Patient Self-assessment Research Articles

The implementation of a self-care tool for patients that may reduce clinician burden.

11017 Background: Addressing the side effects and concerns of patients is paramount during cancer treatment. At this time, this significant workload often involves active management by oncology clinicians which may exacerbate clinician burnout. However, minor side effects and routine concerns may be managed by patients themselves. While there are valuable resources available online including Cancer.net by the American Society of Clinical Oncology (ASCO), patients may benefit from a targeted and personalized approach. Herein, we developed a novel online patient self-assessment and self-care tool within Kaiser Permanente Northern California (KPNC), an integrated healthcare system caring for about 4.5 million patients, that aims to help patients with cancer address routine concerns, enabling them to participate in targeted self-management. Methods: Under the novel 4R Oncology model (Right Info / Right Care / Right Patient / Right Time), the self-care tool was implemented to promote patient self-management and improve team-based care and was further developed into a web-based intervention by KPNC. Patients with specific minor concerns were directed to Cancer.net webpages that described how these concerns could be self-addressed. We assessed pageview (a page loaded within a browser) data from May 2021 to December 2022. Main topics were Managing Side Effects and Concerns Related to Your Cancer Treatment, Nutrition Concerns, Emotional or Practical Concerns, Additional Resources and COVID-19 information. If patients were unable to address their concerns with the self-care tool, they were instructed to contact their care team for follow-up. Results: Within the 20-month study period, there were 4,991 total pageviews of the self-care tool. The most pageviews in one month were 501 in November 2022 and the least were 93 in December 2021. Pageviews increased over time with most months in 2022 reaching over 200 pageviews compared to only half of months in 2021 surpassing 200 pageviews. The most frequent pageviews were diarrhea (124), nutrition (124), sleep (101), use of herbs or supplements (100) and nausea or vomiting (98). While there were many topics available on the website, the most viewed pages involved gastrointestinal concerns. The least viewed included Life Care Planning/Advance Health Care Directive (6) and Chemobrain (8). Conclusions: Examination of pageview data from a self-assessment and self-care tool targeting patients with cancer within an integrated healthcare system reveals substantial interest in self-management. While it is unclear whether patients find the self-care tool’s information useful currently, further research is underway using patient surveys to evaluate its utility. Implementation of helpful information can empower visitors to be aware of their options and engage in self-management of routine conditions, which in turn can optimize their health while decreasing oncology clinician burnout.

Hypothyroidism and Somatization: Results from E-Mode Patient Self-Assessment of Thyroid Therapy, a Cross-Sectional, International Online Patient Survey.

Background: Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained persistent symptoms can be a sign of somatization. This is associated with distress and high health care resource use and can be classified as somatic symptom disorder (SSD). Prevalence rates for SSD differ depending on classification criteria and how they are ascertained, varying between 4% and 25%. As this has not been studied in hypothyroid patients before, the aim of this study was to document somatization in people with hypothyroidism and to explore associations with other patient characteristics and outcomes. Methods: Online, multinational cross-sectional survey of individuals with self-reported, treated hypothyroidism, which included the validated Patient Health Questionnaire-15 (PHQ-15) for assessment of somatization. Chi-squared tests with the Bonferroni correction were used to explore outcomes for respondents with a PHQ-15 score ≥10 (probable somatic symptom disorder [pSSD]) versus a PHQ-15 score <10 (absence of SSD). Results: A total of 3915 responses were received, 3516 of which contained the valid PHQ-15 data (89.8%). The median score was 11.3 (range 0-30 [confidence interval 10.9-11.3]). The prevalence of pSSD was 58.6%. Associations were found between pSSD and young age (p < 0.001), women (p < 0.001), not working (p < 0.001), having below average household income (p < 0.001), being treated with levothyroxine (LT4) (rather than combination of LT4 and L-triiodothyronine [LT3], LT3 alone, or desiccated thyroid extract) (p < 0.001), expression of the view that the thyroid medication taken did not control the symptoms of hypothyroidism well (p < 0.001), and with number of comorbidities (p < 0.001). pSSD was associated with respondent attribution of most PHQ-15 symptoms to the hypothyroidism or its treatment (p < 0.001), dissatisfaction with care and treatment of hypothyroidism (p < 0.001), a negative impact of hypothyroidism on daily living (p < 0.001), and with anxiety and low mood/depression (p < 0.001). Conclusions: This study demonstrates a high prevalence of pSSD among people with hypothyroidism and associations between pSSD and negative patient outcomes, including a tendency to attribute persistent symptoms to hypothyroidism or its treatment. SSD may be an important determinant of dissatisfaction with treatment and care among some hypothyroid patients.

