Structured Patient Interviews Research Articles

Impact of Pain on Symptom Burden in Chemotherapy-Induced Peripheral Neurotoxicity.

Chemotherapy-induced peripheral neurotoxicity (CIPN) affects the quality of life of cancer survivors. However, the impact of pain on symptom burden remains undefined. This study aimed to define differences in the clinical symptom profile of patients with painful and nonpainful CIPN. A total of 579 participants (median age, 59 years [IQR, 19 years]; F=66%) were assessed cross-sectionally 6 months posttreatment. CIPN severity was graded using multiple methods, including patient-reported outcome measures, a clinically graded scale (NCI-CTCAE), and a neurologic examination score. Participants were classified into subgroups based on patient symptom report, with painful CIPN characterized by the presence of shooting/burning pain, and nonpainful CIPN characterized by the presence of numbness or tingling without shooting/burning pain. Behavioral changes were assessed via structured patient interview regarding symptom impact on sleep, exercise, and treatment-seeking. Among 579 participants, 24% (n=140) reported painful CIPN, 48% (n=280) reported nonpainful CIPN, and 28% (n=159) had no CIPN. Participants with painful CIPN demonstrated higher CIPN severity than those with nonpainful CIPN across multiple measures, including NCI-CTCAE, neurologic grading, and patient report (all P<.05). Participants with painful CIPN were more likely to report that their symptoms affected their ability to exercise (P=.007), produced sleep impairment, and increased treatment-seeking behavior due to their symptoms (both P<.001) compared with participants with nonpainful CIPN. Overall, participants with painful CIPN reported higher scores across all CIPN severity measures, including behavioral changes. This study underlines the need for accurate identification of different CIPN subgroups in hopes of informing better treatment and rehabilitation options for cancer survivors with painful CIPN.

Evaluation of medication safety assessment tools for pharmacist-led medication reviews: the Eastern European pilot project.

Background: Pharmacist-led medication reviews (MR) are one of the key methods to support medication safety in polypharmacy patients. The aims of this study were to pilot MRs in Eastern European community pharmacies, describe medication use in polypharmacy patients, and evaluate the usability of medication safety assessment tools. Methods: The MR pilot was undertaken in Estonia, Latvia, Poland, Hungary, Romania, and Bulgaria. Patients who used at least five medicines were directed to the service by their GPs. Data on drug-related problems (DRPs) and adherence were collected by pharmacists through structured patient interviews. Databases for identification of potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) named Inxbase/Riskbase, as well as an integrated tool comprising potentially inappropriate medicines (PIMs) lists EU(7)-PIM and EURO-FORTA, were applied retroactively to the MR pilot data to investigate possibilities for their use and to describe medication use and potential risks in the study population. Results: A total of 318 patients were included in the study, 250 of them elderly (≥65 years). One hundred and eighty (56.6%) participants had a total of 504 pDDIs based on Inxbase analysis. On average, there were 1.6 pDDIs per participant. Twenty-five (5.0%) of the 504 pDDIs were in a high-risk category. A total of 279 (87.7%) participants had a potential ADR in at least one of 10 Riskbase categories. One hundred and fifty-four (20.8%) of the potential ADRs were in a high-risk category. Twenty-seven pDDIs and 68 ADRs documented as DRPs during the service were not included in the databases. Using the integrated EU(7)-PIM/EURO-FORTA PIM list, a total of 816 PIMs were found in 240 (96%) of the 250 elderly participants (on average 3.4 PIMs per elderly participant). Seventy-one (29.6%) of the participants were using high-risk PIMs. Twenty-one percent of high-risk PIMs and 13.8% of medium-risk PIMs were documented as DRPs by the pharmacists during the pilot. Conclusion: Medication safety assessment tools can be useful in guiding decision-making during MRs; however, these tools cannot replace patient interviews and monitoring. Tools that include a thorough explanation of the potential risks and are easy to use are more beneficial for MRs.

