Recall Of Symptoms Research Articles

5.18 Understanding and Improving ADHD Symptom Recall: An Investigation of Temperament and Childhood Symptom Recall Over Time

Symptom onset before age 12 years is needed for an ADHD diagnosis. The current study aimed to examine symptom recall and avenues to improve this recall. This was accomplished through comparing retrospective recall of ADHD symptoms to actual past report of symptoms and examining retrospective report of temperament in relation to childhood ADHD symptoms. It is hypothesized that: 1) retrospective recall of ADHD symptoms will be significantly lower than actual past report; 2) higher levels of current symptoms will be associated with higher levels of retrospectively recalled symptoms; and 3) retrospective reports of temperament traits will be associated with childhood ADHD symptoms. Data were collected from 50 parents and 40 children (Time 2 age M = 13.63 years) who had previously completed a measure of ADHD symptoms (Time 1 age M = 10.72 years). Parents and children completed a retrospective recall of previous child ADHD symptoms, measures of current child ADHD symptoms, and a retrospective report of child temperament. Time 1 childhood ADHD symptoms were higher than Time 2 retrospective recall for both parent (attention F1,47 = 5.98, p = 0.02, η2 = 0.11; hyperactivity F1,47 = 3.71, p = 0.06, η2 = 0.07) and child report (attention F1,38 = 41.01, p < 0.001, η2 = 0.52); hyperactivity (F1,38 = 7.76, p = 0.01, η2 = 0.17). Current ADHD symptoms were the strongest predictor of childhood symptoms for parent and self-report of attention problems (t = 5.29, β = 0.66, p ≤ 0.001; t = 4.07, β = 0.50, p ≤ 0.001) and parent-reported hyperactivity (t = 5.70, β = 0.68, p ≤ 0.001). Reward dependence was associated with parent report of children’s childhood attention problems (t = 1.73, β = 0.27, p = 0.09) and hyperactivity (t = 2.03, β = 0.31, p = 0.05), as well as self-reported childhood hyperactivity (t = –1.20, β = –0.22, p = 0.24). Novelty-seeking was associated with parent report of children’s childhood attention problems (t = 1.28, β = 0.23, p = 0.20) and self-reported childhood attention problems (t = 2.12, β = 0.43, p = 0.04) and hyperactivity (t = 1.10, β = 0.22, p = 0.28). Parent and children underreport previous symptoms of ADHD. Assuming these findings can be replicated in a larger, more diverse sample, assessing child temperament, specifically related to motivational processes and reward seeking, may aid ADHD diagnostic processes.

Hypoglycemia symptoms are reduced in hospitalized patients with diabetes

Hospitalized patients with diabetes are have an impaired ability to detect hypoglycemia events. The purpose of this study was to compare hypoglycemia symptom scores (HSS) in hospitalized patients with diabetes after a documented blood glucose (BG) <70mg/dl with recalled HSS with outpatient hypoglycemia events. Non-critically ill hospitalized patients with diabetes grouped as symptomatic (n=23) or asymptomatic (n=32) at time of index hypoglycemia completed a standardized HSS-Questionnaires (HSS-Q) related to the inpatient event and to recall of symptoms with outpatient hypoglycemia. After controlling for BG at time of index hypoglycemia (49.8±11.4 vs. 57.4±6.8mg/dl, p=0.02), symptomatic patients reported higher HSS than asymptomatic patients with the inpatient event (11.6±7.3 vs. 1.5±3.4, p<0.001) and in the outpatient setting (13.9±8.6 vs. 10.1±10.6, p<0.01). Recurrent hypoglycemia was more frequent in asymptomatic patients (13% vs. 44%, p=0.015) during the hospitalization. Compared to symptomatic patients, asymptomatic patients had lower inpatient and outpatient HSS and more frequent recurrent hypoglycemia events. These results suggest modification of glycemic management strategies in high risk patients to reduce risk for hypoglycemia events.