Nurses’ Assessments Versus Patients’ Self-Assessments of Postoperative Pain: Knowledge and Skills of Nurses for Effective Pain Management

Postoperative pain is the most common form of acute pain. Nurses contribute to effective pain management with their knowledge and skills. The aims of this research were to examine differences between nurses' assessments and patients' self-assessments of postoperative pain, differences in the mentioned (self) assessments with respect to characteristics of both groups of respondents, and the correlation between the NRS and the VRS scale. The study included 103 nurses employed at a hospital and 103 patients treated in the surgical departments after the surgical procedures. Data were collected using the standardized Numerical rating scale (NRS) and Verbal rating score (VRS). The median of patients' self-assessments of pain intensity on the NRS scale was 4, while the nursing assessment of patients' pain was 3, with no significant difference (p = 0.083). No significant differences were found on the VRS scale between nurse assessments and patient self-assessments of current pain intensity. The pain was described as moderate by 35% of participants, including 35.9% nurses and 35% patients. Significant positive correlations were recorded between values on the VRS and NRS scales for nurses (Rho = 0.812; p < 0.001) and patients (Rho = 0.830; p < 0.001). The results of this study may have implications for the improvement of postoperative pain management protocols, with regular use of pain assessment scales and individualization of analgesic prescriptions.

NMOSDCopilot: Feasibility of Smartphone-Based Digital Biomarkers for the Self-Assessment of Vision, Motor and Cognitive Functions in Neuromyelitis Optica Spectrum Disorder (S50.002)

NMOSDCopilot: Feasibility of Smartphone-Based Digital Biomarkers for the Self-Assessment of Vision, Motor and Cognitive Functions in Neuromyelitis Optica Spectrum Disorder (S50.002)

Identifying Digital Biomarkers for the Self-Monitoring of Patients Living with Generalized Myasthenia gravis: a Proof of Concept (P7-8.007)

<h3>Objective:</h3> To identify clinically meaningful digital biomarkers (dBMKs) intended to track symptoms and signs among people living with generalized myasthenia gravis (gMG) and to prepare the development of a software medical device for the patients’ unsupervised digital self-assessment. <h3>Background:</h3> Generalized myasthenia gravis (gMG) is characterized by fluctuating manifestations and heterogeneity in fatigue and muscle group weakness. Literature pinpoints a lack of objective measurement tools for the self-assessment of gMG symptoms outside office visits, resulting in different perceptions between physicians and patients on the impact of the disease. <h3>Design/Methods:</h3> We used a Double Diamond methodology to identify dBMKs of interest for gMG patients and evaluate their relevance for clinicians through qualitative interviews. Unmet needs and dBMKs concepts were prioritized during a technical Proof-of-Concept (PoC) study. The acceptability of the digital device was assessed with prototype-supported interviews. <h3>Results:</h3> Interviews with 27 patients (France, USA) confirmed the feasibility of dBMKs to measure gMG-related neurological functions. All were interested in tracking symptoms. 9 international MG experts were interested in assessing gMG symptomology between office visits with clinically meaningful dBMKs. A PoC study on healthy subjects, performed under different conditions, confirmed the feasibility of analyzing raw data collected by the smartphone’s sensors. 5 digital active measures inspired by clinical gold standards and relying on the smartphone’s sensors were selected with their related dBMKs (ptosis, breathing, dysarthria, upper and lower extremities functions). Patient-reported outcome measures (daily activities, pain, sleep, depression, quality of life) will be incorporated as e-questionnaires. <h3>Conclusions:</h3> We perceived a need for an unsupervised patient self-assessment digital solution to monitor symptomatology outside office visits. In 2023, development of ME&amp;MG, a smartphone solution, will begin. It aims to inform and improve communication between patients and their care teams. International multicenter studies comparing ME&amp;MG to clinical gold standards including the Quantitative Myasthenia Gravis score, will be deployed. <b>Disclosure:</b> Pascal Laforet has nothing to disclose. David Orlikowski has nothing to disclose. Prof. NICOLAS has nothing to disclose. The institution of Prof. Prigent has received research support from VLM - Patients association for lysosomial diseases. The institution of Prof. Prigent has received research support from ADEP Assitance. Dr. Berling has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Adscientiam. Dr. Berling has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Ghislain N’Dah-Sekou has nothing to disclose. Dr. Gorin has received personal compensation for serving as an employee of Ad Scientiam. Dr. Moreira has received personal compensation for serving as an employee of Ad Scientiam. Mrs. Narcy has received personal compensation for serving as an employee of Ad Scientiam. Dr. Plaud has received personal compensation for serving as an employee of Ad Scientiam. Mrs. Touré Cuq has received personal compensation for serving as an employee of Ad Scientiam . Dr. Keller has received personal compensation for serving as an employee of Alexion. Dr. Keller has stock in Alexion, Roche, Novartis, Celgene, Abbvie, Merck, Ionis, Sanofie, Organon, MSD. Mr. Werneburg has received personal compensation for serving as an employee of Alexion. Dr. Aras has received personal compensation for serving as an employee of Alexion Pharmaceuticals Inc. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arrowhead. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunovant. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alector. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Benatar has received intellectual property interests from a discovery or technology relating to health care. Dr. Benatar has received intellectual property interests from a discovery or technology relating to health care.