Fluid Intake Management in Maintenance Hemodialysis Using a Smartphone-Based Application: A Pilot Study

Increased interdialytic weight gain (IDWG) has been associated with increased morbidity and mortality. We evaluated the usefulness and safety of a mobile application (app) that allows patients receiving maintenance hemodialysis to self-monitor their daily fluid intake. Within group comparison before or during intervention. Patients receiving maintenance hemodialysis with mean IDWG of<4%. Participants were trained to use a smartphone-based app, FiApp that allowed them to record fluid intake and compare with individual targeted daily fluid intake determined by the nephrologist. The primary study outcome was the association between IDWG and fluid intake recorded in the FiApp. Secondary outcomes included FiApp safety and usage. Patient interviews were performed at weeks 1 and 4 to collect information regarding FiApp usability and recommendations for app improvements. Mean, median, and standard deviation. Eighteen of 25 patients completed the full 4-week study, provided all app data, and completed 2 patient interviews. The mean 4-week IDWG during app use was similar to the baseline mean 4-week IDWG before app use; however, 61% of the participants had a decrease in IDWG when using the app compared with IDWG at baseline. Of the 18 participants who completed the study, only 1 had a mean 4-week IDWG that was 20% higher than that at baseline. The app was used on≥80% of the days by 13 (72%) of 18 participants, and was used every day in 7 (39%) of 18 participants. The mean relationship between fluid reported in the app and fluid consumed was 40%. This safety study recruited patients who had IDWG of<4%. A smartphone-based app can be safely used to help patients receiving maintenance hemodialysis track and control fluid intake. Motivated patients were able to decrease IDWG despite baseline IDWG being<4% of the body weight. NCT03759847. Patients receiving maintenance hemodialysis struggle to limit fluid intake. Excess fluid intake can lead to adverse cardiovascular events. We developed a smartphone app to help patients receiving dialysis self-monitor their fluid intake. In this safety study in patients receiving dialysis with an interdialytic weight gain of<4% of the body weight, more than half of the patients were able to decrease their interdialytic fluid intake while using the app, and only 1 patient had an increase in interdialytic weight gain of>20% while using the app. Information gleaned from structured patient interviews will be used to refine this app.

P-753 Preferences in subfertile women for hysterosalpingography or transvaginal hydrolaparoscopy in the fertility work-up: a labelled discrete choice experiment.

Abstract Study question What aspects do subfertile women prefer for hysterosalpingography (HSG) or transvaginal hydrolaparoscopy (THL) to assess their Fallopian tubes? Summary answer The chance of a false negative result, failure rate, and waiting time are attributes that impact women’s preference for tubal patency testing strategy. What is known already THL and HSG are commonly used diagnostic tests for tubal patency testing, both with different features. HSG is a radiological procedure whit contrast to evaluate tubal patency, whereas THL is a procedure where access to the pouch of Douglas is obtained with an endoscope and the tubes are tested with methylene blue. THL was found non-inferior to HSG as a first-line test in terms of conception leading to live birth. Until now, limited research has been performed to study the values and preferences of subfertile women in the diagnostic work-up. Study design, size, duration We conducted a labelled discrete choice experiment (DCE), which is an attribute-based survey method for measuring preferences. This DCE consisted of 2 questionnaires with each 12 different choice sets. Women with an indication for tubal patency testing were included in the study between September 2021 and January 2023 in two Dutch hospitals. They were randomly assigned for questionnaire 1 or 2. Participants/materials, setting, methods Attributes were defined based on literature review, structured patient interviews and expert focus groups. This resulted in five final attributes: the chance of having a “false negative” result, complication rate, failure rate, subsequent management after a failed procedure and waiting time. Women were asked to choose between choice sets with hypothetical scenarios of two tubal patency tests with different levels of the attributes. Data were analysed by using multinomial logistic regression. Main results and the role of chance The questionnaire was returned by 75 out of 80 women. Mean age was 31.8 years and mean duration of subfertility was 23.5 months. 65 women experienced primary subfertility vs 10 who experienced secondary subfertility. For THL women preferred a lower chance of a false negative result (p &amp;lt; 0.001), a lower failure rate (p = 0.008) and a shorter waiting time (p = 0.003). Outcomes for chance of complications and management after a failed procedure were not significant. Only for the group of women with primary subfertility, if a THL is not conclusive or if there is a failure to reach the pouch of Douglas, women prefer to have a conventional laparoscopy over expectant management (p = 0.01). Women choosing HSG preferred a lower chance of a false negative result (p &amp;lt; 0.001), a shorter waiting time (p = 0.02) and a lower chance of complications (p = 0.001). Because of the labelled design we performed, we saw that women chose for THL significantly more than for HSG; 83% vs 17% (P = 0.03). This may be caused by way of counselling and the fact that these medical centres are one of the few centres in the Netherlands that perform the THL. Limitations, reasons for caution Our analysis with 78 women, showed significant outcomes in terms of preference on specific attributes, but it is possible that we would have found stronger associations with a larger sample size. Wider implications of the findings These results provide more insight in the perspective of subfertile women about the aspects of tubal patency testing in the fertility work-up and they enable informed decision making. Further research is needed to compare our findings to the other forms of tubal patency testing in the fertility work-up. Trial registration number N20.009