Pulse oximetry to predict the onset of acute mountain sickness: a literature review

Acute mountain sickness (AMS) is a common illness affecting people ascending to high altitudes. AMS may progress rapidly, and can be fatal if symptoms are neglected, acclimatisation processes fail or if the ascent continues. For many patients with AMS or AMS symptoms, medical assistance is given by mountain rescue and allied health professionals. Currently, the prediction of AMS in the high-altitude environment relies upon recognising and tracking subjective symptoms. However, owing to psychophysical factors commonly associated with high-altitude travel, such as stress and fatigue, subjective symptom recall is innately at risk of bias. There is no objective method for predicting AMS. This scoping literature review analyses the accuracy of pulse oximetry as a tool for predicting the onset of AMS.

Artificial Intelligence Algorithm with ICD Coding Technology Guided by the Embedded Electronic Medical Record System in Medical Record Information Management.

The study aims to explore the application of international classification of diseases (ICD) coding technology and embedded electronic medical record (EMR) system. The study established an EMR information knowledge system and collected the data of patient medical records and disease diagnostic codes on the front pages of 8 clinical departments of endocrinology, oncology, obstetrics and gynecology, ophthalmology, orthopedics, neurosurgery, and cardiovascular medicine for statistical analysis. Natural language processing-bidirectional recurrent neural network (NLP-BIRNN) algorithm was used to optimize medical records. The results showed that the coder was not clear about the basic rules of main diagnosis selection and the classification of disease coding and did not code according to the main diagnosis principles. The disease was not coded according to different conditions or specific classification, the code of postoperative complications was inaccurate, the disease diagnosis was incomplete, and the code selection was too general. The solutions adopted were as follows: communication and knowledge training should be strengthened for coders and medical personnel. BIRNN was compared with the convolutional neural network (CNN) and recurrent neural network (RNN) in accuracy, symptom accuracy, and symptom recall, and it suggested that the proposed BIRNN has higher value. Pathological language reading under artificial intelligence algorithm provides some convenience for disease diagnosis and treatment.

P55. Do patients accurately recall symptoms pre and post lumbar epidural steroid injection: A cohort study of recall bias in patient reported outcomes

<h3>BACKGROUND CONTEXT</h3> Although patient-reported outcomes (PROs) have become important in the evaluation of spine surgery patients, the accuracy of patient recall of pre or post-intervention symptoms following epidural steroid injection remains unknown. <h3>PURPOSE</h3> The purpose of this study was 1) to characterize the accuracy of patient recollection of back/leg pain following epidural steroid injection; 2) characterize the direction and magnitude of recall bias; 3) characterize factors that impact patient recollection. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort study. <h3>PATIENT SAMPLE</h3> Consecutive patients 18 years and older undergoing lumbar epidural steroid injection presenting with neurogenic claudication or radiculopathy secondary to degenerative lumbar spinal stenosis <h3>OUTCOME MEASURES</h3> Numeric pain scale (NPS) for back pain and leg pain. <h3>METHODS</h3> Using standardized questionnaires, we recorded numeric pain scores (NPS) for patients undergoing lumbar epidural steroid injections at our institution. Baseline pain scores were obtained prior to injection, 4 hours and 24-hours post-injection. At a minimum of 2 weeks following the injection, patients were asked to recall their symptoms pre-injection and at 4 hours and 24-hours post-injection. Actual and recalled scores at each time point were compared using paired t-tests. Multivariable linear regression was used to identify factors that impacted recollection. <h3>RESULTS</h3> Sixty-one patients with a mean age of 61.4 years (56% female) were included. Compared to their pre-injection pain score, patients showed considerable improvement at both 4 hours [Mean Difference (MD) = 2.18, 95% Confidence Interval (CI) 1.42 to 2.94)) and 24 hours (MD = 2.64, 95% CI 1.91 to 3.34) post-injection. Patient recollection of pre-injection symptoms was significantly more severe than actual (MD = 1.39, 95% CI 4.82 to 6.08). The magnitude of recall bias was moderate to severe and exceeded the minimal clinically important difference (MCID). Patient recollection of symptoms was also significantly more severe than actual at 24 hours (MD = 0.63, 95% CI -1.17 to -0.07), mild magnitude of bias that did not exceed MCID. No significant recall bias was noted on patient recollection of post-injection symptoms at 4 hours (MD = 0.41, 95% CI -1.05 to 0.23). Linear regression models for differences between actual and recalled pain scores reveal that for recall at 4 hours post-injection, older patients were better at recalling pain. <h3>CONCLUSIONS</h3> Relying on patient recollection does not provide an accurate measure of pre-injection status after lumbar epidural steroid injection, although patients did recall their 4 hour and 24-hour post-injection status. These findings support previous studies indicating that relying on patient recollection does not provide an accurate measure of pre-intervention symptoms. Patient recollection of post-intervention symptoms, however, may have some clinical utility and requires further study. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Clusters of community-dwelling individuals empirically derived from stool diaries correspond with clinically meaningful outcomes.