A pilot study comparing the efficacy of autologous cultured fibroblast injections with hyaluronic acid fillers for treating nasolabial folds

Autologous cultured fibroblast injections for soft tissue augmentation are a potential alternative to other filler materials. No studies have compared autologous fibroblast injections and hyaluronic acid (HA) fillers for treating nasolabial folds (NLFs). To compare the efficacies and safeties of autologous cultured fibroblast injections and HA fillers for treating NLFs. This prospective, evaluator-blinded, pilot study enrolled 60 Thai female adult patients diagnosed with moderate to severe NLFs. They were randomized to receive either 3 treatments of autologous fibroblasts at 2-week intervals or 1 treatment with HA fillers. The primary outcome was the clinical improvement of the NLFs graded by 2 blinded dermatologists immediately after injection and at 1-, 3-, 6-, and 12-month follow-ups. Objective measurement of the NLF volume was evaluated. Patient self-assessment scores, pain scores, and adverse reactions were recorded. Of the 60 patients, 55 (91.7%) completed the study protocol. The NLF volumes improved significantly in the autologous fibroblast group at all follow-ups relative to baseline (P = 0.000, 0.004, 0.000, 0.000, and 0.003). The patients in the autologous fibroblast group rated more noticeable NLF improvements than those in the HA filler group (3-month follow-up, 58.41% vs. 54.67%; 6-month follow-up, 52.50% vs. 46%; 12-month follow-up, 44.55% vs. 31.33%). No serious adverse reactions were recorded. Autologous fibroblast injections are safe and effective for treating NLFs. These injections also promise sustained growth of living cells, possibly leading to a greater persistence than shown by other fillers.

How Do the ASCEND Study Findings Help Us as Dialysis Patients?

How Do the ASCEND Study Findings Help Us as Dialysis Patients?

The Efficacy and Safety of Dr. SKS Hair Booster Serum (a Cocktail of Micronutrients and Multivitamins) in Adult Males and Females With Androgenetic Alopecia: An Open-Label, Non-randomized, Prospective Study.