Unrestricted drinking before surgery: a structured patient interview.

Our recent study [1] showed that unrestricted drinking before surgery, and its implementation using fasting cards, shortened the median pre-operative liquid fasting time to 2.1 h. Although adherence to the guidelines was significantly improved, critics questioned whether patients drink too much liquid immediately before induction of anaesthesia. Therefore, we evaluated our study data regarding patients' drinking behaviour. In the third PDSA cycle [1], 25 weeks after the implementation of fasting cards, 143 patients underwent a structured interview. The results are summarised in Table 1. On the day of surgery, 130 (91%) patients had drunk at least 100 ml of liquid or at least 2 ml.kg−1 if they were children. The minimum time interval between drinking clear liquids and induction of anaesthesia was 25 min (Fig. 1). The median (IQR [range]) volume of the last liquid intake before induction of anaesthesia was 200 (150–250 [50–500]) ml. Patients were asked about the total amount drunk on the day of surgery. Of 108 patients, six had not drunk anything at all, two patients had only taken a few sips with their morning medication and two infants had drunk 50 ml each. Of the remaining 98 patients, the median (IQR [range]) pre-operative cumulative drinking volume was 400 (200–500 [100–1500]) ml, and was higher when anaesthesia was induced later in the day. Patients with induction of anaesthesia before 11.00 (n = 44) had drunk a median (IQR [range]) of 250 (200–363 [100–500]) ml, while patients with induction of anaesthesia after 11.00 (n = 54) had drunk a median (IQR [range]) of 500 (400–750 [100–1500]) ml; p < 0.0001. Regarding drinking quantities, patients drank small amounts repeatedly, hence the pre-operative total liquid intake increased as the day went on. Patients who usually drink little and may still be worried about urinary urgency also drink little pre-operatively. For them, small sips are enough to reduce thirst and dry mouth [2]. Thus, the lowest pre-operative cumulative drinking volume at anaesthetic induction, both before and after 11.00, was 100 ml. Other patients liked to drink more during the day; the largest cumulative total when anaesthetic induction was after 11.00 was 1500 ml, which was three times the largest cumulative total when anaesthetic induction was before 11.00 (500 ml). For elderly patients in particular, it is important to drink in the morning; these patients consume about 60% of their daily liquid intake between 05.00 and 13.00 and another 30% until 19.00. They might intentionally avoid drinking in the evening because they are concerned regarding night-time incontinence [3]. Therefore, the risk of peri-operative dehydration in this group is relatively high. Prolonged deprivation of fluids harms patients [4], but forcing them to drink more than they want to, for example in the context of studies with rigid drinking instructions, makes them uncomfortable. Patients who drank an amount they were used to had less anxiety [2], and anxiety regarding their operation is the most troublesome aspect for many patients [5]. Unrestricted drinking before surgery allows patients to drink on the day of surgery in the manner they are used to and find comfortable. Therefore, only 3.5% of our study patients reported severe thirst, even though thirst appears to be the most frequent feature of peri-operative discomfort [5]. Unrestricted intake of clear liquids before induction of anaesthesia has been shown to reduce the incidence of postoperative nausea and vomiting [6, 7], a predictor of patient dissatisfaction with anaesthesia [7, 8]. Only 2.8% of our patients required an anti-emetic in the recovery room. Our study has some limitations. In the interviews, the patients were able to state the time of the last liquid intake very precisely. However, the amount of liquid last drunk sometimes referred to a time-period rather than a time-point. Thus, the last amount of liquid consumed may have been overestimated. Data on the total amount drunk on the day of surgery were not available for 35 patients as this question was only added to the interview on the second day of the survey. In summary, patients were allowed unrestricted drinking before surgery, drank wisely and according to their needs. The amount and type of liquid desired were highly individual. This liberal liquid regime may prevent peri-operative anxiety, stress, postoperative nausea and vomiting, postoperative delirium and other complications. No competing interests declared. Open Access funding enabled and organized by Projekt DEAL.

