chronic non-cancer pain to support decision-making. What Did We Do? We sought to identify, summarize, and critically appraise literature comparing the clinical effectiveness of nabilone and placebo or alternative pharmacological options. We also searched for evidence-based guidelines that provide recommendations about the use of nabilone for the treatment of chronic non-cancer pain. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2015. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? We found 1 overview of reviews and 2 systematic reviews that assessed the clinical efficacy and safety of nabilone for the treatment of chronic non-cancer pain. The evidence on the clinical efficacy of nabilone was mixed with some studies reporting an improvement in pain in those treated with nabilone versus placebo or active comparators and other studies reporting no difference between groups. Adverse events were more common in people living with chronic non-cancer pain who received nabilone than those who received placebo, ibuprofen, or amitriptyline. Adverse events were more common in those who received dihydrocodeine or gabapentin than nabilone. It is uncertain if nabilone is an effective treatment for people living with chronic non-cancer pain due to the varied results and methodological limitations of the included studies. We found 1 guideline that included a recommendation specific to nabilone and 2 guidelines that included recommendations on the use of cannabinoids in general. One guideline recommends against the use of nabilone for chronic pain, 1 guideline recommends offering a trial of non-inhaled cannabinoids (such as nabilone) for people living with chronic pain, and 1 guideline suggests cannabinoids be avoided in people with osteoarthritis and low back pain and discussed with people with neuropathic pain. What Does This Mean? Due to the uncertainty of the clinical evidence, decision-makers may wish to consider other factors such as costs, equity, and patient values and preferences when making decisions on the use of nabilone for people living with chronic non-cancer pain. Future high-quality, longer-term (e.g., RCT with follow-up studies) studies are needed to understand the efficacy and safety of nabilone for the treatment of people living with chronic non-cancer pain.

Hereditary urolithiasis at a young age on the example of a clinical case

To study the clinical features and course of urolithiasis in a young female patient, to suggest the cause of the simultaneous sudden formation of kidney stones in the patient and her mother within a year. Main provisions: urolithiasis (KSD) is one of the most common diseases of the urinary tract. The relevance of effective treatment of this problem arises from the steady increase in the number of patients around the world, especially in Russia. According to many researchers, this trend is due to the increase in life expectancy, changes in lifestyle and nutrition, as well as changes in the composition of water and climate conditions. Approximately two thirds of patients, develop the disease at the age from 30 to 60. Characteristic features of urolithiasis are repeated recurrence and a high incidence of complex forms, which complicates the treatment of such patients significantly. Diagnostic algorithm and treatment of urolithiasis are demonstrated in this article on the example of a medical history of a young patient with rapidly progressing urolithiasis. A similar disease with the same symptoms of urolithiasis was revealed in the patient’s parent a week later, which suggests a hereditary predisposition factor or manifestation of urolithiasis being dependent on the hard drinking water. The simultaneous sudden formation of kidney stones within a year in a patient at a young age and her mother emphasizes the hereditary nature of the disease. Probably, the peculiarities of national cuisine or the individual preferences of patients played a significant role in the development of the pathology. The composition of drinking water is extremely important. The patient is from the Republic of Bashkortostan, where water hardness is 7.8–8.0, which does not meet the standard.