Background Androgenetic alopecia (AGA) is frequently encountered in dermatological practice; however, there is a lack of approved treatment. At present, only three therapies have been approved for on-label use in androgenetic alopecia: minoxidil, finasteride, and lower-level laser therapy. Micronutrients are primary elements in the normal hair follicle cycle, and their role in androgenetic alopecia is a growing matter of research nowadays. This study aims to investigate the clinical efficacy and safety of Dr. SKS Hair Booster Serum, a cocktail of micronutrients and multivitamins (copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin), in male and female patients with androgenetic alopecia. Methods We did an open-label, non-randomized, multicenter, prospective study across five hair clinic chains in India (Mumbai, Hyderabad, Jabalpur, Balaghat, and Nagpur). Eligible participants were patients with a confirmed diagnosis of androgenetic alopecia based on clinical examination and trichoscopic findings, age of 18 years or older, and any gender. Each patient received Dr. SKS Hair Booster Serum, 1 ml in volume, once a month by mesotherapy or derma roller/derma pen for up to six months. All patients were subjected to a 60-second hair counttest (comb test), hair pulltest, global photographic assessment (GPA), trichoscopy assessment, patient self-assessment questionnaire, and safety assessment at baseline and six months after the treatment. Results One thousand patients (500 males and females each) with androgenetic alopecia were analyzed. There was a significant reduction in hair fall with bulb (<0.0001) and without bulb (<0.0001) six months after the treatment versus baseline. There was a significant improvement in the number of hairs removed per pull (<0.0001), global photographic assessment score (<0.0001), hair growth rate (<0.0001), follicular hair density (<0.0001), vellus hair density (<0.0001), and terminal hair density (<0.0001) six months after the treatment versus baseline. The majority of patients (95%) were satisfied with six-monthtreatment of Dr. SKS Hair Booster Serum. No major adverse events were reported during the study. Conclusion Dr. SKS Hair Booster Serum was found to be a safe and effective treatment for androgenetic alopecia, with 95% patient self-assessment score.

174 - Psychological distress in lung cancer: patient self-assessment versus lung cancer nurse specialist (LCNS) judgement

174 - Psychological distress in lung cancer: patient self-assessment versus lung cancer nurse specialist (LCNS) judgement

Patient and Physician Assessments of Clinical Status: A Mixed-methods Study of Interstitial Lung Disease

The SARS-CoV-2 pandemic necessitated novel health care delivery for patients with interstitial lung disease (ILD), including reduced in-person appointments and physiologic testing to minimize transmission. Clinicians often have been required to rely on patients' subjective assessments of their clinical status during phone follow-up appointments. It is unknown how accurate a patient's self-assessment is compared with that of their physician during an in-person evaluation. Are patients' self-assessments of their clinical status in agreement with their physicians' assessments, and are telemedicine vsin-person visits acceptable? Patients were enrolled prospectively from the University of Calgary ILD clinic. Participants were asked by phone before the in-person appointment and after the appointment to rate their clinical status on a five-point Likert scale. Physicians then rated the patient's clinical status after the appointment on a similar five-point Likert scale, masked to patient responses. Patients and physicians were asked if an in-person appointment was necessary or if telemedicine would have sufficed. Clinical variables associated with physician assessments were assessed. Fifty patients with mean age of 67 ± 11.8 years participated. Mean time since last follow-up was 5.0 ± 3.0months. No correlation was found between the preclinical patient self-assessment and postclinical physician assessment (P= .18; κ= 0.28). Correlation of postclinical assessment was statistically significant (P< .001), with moderate agreement (κ= 0.49). Physicians thought telephone visits were acceptable for 58%of appointments, whereas only 12%of patients preferred telephone visits. Physician's assessment of clinical status seemed to be driven by change in diffusion capacity of the lungs for carbon monoxide (P= .039). Telemedicine may improve access to care for patients during pandemic management, in rural communities, and for those with impaired mobility. Despite these benefits, our data support that patients and physicians may not agree on determination of clinical status and that patients generally prefer in-person patient-physician interactions.

Validation of a pictorial-based range of motion self-assessment tool in shoulder arthroplasty

BackgroundRange of Motion (ROM) assessment is a key method of assessing recovery progress in shoulder arthroplasty. The development of a reliable patient-based self-assessment tool for ROM could reduce the need for clinician dependent modes of outcome assessment after shoulder arthroplasty, allowing for greater optimization of healthcare resources including physician and clinic time. The primary aim of this study was to test the validity and reliability of a pictorial-based patient self-assessment of ROM in postshoulder arthroplasty in terms of the correlation between patient-based and clinician-based ROM assessments. The secondary aim was to determine the relationship between patient- and clinician-based ROM assessment with corresponding patient-reported outcome measures (PROMs). MethodsThis was a cross-sectional study of 126 patients identified from a list of patients scheduled for an elective shoulder arthroplasty postsurgery follow-up visit. Patients completed a pictorial-based ROM self-assessment questionnaire where they identified pictorial diagrams best representing their active shoulder ROM. Shoulder ROM was then assessed by a clinician with a goniometer, and PROMs including the Oxford Shoulder Score, American Shoulder and Elbow Surgeons score, pain score, and satisfaction score were measured. Intraclass correlation coefficients (ICCs) were used to assess interobserver agreement between the clinician and patient-based ROM scores. Pearson correlation and multiple regression analyses were used to analyze the relationship between measured ROM and PROM scores. ResultsStrong correlation was found between patient and clinician measured ROM for forward flexion (ICC = 0.70) and internal rotation (ICC = 0.72), while moderate correlation was noted for abduction (ICC = 0.66) and external rotation (ICC = 0.58). Patients tended to overestimate their shoulder ROM for all four measured movements. Both patient and clinician measured ROM were significantly correlated with PROMs, with forward flexion and abduction being the most correlated with PROMs (coefficient = 0.313-0.544) compared to other ROMs. The questionnaire difficulty was rated as “Very easy,” “Easy,” or “OK” by 96.8% (122/126) of patients. ConclusionsThis pictorial-based ROM self-assessment questionnaire found moderate to high agreement of patient-clinician measured ROM and correlation between measured ROM and PROMs. This easy-to-use self-assessment tool may prove useful in increasing convenience and compliance to outcome assessment in shoulder arthroplasty.