Pulmonary symptoms in adolescent and adult patients with a spinal deformity.

Patients with spinal deformities, both adolescents and adults, often experience pulmonary symptoms such as shortness of breath during physical exertion and reduced exercise tolerance. These symptoms significantly affect their daily functioning, and recent research by Van Kempen et al. (2022) involving 8,723 AIS patients found that declines in pulmonary function tests (PFTs) were linked to the severity of their spinal deformities.However, these clinically relevant pulmonary symptoms are not routinely monitored, which could have health implications as patients age, given the gradual deterioration of pulmonary function associated with the severity of their spinal deformities. PFTs have been used to quantify these symptoms, but a discrepancy exists between these objective measurements and the subjective experiences of patients, reducing their clinical value. To address this gap, patient-reported outcome measures (PROMs) capturing the patient's perspective are needed but are currently lacking.The presentation outlines ongoing efforts to rectify this situation, with a focus on measuring pulmonary function and exercise tolerance through structured patient interviews, the use of smart vests with sensors, and the development of a patient-reported outcome measure (PROM). These endeavors aim to improve the monitoring and management of pulmonary symptoms in spinal deformity patients, ultimately enhancing their quality of life and long-term health. (Presented at the 2009st Meeting, November 8, 2023).

Associated factors of potential drug-drug interactions and drug-food interactions in patients with multiple sclerosis.

Background:Multiple sclerosis (MS) is the most common immune-mediated demyelinating disease in younger adults. Patients with MS (PwMS) are vulnerable to the presence of potential drug–drug interactions (pDDIs) and potential drug–food interactions (pDFIs) as they take numerous medications to treat MS, associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can increase treatment success and reduce side effects.Objective:We aimed at determining the frequency and severity of pDDIs and pDFIs in PwMS, with regard to polypharmacy.Methods:In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged ⩾18 years. Data collection was performed through patient record reviews, clinical examinations and structured patient interviews. pDDIs and pDFIs were identified using two DDI databases: Drugs.com Interactions Checker and Stockley’s Interactions Checker.Results:We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%) had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334 patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a 15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001). The most frequently recorded severe pDDI was between citalopram and fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent severe pDFI.Conclusion:Pw/P were particularly at risk of severe pDDIs. Age and educational level were found to be factors associated with the occurrence of pDDIs, independent of the number of medications taken. Screening for pDDIs/pDFIs should be routinely done by the clinical physician to increase drug safety and reduce side effects.

Study on Evaluation of Medication Adherence and Drug Related Problems In High Risk Elderly Population

Medication adherence is a crucial component in the treatment of chronic diseases. In the elderly, clinicians are faced with a unique set of problems associated with adherence that they may not have been adequately trained for. The present study was designed to assess the socio-demographic profile, adherence and drug-related problems among elderly. Methods: An observational study involving 30 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of adherence and DRP were assessed by means of an identification tool specifically developed for use by community pharmacists, including a semi structured patient interview and a checklist of common DRP. Results: Out of 30 study subjects, it was observed that majority of the study subjects had drug related problems. High, moderate and low adherence to medication was found. Conclusion: It is evident that there is a great need on the part of health care providers to not only prescribe medications to the patients but also make a conscious effort to address the issue of non-adherence to the prescribed medications and other non-pharmacological measures. Keywords: Morisky, Drug compliance, elderly, habits, medications

Prevalence of Drug Related Problems in Patients with Chronic Diseases- a Community Based Study in Dakshina Kannada