Functional gastrointestinal disorders (FGIDs) are diagnosed according to expert consensus criteria based on recall of symptoms over periods of 3 months or longer. Whether the expert opinion concords with underlying disease process and whether individual recall is accurate are both in doubt. This study aimed to identify naturally occurring clusters of individuals with respect to symptom pattern, evaluate their significance, compare cluster profiles with expert opinion and evaluate their temporal stability. As part of a random population study of FGID-related symptoms, we first explored the use of prospective stool and symptom diaries combined with empirical grouping of individuals into clusters using nonhierarchical cluster analysis. The analysis identified two clusters of individuals, one of which was characterized by elevated scores on all domains of symptoms (26% of the sample) and one that was low to average on all domains (74% of the sample). Cluster membership was found to be stable over a long interval. Clusters were found to differ on most domains of quality-of-life (d = 0.46-0.74), self-rated health (d = -0.42) and depression (d = -0.42) but not anxiety. Prevalence of clinically diagnosed irritable bowel syndrome (IBS) was higher in the more impacted cluster (33%) compared with the healthy cluster (13%; P < 0.0001). A naturalistic classification of individuals challenges consensus criteria in showing that some IBS individuals have a symptom experience not unlike health. The proposed approach has demonstrated temporal stability over time, unlike consensus criteria. A naturalistic disease classification system may have practical advantages over consensus criteria when supported by a decision-analytic system.

Mismatch of corneal specialists\u2019 expectations and keratoconus knowledge in general ophthalmologists - a prospective observational study in Switzerland

BackgroundTo assess whether Swiss general ophthalmologists have the minimal keratoconus knowledge that corneal specialists would expect them to have.MethodsCorneal specialists defined “minimal keratoconus knowledge” (MKK) with respect to definition, risk factors, symptoms and possible treatment options of keratoconus. A telephone interview survey was conducted among one hundred ophthalmologists (mean age 51.9 years (SD 9.5), 60 % male) from the German-speaking part of Switzerland. For each participant, years of work experience, number of keratoconus patients seen per year and access to a topography device were obtained. We calculated the proportion of MKK and examined in multivariate analyses whether ophthalmologists with access to topography and with greater work experience performed better than other groups.ResultsNo single ophthalmologist had MKK. The mean MKK was 52.0 %, and the range was 28.6–81.0 %. Per 10 years of working in private practice, the MKK decreased by 8.1 % points (95 % CI: -14.2, -2.00; p = 0.01). Only 24 % of participants correctly recalled the definition of keratoconus, 9 % all risk factors, 5 % all symptoms and 20 % all treatment modalities. The MKK values were not associated with the number of keratoconus patients seen per year and the availability of topography to diagnose keratoconus.ConclusionsThere is a substantial mismatch between corneal specialist’ expectations and general ophthalmologists’ knowledge about keratoconus. The low recall of symptoms and risk factors may explain why ophthalmologists diagnose relatively few cases of keratoconus, resulting in inefficient care delivery and delayed intervention.

"Do I Have a Memory Problem? I Can't Recall": An Evaluation of Measurement Invariance in Subjective Reporting of Memory Symptoms among Persons with and without Objective HIV-Associated Memory Impairment.