Validation study of the Chinese version of atopic dermatitis control tool

To assess the reliability, validity and responsiveness of the Chinese version of the atopic dermatitis control tool (ADCT). After this study obtained authorization for the Chinese version of the ADCT scale. 114 patients with atopic dermatitis were enrolled from the Department of Dermatology, Peking University First Hospital using convenience sampling from October 2022. Patients were surveyed using the General Information Questionnaire, Chinese version of ADCT, patient-oriented eczema measure (POEM),peak pruritus numerical rating scale (PP-NRS),dermatology life quality index (DLQI) and the global patient self-assessment for disease severity. Mann-Whitney rank sum test and Spearman correlation analysis were used for item analysis; content validity was assessed using content validity index (CVI); exploratory factor analysis was used to assess structural validity; Cronbach' alpha coefficient was used to assess internal consistency; Spearman correlation analysis was used to assess the correlation of ADCT with other scales to assess external responsiveness. The results showed that all items were retained by item analysis. I-CVI was 0.9-1, and S-CVI/Average was 0.983; the scale extracted one common factor by factor analysis, the cumulative variance explanation rate was 77.927%; the Cronbach' alpha coefficient of the scale was 0.937; the correlation coefficients of the Chinese version of ADCT with POEM, PP-NRS, and DLQI were 0.805, 0.861, and 0.709 respectively. In conclusion, the Chinese version of the ADCT has adequate reliability, validity and responsiveness, and is suitable for measuring disease control in Chinese patients with atopic dermatitis.

Effect of platelet counts and activator in platelet-rich plasma on the treatment of androgenetic alopecia, split-head comparison: A randomised, double-blind study.

Background Androgenetic alopecia is a common, chronic, non-scarring alopecia. It is characterised by stepwise miniaturisation of the hair follicles, due to alteration in the hair cycle dynamics, leading to the transformation of terminal hair follicles into a vellus ones. Oral finasteride and topical minoxidil are the only approved drugs for treating this condition. Due to a limited number of effective therapies for androgenetic alopecia, platelet-rich plasma may be an effective alternative treatment. Aims To study the effect of activator in platelet-rich plasma and baseline platelet count in platelet-rich plasma on the treatment of androgenetic alopecia. Methods A randomised, double-blind split-head comparative study. The sample size was calculated and randomisation was done. Patients with androgenetic alopecia were allocated into two groups; in the first group, autologous activated platelet-rich plasma was injected in the right half of the affected scalp and autologous non-activated platelet-rich plasma was injected in the left half of the affected scalp and vice versa in the second group. Patients were also categorised on the basis of platelet counts in their platelet-rich plasma in three groups; group A (6-8 lakh/mm3), group B (8.1-10 lakh/mm3) and group C (>10 lakh/mm3). Interventions were done monthly for three months and followed up for the next three months. Effects of interventions were assessed by hair density, hair thickness, patient self-assessment and clinical photography. Results A total of 80 patients were included in the study. Activated platelet-rich plasma produced significant improvement of hair density after four months and hair thickness at 6 months. An increase in platelet count led to a significant increase in hair density and hair thickness after three and four months respectively and a highly significant increase in both parameters at the end of the study. Limitations Long-term follow-up of cases was not done and no measurement of vellus hair count was done. Conclusion There is a significant effect of activator and platelet count of the platelet-rich plasma on hair density as well as hair thickness.