Drug related problem (DRP) can be defined as an event which involves drug therapy that may actually or sometimes potentially interfere the desired health outcomes. DRPs in patients with chronic diseases are more common due to the longer duration of therapy as well as altered physiology in such patients. In addition to this, patients suffering from chronic illnesses usually have multiple diseases and take more number of medicines including over the counter medications in community settings. There is a relative lack of information and inadequate documentation about DRPs in the community setting which may be because of gaps in the continuity of medical and pharmaceutical care. So a community based observational study was conducted in different places of Dakshina Kannada district of Karnataka to identify and assess the prevalence of drug related problems in patients with chronic diseases using Hepler - Strand classification for duration of 6 months from October 2019 to March 2020 by enrolment of 150 patients diagnosed with any chronic disease. Patients diagnosed with psychiatric illnesses, patients aged below 18 years old, pregnant and lactating women were excluded from the study. Medical information was collected using structured patient interview form and data were analysed and interpreted using Microsoft Excel 2010. From this study, it was found that the prevalence of patients identified for the presence of DRPs was 54.67% and was more in female gender, age above 60 years, patients with multiple co-morbidities and patients on poly-pharmacy. Thus the study concluded that pharmacist interventions play a major role in identifying and assessing prevalence of DRPs and their risk factors.

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral.

Background: Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral. Methods: In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (n = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities. Results: 68% of the patients followed a pathway where family physician (FP) visits were dominant (“FP-centric”) and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant (“ED-centric”). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12–111) vs. 22 (IQR: 5–69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit. Conclusions: Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.

Structured patient interview to assess clinical outcomes in complicated urinary tract infections in the APEKS-cUTI study: pilot investigation.

Background:The APEKS-cUTI study demonstrated the non-inferiority of cefiderocol to imipenem−cilastatin in the primary endpoint of the composite of clinical and microbiological outcome in patients with complicated urinary tract infections (cUTIs). We piloted a structured patient interview (SPI) to evaluate clinical outcomes based on patient-reported symptoms while conducting this pivotal randomized, double-blind, phase-2 study. The objectives were to assess the value of the SPI, using its performance relative to physician assessment, and also to strengthen the value of patient-reported measures in conducting clinical trials for cUTI treatment.Methods:In addition to the protocol-defined clinical and microbiological outcomes, patients randomized in the APEKS-cUTI study were interviewed by the investigator or qualified study personnel at screening/baseline, early assessment (EA), end of treatment (EOT), test of cure (TOC), and follow-up (FUP). The 14-element questionnaire graded cUTI symptoms as absent or present, and if present, as mild, moderate, or severe. Changes in post-baseline symptoms based on patients’ responses were rated by the interviewer. The overall clinical outcome was evaluated based on the responses provided by patients at each time point.Results:Among the 371 patients in the modified intention-to-treat population, the rate of SPI completion in each treatment arm exceeded 90% at each time point. SPI-assessed clinical cure rates were 89.7% in the cefiderocol arm and 84.9% in the imipenem–cilastatin arm. There was substantial agreement between SPI evaluation and investigator global assessment of clinical outcome at TOC and FUP, with lower agreement at EA and EOT.Conclusion:This analysis suggests that patient-reported symptoms can be effectively captured in hospitalized patients with cUTI in a clinical trial setting. Development of a validated patient-reported outcome for use in such a setting is warranted.Registration:NCT02321800 (registered on 22 December 2014).

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand.

Background:Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.Objective:This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.Methods:A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.Results:Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.Conclusions:A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Effect of Physiotherapy Integrated Exercise Rehabilitation Protocol on Outcomes for Patients with Patellofemoral Pain Syndrome

Abstract Background: Patellofemoral pain syndrome is characterized by anterior knee pain, which may limit the performance of functional daily activities. Aim: to evaluate the effect of physiotherapy integrated exercise rehabilitation protocol on outcomes of patients with patellofemoral pain syndrome Methods: Research design: A quasi - experimental (pre/ post) design was used. Setting: The study was conducted in the Physiotherapy Department at Assiut University Hospital. Sample: A purposive sample of (60) adult patients aged 20- 65 years diagnosed with patellofemoral pain syndrome. Tools: two tools (I): Structured patient interview questionnaire; this tool consisted of two parts; Part 1: Patients demographic characteristics and Part 2: Patient's medical data assessment. Tool (II): Kujala Patellofemoral Questionnaire (KPQ) scale. Results: Exercise rehabilitation protocol resulted in a highly statistically significant difference in the pre / post protocol in the whole items of Kujala patellofemoral score. Conclusion: The exercise rehabilitation protocol was more effective in improving patient's outcomes (reducing pain, improving activities of daily living in patients with patellofemoral pain syndrome. Recommendation: Screening programs to identify the risk factors for prolonged pain and knee functional deficit, and the potential association with degenerative joint disease.