Memory symptoms and objective impairment are common in HIV disease and are associated with disability. A paradoxical issue is that objective episodic memory failures can interfere with accurate recall of memory symptoms. The present study assessed whether responses on a self-report scale of memory symptoms demonstrate measurement invariance in persons with and without objective HIV-associated memory impairment. In total, 505 persons with HIV completed the Prospective and Retrospective Memory Questionnaire (PRMQ). Objective memory impairment (n = 141) was determined using a 1-SD cutoff on clinical tests of episodic memory. PRMQ measurement invariance was assessed by confirmatory factor analyses examining a one-factor model with increasing cross-group equality constraints imposed on factor loadings and item thresholds (i.e., configural, weak, and strong invariance). Configural model fit indicated that identical items measured a one-factor model for both groups. Comparison to the weak model indicated that factor loadings were equivalent across groups. However, there was evidence of partial strong invariance, with two PRMQ item thresholds differing across memory impairment groups. Post hoc analyses using a 1.5-SD memory impairment cutoff (n = 77) revealed both partial weak and partial strong invariance, such that PRMQ item loadings differed across memory groups for three items. The PRMQ demonstrated a robust factor structure among persons with and without objective HIV-associated memory impairment. However, on select PRMQ items, individuals with memory impairment reported observed scores that were relatively higher than their latent score, while items were more strongly associated with the memory factor in a group with greater memory impairment.

Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: A pilot study.

Patient-reported outcome measures (PROMs) for assessment of chronic rhinosinusitis (CRS) employ a variety of recall periods and response scales for reporting CRS symptom burden. CRS patient perspective is unknown with respect to recall periods and response scales in PROMs. Cross-sectional study. Tertiary rhinology clinic. Sixty three adults with CRS. Participants were asked to choose which CRS symptom recall period-1day, 2weeks, 1month or greater than 1month-was most reflective of their current disease state and best to base treatment recommendations (including surgery) upon. Participants were also asked to report which of six response scales (one visual analogue scale [VAS] and five Likert scales ranging from four to eight items) were easiest to use and understand, and most preferred. A majority of participants felt the current state of their CRS symptoms was best reflected by a recall period of 2weeks to 1month; however, patients preferred that recommendations about treatments, including endoscopic sinus surgery, be determined by symptoms experienced over at least a one-month period. Participants generally found the VAS and seven-item Likert scale to be the easiest to use and understand, and their most preferred scales. No patient characteristics associated with preferences for recall periods or response scales. Future PROMs for CRS symptoms should consider assessment of symptoms over a one-month time frame and use either a VAS or seven-item Likert response scale to optimally balance reflection of current disease state, need for intervention and patient preference.

COVID-19 infection in patients with mast cell disorders including mastocytosis does not impact mast cell activation symptoms

COVID-19 infection in patients with mast cell disorders including mastocytosis does not impact mast cell activation symptoms

Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study

BackgroundSeveral factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors.MethodsA cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15–17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females.ResultsOf 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report ‘feeling scared’ as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report ‘embarrassment’, ‘worry about wasting doctor’s time’ and ‘difficulty arranging transport’. This was also seen for recalling risk factors, where ‘embarrassment’ and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting ‘embarrassment’ and ‘feeling scared’.ConclusionsThe most commonly perceived barriers to seeking cancer care were ‘feeling scared’ and ‘feeling worried about what the doctor might find’, followed by practical and service barriers. Females and adolescents were more likely to report ‘fear’ as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.

PH Professional Network: The Benefits and Challenges in Delivering Telehealth in Pediatric Pulmonary Hypertension

PH Professional Network: The Benefits and Challenges in Delivering Telehealth in Pediatric Pulmonary Hypertension

Gastrointestinal symptom and stress recall survey in frontline healthcare workers after consumption of a combined quebracho/conker tree/M. balsamea willd extract during the COVID-19 pandemic

Gastrointestinal symptom and stress recall survey in frontline healthcare workers after consumption of a combined quebracho/conker tree/M. balsamea willd extract during the COVID-19 pandemic

The Accuracy of Retrospective Recall of Childhood ADHD: Results from a Longitudinal Study