Impairment due to Contextual Factors: External Assessment and Self-Assessment of Rehabilitants in Psychosomatic Rehabilitation

In addition to an existing external assessment tool for the ICF-based assessment of the impairment of rehabilitation patients due to environmental and personal contextual factors, a self-assessment tool was developed and used for rehabilitation patients in a psychosomatic rehabilitation clinic. The aim was to compare the assessment of the impairment by contextual factors rated by the external assessment and by the rehabilitation patients on the other hand. Furthermore, the aim of the study was to obtain initial indications of the applicability of the newly designed self-evaluation instrument. A sample of N=103 rehabilitation patients was examined via both the external and the self-evaluation tools. A comparative evaluation of the assessment of the external assessor and the rehabilitants' assessments was carried out using measures of assessor agreement (Cohen's Kappa, percentual agreement). The results were set in relation to the data of the routine assessment of the rehabilitation facility (Eta-Coefficient). The external assessor and the rehabilitants get to different results in their assessment of the extent of impairment by individual contextual factors. For eight of the 15 context factors, there was only a moderate degree of agreement between the assessors (Cohen's Kappa). The percentage of non-agreement between rating of the external assessor and self-assessment lies between approx. 20% and up to approx. 40% of the cases for the majority of the context factors. Whether or not there is an impairment across all contextual factors (overall measure) was answered non-concordantly in just under a third of the cases. Mostly moderate correlations were found between the context factors classified as particularly relevant in the self-evaluation tool and scales of psychometric survey (e. g. BDI-II). This result provides a first indication of the convergent validity of the self-report tool. More attention should be paid to a supplementary assessment of impairment by contextual factors via the rehabilitation patient's self-assessment in addition to the external assessment. There is a need for further research with regard to the development of the self-assessment tool presented.

Feasibility, use and benefits of patient-reported outcome measures in palliative care units: a multicentre observational study

BackgroundResearch has shown that routinely assessed, patient-reported outcome measures (PROMs) have positive effects in patients with advanced oncologic diseases. However, the transferability of these results to specialist palliative care is uncertain because patients are more impaired and staff doubt the feasibility and benefits. The aim of this study is to evaluate the feasibility of patient self-assessment of PROMs, their use by staff and the benefits in palliative care wards.MethodA multicentre observational study was conducted in the context of the implementation of the Integrated Patient Outcome Scale (IPOS) in three specialist palliative care wards at university hospitals in Germany. All admitted patients who screened positive regarding their ability to complete questionnaires were asked to participate and complete the IPOS on paper weekly, with assistance if necessary. Feasibility of questionnaire completion (e.g. proportion of patients able to complete them), use (e.g. involvement of different professional groups) and benefit (e.g. unexpected information in IPOS as rated by treating physicians) were assessed. Staff members’ opinion was obtained in a written, anonymous evaluation survey, patients’ opinion in a short written evaluation.ResultsA total of 557 patients were screened for eligibility, 235 were assessed as able to complete the IPOS (42.2%) and 137 participated in the study (24.6%). A majority needed support in completing the IPOS; 40 staff members and 73 patients completed the evaluation.Unexpected information was marked by physicians in 95 of the 137 patient questionnaires (69.3%). The staff differed in their opinions on the question of whether this also improved treatment. A majority of 32 staff members (80.0%) were in favour of continuing the use of IPOS (4 against continuation, 4 no answer); 43 (58.9%) patients rated their overall experience of IPOS use as ‘positive’, 29 (39.7%) as ‘neutral’ and 1 (1.4%) as ‘negative’.ConclusionsWhile most staff wished to continue using IPOS, it was a challenge to integrate the effort to support the completion of IPOS into daily practice. Digital implementation was not successful, despite various attempts. To explore the effects on care and patient outcomes, multicentre cluster-randomised trials could be employed.Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00016681 (24/04/2019).

Relationship Between Asthma Control as Measured by the Asthma Impairment and Risk Questionnaire (AIRQ) and Patient Perception of Disease Status, Health-Related Quality of Life, and Treatment Adherence.