LIMB GIRDLE MUSCULAR DYSTROPHIES: P.144 Patient reported quality of life in limb girdle muscular dystrophy: A cross-sectional survey

We aimed to identify the symptoms that most impact quality of life in individuals with limb girdle muscular dystrophy (LGMD). LGMD is a group of multisystem disorders impairing the physical, mental, and social health of patients while inflicting significant disability. The identification of the symptoms and manifestations most significant to a patient's health and the relationship between these issues and patient characteristics are lacking in LGMD. LGMD-affected individuals from patient registries (JAIN foundation, C3 registry, and global FKRP registry) that include both mixed LGMD and disease specific patient populations (LGMDR1, R2 and R9) participated in a large cross-sectional study to determine the frequency and relative importance of LGMD symptoms identified through prior structured patient interviews.

Patient reported symptoms, coping and quality of life during somatostatin analogue treatment for metastatic small- intestinal neuroendocrine tumours

BackgroundPatients with metastatic small-intestinal neuroendocrine tumours (NET) have been shown to have a reduced quality of life compared to the general population and many have disabling symptoms during somatostatin analogue (SSA) treatment. The aim of this prospective study was to document the patient-reported symptoms, coping and quality of life during SSA treatment and to measure patients’ fat-soluble vitamin levels.MethodsPatients with metastatic small-intestinal NET on treatment with long-acting SSA were included. Data on patient characteristics, blood samples, questionnaires (EORTC-QLQ-C30 and GI.NET-21) and structured patient interviews were collected at inclusion and after 1 year.ResultsEighty-eight patients were included, 77 (88%) attended 1 year follow-up. Approximately 50% of patients reported symptoms, the most common symptoms at baseline and after 1 year follow-up were diarrhoea, flatulence, fatigue, abdominal discomfort and sore injection lumps. Diarrhoea and fatigue were reported as their main complaint, 23% had > 5 daily episodes of diarrhoea and 59% reported fatigue. However, patients reported a high perceived quality of life, high daily activity, coped with their symptoms and managed their daily life well. Deficiency of vitamin D (27%) and A (13%) were observed.ConclusionsPatients with metastatic small-intestinal NET on SSA treatment reported a high frequency of symptoms. Minor improvements were seen after 1-year of follow-up, illustrating that many symptoms might be difficult to improve, or may not be recognised by the health service. Patients, however, generally reported a high quality of life. Care for NET patients on SSA treatment should include a regular systematic symptom registration and vitamin measurements.

Telemedicine Online Visits in Urology During the COVID-19 Pandemic—Potential, Risk Factors, and Patients’ Perspective

The current coronavirus disease 2019 (COVID-19) pandemic has placed considerable strain on hospital resources. We explored whether telemedicine (defined as a videoconference) might help. We undertook prospective structured phone interviews of urological patients (n = 399). We evaluated their suitability for telemedicine (judged by a panel of four physicians) and their risks from COVID-19 (10 factors for a poor outcome), and collected willingness for telemedicine and demographic data. Risk factors for an adverse outcome from COVID-19 infection were common (94.5% had one or more) and most patients (63.2%) were judged suitable for telemedicine. When asked, 84.7% of patients wished for a telemedical rather than a face-to-face consultation. Those favouring telemedicine were younger (68 [58–75] vs 76 [70–79.2] yr, p < 0.001). There was no difference in preference with oncological (mean 86%) or benign diagnoses (mean 85%), or with COVID-19 risks factors. In subgroup analysis, men with prostate cancer preferred telemedicine (odds ratio: 2.93 [1.07–8.03], p = 0.037). We concluded that many urological patients have risk factors for a poor outcome from COVID-19 and most preferred telemedicine consultations at this time. This appears to be a solution to offer contact-free continuity of care. Patient summaryRisk factors for a severe course of coronavirus disease 2019 are common (94.5%) in urology patients. Most patients wished for a telemedical consultation (84.7%). This appears to be a solution to offer contact-free continuity of care.