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset condition that may continue into adulthood. When assessing adult patients, clinicians usually rely on retrospective reports of childhood symptoms to evaluate the age-of-onset criterion. Since inaccurate symptom recall may impede the diagnosis and treatment of ADHD, knowledge about the factors influencing retrospective reports is needed. This longitudinal study investigated (a) the accuracy of retrospective symptom ratings by adult participants with a childhood diagnosis of ADHD (self-ratings) and parents or significant others (proxy ratings), and (b) the influence of current ADHD symptom severity and ADHD-associated impairments on retrospective symptom ratings. Participants (N = 55) were members of the Cologne Adaptive Multimodal Treatment (CAMT) study who had been referred and treated for ADHD in childhood and were reassessed in adulthood (average age 27 years). Participants’ retrospective self-ratings were substantially lower than, and did not correlate with, parents’ ADHD symptom ratings provided at study entry, while retrospective symptom ratings provided by proxy respondents correlated moderately with parents’ childhood ratings. In addition, participants were more likely to underreport childhood symptoms (79%) and more frequently denied the presence of three or more childhood symptoms (17%) compared to proxy respondents (65% underreporting, 10% false-negative recall). Proxy respondents’ symptom recall was best predicted by childhood ADHD, while participants’ symptom recall was best predicted by current ADHD symptom severity. ADHD-associated impairments were not correlated with symptom recall after controlling for childhood ADHD. Together, these findings suggest a recall bias in adult patients and question the validity of retrospective reports, even in clinical samples.

The concatenation of association between gastroesophageal reflux and obstructive adenotonsillar hypertrophy

ObjectivesGastroesophageal reflux (GER) is frequently seen in patients with adenotonsillar hypertrophy. However, the sequential association between GER and adenotonsillar hypertrophy is unknown. This leads to unpredictable outcomes while treating patients of adenotonsillar hypertrophy with GER. The objective of this study is to evaluate the prevalence of GER and gastroesophageal reflux disease (GERD) in paediatric patients with obstructive adenotonsillar hypertrophy (OATH), and to assess the effect of adenotonsillectomy (AT) on GER as well as GERD. MethodsIn this prospective cohort study, consecutive pediatric patients with grade III/IV hypertrophy of adenoid or/and tonsillar tissue who were planned for AT were recruited after excluding comorbidities predisposing to GER. Symptoms of GERD using Gastro Esophageal Reflux Questionnaire for Young Children (GERQ-YC) and Reflux Indices (RI) obtained from 24-h ambulatory esophageal pH monitoring were evaluated in all patients pre-operatively and 12 weeks following AT. ResultsA total of 49 patients with OATH with average age of 6 years were included in this study. With a RI of >4.3% as the threshold for making the diagnosis of GER on esophageal pH monitoring, the prevalence of GER was 20.4%. The average RI preoperatively was 15.7% which reduced to 1.7% following AT (p = 0.004). Among the 10 patients with preoperative GER, 80% of the patients had no evidence of GER after surgery. New incidences of GER was not observed post operatively in this cohort. As per the GER symptom scoring system, 31% of the parents reported GERD pre-operatively which resolved completely in all patients following surgery. Conclusions– In this study, the prevalence of GER proven by 24 h ambulatory esophageal pH monitoring is 20% in pediatric patients with OATH. Following AT, GER resolved in 80% of cases and was reduced substantially in the remaining cases in the subset of patients with pre-operative GER. The symptoms of GERD based on parents' recall of child's previous symptoms may not accurately represent presence of GER. Our results suggest that OATH can result in GER due to increased negative intra-thoracic pressure as a result of breathing against an obstructed upper airway and hence, GER subsides following surgical removal of the obstructive pathology. To establish this concatenational association of OATH and GER, larger studies are mandated.

Effect of the trajectory of exertional breathlessness on symptom recall and anticipation: A randomized controlled trial

Breathlessness is a major cause of physical limitation. Recalled breathlessness intensity may differ from experienced intensity and be influenced by the intensity trajectory including the 'peak-end rule'. The primary aim was to test if adding two minutes of low intensity exercise at the end of an exercise test would change the recalled breathlessness. Secondary aims included to analyse the impact of the peak and end exertional breathlessness intensity on breathlessness recall. Randomized controlled trial of 92 adults referred for exercise testing who were randomized (1:1), at test end, to 2 minutes of additional low intensity exercise (intervention; n = 47) or stopping at peak exertion (control; n = 45). Experienced breathlessness during the test and recalled intensity (30 min after the test) was assessed using the Borg CR10 scale. Participants were aged a mean 59 years; 61% men; 79% reported a mMRC ≥1. There was no between-group difference in recalled breathlessness intensity, 5.51 ([95% CI] 5.00 to 6.01) vs. 5.73 (5.27 to 6.20; p = 0.52) in controls, even though the intervention group had a significantly lower end breathlessness (mean difference 0.96; 0.24 to 1.67; p = 0.009). Recalled exertional breathlessness was most strongly related to peak breathlessness (r2 = 0.43). When analyzed together, end breathlessness did not add any explanatory value above that of peak breathlessness. Adding an episode of two minutes of lower exercise and breathlessness intensity at the end of an exercise test did not affect symptom recall, which was most strongly related to peak breathlessness intensity. ClinicalTrials.gov (NCT03468205).

Patient demographic and psychosocial characteristics associated with 30-day recall of self-reported lower urinary tract symptoms.

Measurement of self-reported lower urinary tract symptoms (LUTS) typically uses a recall period, for example, "In the past 30 days…." Compared to averaged daily reports, 30-day recall is generally unbiased, but recall bias varies by item. We examined the associations between personal characteristics (eg, age, symptom bother) and 30-day recall of LUTS using items from the Symptoms of Lower Urinary Tract Dysfunction Research Network Comprehensive Assessment of Self-reported Urinary Symptoms questionnaire. Participants (127 women and 127 men) were recruited from 6 US tertiary care sites. They completed daily assessments for 30 days and a 30-day recall assessment at the end of the study month. For each of the 18 tested items, representing 10 LUTS, the average of the participant's daily responses was modeled as a function of their 30-day recall, the personal characteristic, and the interaction between the 30-day recall and the characteristic in separate general linear regression models, adjusted for sex. Nine items representing 7 LUTS exhibited under- or overreporting (recall bias) for at least 25% of participants. Bias was associated with personal characteristics for six LUTS. Underreporting of incontinence was associated with older age, lower anxiety, and negative affect; overreporting of other LUTS was associated with, symptom bother, symptom variability, anxiety, and depression. We identified under- or overreporting that was associated with personal characteristics for six common LUTS. Some cues (eg, less bother and lower anxiety) were related to recall bias in an unexpected direction. Thus, providers should exercise caution when making judgments about the accuracy of a patient's symptom recall based on patient demographic and psychosocial characteristics.

Timing of assessments for PRO measures in advanced RCC clinical trials.

e19101 Background: Efficient and thoughtful collection of PROs in randomized cancer trials is necessary, especially when comparing drugs with differing administration schedules. Assessment timing for PROs can dramatically influence results. We sought to better understand how different assessment schedules affect interpretation of toxicity using PRO data. Methods: We reviewed 3 randomized trials in advanced/metastatic RCC with a control arm of sunitinib administered 4 weeks on/2 weeks off. All 3 trials used FACT Kidney Symptom Index (FKSI-19 or -DRS) and one also used EORTC QLQ-C30. For each trial, we chose patient-reported diarrhea and bone pain due to their strong association with the therapeutic intervention and the disease, respectively. Results: For the first 12 weeks, all trials had PRO assessments at baseline but had differing schedules thereafter. PRO assessment in Trial 1 was every 3 weeks; Trial 2: week 6 and week 12; Trial 3: every 3 weeks on the investigational arm and at weeks 4, 6, 10 and 12 on the sunitinib arm. Notably, all assessments for Trial 2 were after 2-week sunitinib washout while Trials 1 and 3 had assessments before and after washout. The table shows the percentage of patients who experienced any worsening from baseline in diarrhea and bone pain in the first 2 assessments. In each trial, more patients had worsening following periods of treatment versus washout on the sunitinib arm, with no such fluctuation on the non-sunitinib arms. The pattern was more apparent for diarrhea (treatment-related) than for bone pain (disease-related). Conclusions: Patients’ recall of symptoms may vary depending on the timing of PRO assessments in relation to drug administration and may be more prominent with respect to treatment-related symptoms, as disease-related symptoms are less impacted by drug toxicity and washout. Clinical protocols should carefully consider PRO assessment timing in relation to drug administration to improve interpretation of toxicity. Higher fidelity PRO data can be obtained with weekly collection of symptoms during the first few months of cancer clinical trials. [Table: see text]

Knowledge of Stroke Warning Signs, Risk Factors, and Response to Stroke among Lebanese Older Adults in Beirut

Background and objectives: Stroke is a global burden. In Lebanon, recent studies have shown that stroke prevalence may be higher than other developing countries. While older people are particularly vulnerable to stroke, research suggests that they have poor stroke awareness. Since awareness is crucial for early hospital admission, thereby outcome, the main objectives of this study were to assess knowledge of stroke ie, symptoms, risk factors, and intended behavior in case of stroke suspicion. Methods: A community-based survey targeting adults aged 50 and above was conducted at 20 random pharmacies in Beirut from May to October 2018 through face to face interviews utilizing a structured questionnaire composed of open and closed ended questions. Descriptive and multivariable analyses were performed. Main Results: In total, 390 participants completed the questionnaire. Sixty-eight percent were able to spontaneously recall at least 1 stroke symptom, most frequently headache (29.2%), hemiparesis (25.4%), and dizziness (19.5%). Furthermore, 85.4% spontaneously recalled at least 1 risk factor, most frequently hypertension (48.2%), smoking (20.5%), and stress (43.1%). In case of stroke suspicion 57.69% would call an ambulance. Knowing a stroke patient and educational level were predictors for recall of more symptoms and risk factors for stroke. Adequate response to stroke was positively associated with identification of more stroke symptoms but inversely associated with having diabetes. Conclusions and Recommendations: There are major gaps in stroke knowledge among Beirut's older population. Culturally tailored awareness campaigns should be implemented at multiple levels using different media methods to target vulnerable populations at higher risk for stroke and their families. These campaigns should focus on improving stroke symptoms awareness and actions to take when suspecting stroke.

No evidence that omission and confirmation biases affect the perception and recall of vaccine-related information.

Despite the spectacular success of vaccines in preventing infectious diseases, fears about their safety and other anti-vaccination claims are widespread. To better understand how such fears and claims persist and spread, we must understand how they are perceived and recalled. One influence on the perception and recall of vaccination-related information might be universal cognitive biases acting against vaccination. An omission bias describes the tendency to perceive as worse, and recall better, bad outcomes resulting from commissions (e.g. vaccine side effects) compared to the same bad outcomes resulting from omissions (e.g. symptoms of vaccine preventable diseases). Another factor influencing the perception and recall of vaccination-related information might be people's attitudes towards vaccines. A confirmation bias would mean that pre-existing pro-vaccination attitudes positively predict perceptions of severity and recall of symptoms of vaccine preventable diseases and negatively predict perceptions of severity and recall of vaccine side effects. To test for these hypothesized biases, 202 female participants aged 18-60 (M = 38.15, SD = 10.37) completed an online experiment with a between-subjects experimental design. Participants imagined that they had a 1-year old child who suffered from either vaccine side effects (Commission Condition) or symptoms of a vaccine-preventable disease (Omission Condition). They then rated a list of symptoms/side effects for their perceived severity on a 7-point Likert scale. Finally, they completed a surprise recall test in which they recalled the symptoms/side effects previously rated. An additional scale was used to measure their attitudes towards vaccines. Contrary to the hypotheses, perceptions of severity and the recall of symptoms/side effects were not associated with experimental condition, failing to support the omission bias, nor did they interact with attitudes towards vaccines, failing to support the confirmation bias. This cast doubt on the possibility that the spread of anti-vaccination claims can be explained by these particular universal cognitive biases.