Critical asthma outcomes highlighted in clinical guidelines include asthma-related quality of life, asthma exacerbations, and asthma control. An easy-to-implement measure of asthma control that assesses both symptom impairment and exacerbation risk and reflects the impact of asthma on patients' lives is lacking. Hence, the objective of this study was to assess the Asthma Impairment and Risk Questionnaire (AIRQ®) construct validity relative to patient self-perception of asthma status and validated disease-specific patient-reported outcome (PRO) measures. Baseline data were analyzed from patients (aged ≥ 12 years) with asthma participating in a 12-month observational study assessing the ability of AIRQ to predict exacerbations. At entry, patients completed a sociodemographic questionnaire, AIRQ, 3 questions addressing self-perceived asthma status, Saint George's Respiratory Questionnaire (SGRQ), mini-Asthma Quality of Life Questionnaire (AQLQ), and Adult Asthma Adherence Questionnaire (AAAQ). Descriptive statistics were calculated for demographic and clinical characteristics. AIRQ construct validity was evaluated by assessing correlations between total AIRQ score and patient self-assessments, SGRQ, mini-AQLQ, and AAAQ scores. Comparisons of SGRQ, mini-AQLQ, and AAAQ total and component/domain scores by AIRQ control category were performed using general linear models and Scheffe's post hoc adjustments for pairwise comparisons. A total of 1112 patients were enrolled: 70% female, 78% White, mean (standard deviation) age 43.9 (19.5) years. There were highly significant correlations between AIRQ score and patient self-perception of overall control (r = 0.69; p < 0.001), total SGRQ (r = 0.74, p < 0.001), and mini-AQLQ (r = -0.78, p < 0.001) scores. As AIRQ control category worsened, so did total and domain SGRQ, mini-AQLQ, and AAAQ impediment-to-inhaled-corticosteroid-adherence scores (all pairwise comparisons p < 0.001). Findings demonstrate the construct validity of AIRQ relative to patient self-perception of asthma status, disease-specific PRO measures, and treatment adherence barriers. AIRQ can be a useful instrument to raise awareness of the unrecognized impacts of asthma on patients' lives.

"Only fixation" in cases with failed decompression for lumbar canal stenosis - Analysis of outcome in 14 cases.

The rationale of "only fixation" of affected spinal segments without any form of bone or soft-tissue decompression in cases with failed decompressive laminectomy for lumbar canal stenosis is discussed on the basis of an experience with 14 cases. During the period between 2010 and 2022, 14 patients who symptomatically worsened or did not improve following a long-segment "wide" decompressive laminectomy for multisegmental lumbar canal stenosis were identified. All patients were treated by segmental spinal stabilization aimed at arthrodesis by facetal distraction by Goel's facetal spacers (6 cases) or Camille's transarticular facetal fixation (8 cases). No bone, soft tissue, or disc resection was done for spinal or neural canal "decompression." Oswestry Disability Index and Visual Analog Scale were used to clinically assess the patients before and after the surgery and at follow-up. In addition, video recordings of patient's self-assessment of clinical outcome were used to monitor the outcome. During the average period of follow-up of 71 months (range 6 months to 16 years), all patients recovered in majority of their major symptoms, the recovery was observed in the immediate postoperative period. During the period of follow-up, none of the patients complained of recurrent symptoms or needed any additional surgery. There was firm stabilization and evidences of bone fusion of the treated spinal segments in all patients. There were no infections or implant failure. No patient worsened after treatment. Instability of the spinal segments is the primary issue in cases with lumbar canal stenosis and stabilization in the treatment.

Psychometric evaluation of Oral Mucositis Daily Questionnaire: A cross-cultural adaptation of the Malay version in multiethnic adult autologous stem cell transplant

ObjectiveMucositis is one of the most feared side effects of cancer treatment. Psychometric analysis of a patient self-assessment score, the oral mucositis daily questionnaire in Malay (OMDQ-Mal) and its construct validity by means of confirmatory factor analysis (CFA) is lacking. This research aimed to test the validity and reliability of OMDQ-Mal. MethodsA total of 114 autologous stem-cell transplantation patients aged ≥ 18 years old at a national hematology center in Malaysia from April 2019 to December 2020 completed OMDQ-Mal concurrently with physician scores. Internal consistency and reproducibility were determined by Cronbach alpha and intraclass correlation coefficient, respectively. Correlations with physician scores were determined by Spearman correlation. Discriminative validity and construct validity were determined by Mann–Whitney U and CFA, respectively. ResultsOMDQ-Mal demonstrated high internal consistency (α ​= ​0.874). Test–retest reliability between paired days were moderate to excellent (95% CI ​= ​0.676–0.953). Items in OMDQ-Mal had moderate to strong correlations with physician scores (ρ ​= ​0.503–0.721). Discriminative validity indicated that the scores of scales were significantly different between participants with severe and mild conditions. Construct validity results of loading factors 0.708–0.952; composite reliability 0.879–0.974; average variant extracted 0.710–0.841; and heterotrait–monotrait ratio 0.528 established the convergent and divergent validity. ConclusionsIn conclusion, the OMDQ-Mal, which captured important quality of life responses, demonstrated adequate validity and reliability. This was supported by a two-component model CFA. The strong correlation of OMDQ-Mal with both physician scores indicated its potential as a comprehensive patient-reported outcome measure of mucositis of the entire alimentary tract.

Comparison between topical cetirizine with minoxidil versus topical placebo with minoxidil in female androgenetic alopecia: a randomized, double-blind, placebo-controlled study

Androgenetic alopecia (AGA) is the most common cause of hair loss in both genders with a higher psychological impact on females. Currently, topical minoxidil is the only FDA-approved treatment for female AGA and it needs life-long application and causes side effects. Cetirizine is an antihistamine that may be effective in hair loss treatment. This study aimed to compare the efficacy and safety of topical cetirizine with minoxidil (group 1) versus topical minoxidil with placebo (group 2) in female patients with AGA. This was a double-blind, randomized, controlled, parallel study conducted at Dermatology Clinic, Cairo University Teaching Hospital (Kasr- Al- Ainy), Egypt. Sixty-six patients with female AGA, aged 20–50 years, Sinclair (II–IV), were randomly assigned to one of the 2 groups for 24 weeks. The trichoscopic parameters, patients’ self-assessment, side effects and global photographic assessment were evaluated. There was a statistically significant change from baseline in frontal and vertex terminal and vellus hair density (P < 0.0005) with a significant increase in vertex hair shaft thickness and average number of hairs per follicular unit in group 1 (P < 0.05). Patients reported significantly better scores in patient self-assessment in group 1 (P < 0.05). Side effects were not significantly different between groups (P > 0.05). Topical cetirizine increases hair shaft thickness and results in a higher clinical improvement from patients’ perspective with a good safety profile (NCT04481412, study start date: July 2020).

Cytochrome P-450-mediated herb and food–drug interactions can be identified in cancer patients through patient self-reporting with a tablet application: results of a prospective observational study

Consumption of herbs, food used as medicine and dietary supplements (HFDSs) is common in cancer patients. Herbs and food-drug interactions (HFDIs) can lead to serious adverse effects and can be prevented. We previously reviewed cytochrome P-450 (CYP)-mediated HFDI for 261 HFDSs and we classified the risk of CYP inhibition and induction on a level of evidence scale from 1 (high evidence, supported by several clinical studies) to 5 (low evidence, only limited preclinical data). We conducted a prospective, non-interventional study (NCT04128865) to assess whether self-assessment of patients could detect HFDI classified as 'probable' (i.e. level 1, 2 or 3 of the scale) in a population of cancer patients. Patients were invited through a tablet application to report their consumption of herbs, regular CYP-interacting food consumption and dietary supplements, as well as some clinical data and cancer treatments. The patient's completion of the survey could be supervised by a health care professional or not. A prespecified threshold of 5% of HFDIs classified as 'probable' detected with the application was deemed relevant. Between 29 March 2018 and 22 June 2018, 143 patients completed the survey. Ninety-five patients (66%) reported at least one current systemic cancer treatment and were included in the analyses. Seventy-four patients reported an intake of at least one HFDS (77.9%), while 21 patients reported no HFDS (22.1%). Twenty-two HFDIs classified as 'probable' were found in 16 patients (16.8%) with the application, which was significantly superior to the prespecified threshold (P= 0.02). The interactions were reported with food (n= 19, 86%) more frequently than with herbs (n= 3, 14%) or with dietary supplements (no interaction reported). Self-assessment of HFDS interaction with cancer treatment with an application is feasible and should be considered in daily routine. Prospective interventional studies should be conducted to better assess the clinical benefits of this approach.