Abstract 131: Feasibility and Efficacy of Central Blinded Video Rankin Scale Outcome Assessments in a Randomized Clinical Trial

Introduction: In randomized clinical trials, central adjudication is frequently used for study outcomes. However, stroke trials have historically used site-derived Rankin scale assessments as primary outcome. Hypothesis: A central adjudication of Rankin scale assessment is at least as accurate as site-derived assessment. Methods: We studied acute stroke survivors from the RESILIENT study, where primary outcome was the consensus Rankin scale rating of two blinded central adjudicators who independently watched video recordings of a 90-day post-stroke structured patient and/or family interview. We compared agreement rates (weighted kappa statistics) between both central adjudicators with that between the blinded site investigator and the consensus reading between central adjudicators. Results: Trial randomized 221 patients to thrombectomy or medical treatment alone. At 90 days, 161 (73%) survived and 142/161 (88%) had quality video recordings for central adjudicators. Median (interquartile range) Rankin scores were similarly 3 (2-4) for each central rater and for the site investigators. Agreement rates between central adjudicators was 79.6% (kappa=0.94, p&lt;0.001), while agreement between site investigator and consensus rating from central adjudicators was 76.8% (kappa=0.92, p&lt;0.001). Conclusions: Central blinded Rankin scale outcome assessment is feasible and is at least as good as site investigator assessments. For open-label trials with blinded clinical outcome assessment, central adjudication of video-recorded interviews provides safer blinding and accountability.

The risk of polypharmacy, comorbidities and drug-drug interactions in women of childbearing age with multiple sclerosis.

Background and Aims:Multiple sclerosis (MS) is the most common neuroimmunological disease of the central nervous system in young adults. Despite recommended contraception, unplanned pregnancies can occur in women of childbearing age with MS. MS- and comorbidities-related multimedication in these patients represents a potential risk. We aimed to raise awareness regarding the frequency of polypharmacy and drug–drug interactions (DDIs) in female MS patients of childbearing age.Methods:Sociodemographic, clinical and pharmaceutical data were collected through patient records, clinical investigations and structured patient interviews of 131 women with MS. The clinical decision support software MediQ was used to identify potential DDIs. A medication and DDI profile of the study population was created by statistical analysis of the recorded data.Results:Of the 131 female MS patients, 41.2% were affected by polypharmacy (concurrent use of ⩾5 drugs). Polypharmacy was associated with higher age, higher degree of disability, chronic progressive MS disease course and comorbidities. With an average intake of 4.2 drugs per patient, a total of 1033 potential DDIs were identified. Clinically relevant DDIs were significantly more frequent in patients with polypharmacy than in patients without polypharmacy (31.5% versus 5.2%; Fisher’s exact test: p < 0.001).Conclusion:For the first time, a comprehensive range of potential DDIs in women of childbearing age with MS is presented. Polypharmacy is associated with the occurrence of clinically relevant DDIs. This shows the need for effective and regular screening for such interactions in order to prevent avoidable adverse effects.

Dietary lifestyle modifications for vitiligo patients

Background and objective: Changing the patient lifestyle as regarding diet well helped in vitiligo patient cure. Aim: to examine the effect of applying dietary instructions on dietary lifestyle modifications of vitiligo patients.Methods: Research design: Quasi experimental research design with one group (Pre/Post-test) was utilized in this study. Setting: the study was conducted in the ultraviolet unit at the Dermatology Department of Asyut University Hospitals. Study tool: Structured patient interview questionnaire sheet. It included two parts: Part 1: Assessment of patient’s sociodemographic variables. Part 2: Dietary pattern assessment: derived from Patient Life Style Pattern Assessment Sheet (PLSPAS) for Vitiligo.Results: The mean age of the studied sample was (mean ± SD 34.62 ± 12.35), 51.6% were female, 70% were living in rural areas, a highly statistically significant difference in the total mean knowledge scores between pre and post application of the dietary instructions (p value = .002).Conclusions: The present study concluded that there was a great improvement in the dietary lifestyle pattern of the studied sample after application of dietary instructions. Recommendations: Replication of the study on a larger probability sample from different geographical locations for generalization of the results. Printing copies of the dietary instructions for dissemination among all vitiligo patients attending the dermatology ward for treatment or follow-ups.

A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge

BackgroundLittle is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual...