Tertiary Care Clinic Research Articles

Image Findings of Juxtacortical Lesions

Juxtacortical lesions appear as neoplastic formations on the outer cortical surface of bone. They can arise from nonneoplastic and neoplastic origin, the latter of which might be malignant. Juxtacortical lesions of neoplastic origin can be categorized into bone-forming lesions, cartilaginous lesions, fibrous lesions, lesions of local vascular or neurogenic origin, or metastatic lesions. Forming a differential diagnosis can be challenging for any physician assistant. We selected a series of cases from our tertiary care clinic that have been subject to discussion for their similarity but vastly different prognosis. Our aim is to provide a rubric to compare juxtacortical lesions with guide orthopaedic and sport medicine providers in determining the immediacy of referral and follow-up.

Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries.

Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey at 29 ART clinics in high TB burden countries within the global IeDEA network. We used structured questionnaires to collect clinic-level data on the TB and HIV services and the availability of diagnostic tools and treatment for MDR-TB. Of 29 ART clinics, 25 (86%) were in urban areas and 19 (66%) were tertiary care clinics. Integrated HIV-TB services were reported at 25 (86%) ART clinics for pan-susceptible TB, and 14 (48%) clinics reported full MDR-TB services on-site, i.e. drug susceptibility testing [DST] and MDR-TB treatment. Some form of DST was available on-site at 22 (76%) clinics, while the remainder referred testing off-site. On-site DST for second-line drugs was available at 9 (31%) clinics. MDR-TB treatment was delivered on-site at 15 (52%) clinics, with 10 individualizing treatment based on DST results and five using standardized regimens alone. Bedaquiline was routinely available at 5 (17%) clinics and delamanid at 3 (10%) clinics. Although most ART clinics reported having integrated HIV and TB services, few had fully integrated MDR-TB services. There is a continued need for increased access to diagnostic and treatment options for MDR-TB patients and better integration of MDR-TB services into the HIV care continuum.

P247 Comparison of discontinuation/switching between infliximab biosimilar and originator among Inflammatory Bowel Disease patients: a real-world analysis of two Canadian cohorts

Abstract Background Biosimilar infliximab (INF-B) has been approved in Canada for Inflammatory Bowel Disease (IBD) for over five years, but real-world descriptions of therapy persistence (discontinuation/switching) comparing INF-B to bio-originator (INF-O) are still scarce. Our objectives are to describe and compare therapy discontinuation/switching of INF-B and INF-O in IBD. Methods We used data from two IBD tertiary care clinics in Canada, in Montreal (QC) and Hamilton (ON). We studied biologic-naïve and biologic-experienced IBD adult initiating INF-B or INF-O between Jan. 2015 and Jul. 2020. We assessed time to discontinuation/switching through Kaplan-Meier curves (right-censoring due to loss to follow-up or end of the observation period). Reasons for discontinuation were assessed. Multivariable Cox regression models were performed to assess difference in time to discontinuation/switching between the two infliximab types. Model variables included age at infliximab initiation, sex, underlying condition (Ulcerative Colitis or Crohn’s Disease), disease duration, race/ethnicity, calendar year of infliximab start, current smoking, clinical centre, and previous use of other biologics, as well as previous/current use of corticosteroids, non-biologic immunosuppressants, budesonide, or 5-aminosalicylates. Results We studied 306 patients followed an average of 1.4 (standard deviation, SD=0.99) years. Patients were 46.7% female, with median age at infliximab initiation of 32 (interquartile range, IQR 21 to 47) years and median disease duration of 3.5 (IQR 0.9 to 11.7) years. Age, sex, and other baseline characteristics were comparable between the two groups, though there was a trend towards more INF-B initiation in recent years (Table 1). We identified 70 discontinuation/switching events; the main reasons for discontinuation/switching were adverse events (37.1%) and secondary loss of response (28.6%). The median time to discontinuation/switching was 4.1 (95% confidence interval, CI 3.4–5.5) years among INF-O and 3.0 (95% CI 2.2–3.5) years in the INF-B group. In the multivariate model, risk of the main outcome was not clearly different between the two groups (hazard ratio, HR 1.21, 95% CI 0.64–2.32 – Table 2). Older age and corticosteroids were significantly associated with discontinuation/switching of the initial infliximab therapy. Conclusion In this real-world analysis, we were unable to demonstrate differences in risk of discontinuation/switching among initiators of infliximab biosimilar or originator in IBD.

Retrospective analysis on the effect of duration of ejaculatory abstinence on fertilization, embryo development, and pregnancy rates in patients undergoing conventional in vitro fertilization

Aim: This study aims to find out how different sexual abstinence period influences semen parameters, fertilization, embryo development, and pregnancy rates in patients undergoing conventional in vitro fertilization. Setting and designs: A retrospective analysis was conducted at a tertiary level infertility care clinic. Materials and methods: The clinical study included 532 patients between January 2017 and July 2021 who had been treated with conventional in vitro fertilization. The effect of sexual abstinence on primary outcomes such as semen volume, total sperm concentration, total motile sperm concentration, sperm morphology, and secondary outcomes such as fertilization rate, cleavage rate, top quality day 3 and day 5 embryo development rate, implantation and clinical pregnancy rate between fresh versus frozen embryo transfer on day 3 and day 5 of conventional in vitro fertilization under three groups, that is, sexual abstinence of less than or equal to 1, 2 to 5, and 6 to 7 days was evaluated. Statistical analysis used: Chi-square test was used to evaluate the qualitative variables whereas one-way analysis of variance was used to evaluate the quantitative variables. Results: Group II with 2 to 5 days of abstinence, observed a positive correlation between abstinence period and semen volume, total sperm concentration, total motile sperm concentration, and morphology. Fertilization rate was higher in groups II and III than group I (P = 0.21) with no significant difference in cleavage rate (P = 0.4) and embryo development on day 3 (P = 0.1057). The formation of AA grade blastocyst between group I and group II was 27.54 % and 23.47 %, respectively, with a P-value of 0.007154. Both fresh and frozen embryo transfers of groups II and III of abstinence period had implantation and clinical pregnancy rates of 23.39% and 43.83%, respectively. Conclusion: Our study did not find any significant difference in primary and secondary outcomes of conventional in vitro fertilization between the three groups. We recommend further prospective large randomized control studies to prove any association between duration of abstinence and pregnancy outcomes.

P015 Impact of IBD on Daily Lives: A Descriptive Insight to Patient's Experience in the Work and Study Settings.

Persons with inflammatory bowel diseases (IBD) endure the uncomfortable symptomatology of the disease, while trying to carry out daily activities. Given that IBD is not physically distinctive, it may be overlooked and lead to discrimination in the workplace and school. We aim to describe work and study experiences from patients with IBD. A questionnaire containing sociodemographic, psychological, and medical inquiries was administered to patients with IBD in a tertiary care clinic. The survey captured past and present employment and scholarly status. Productivity was established by the number of early leaves or absences patients experienced due to disease symptomatology. Qualitative and quantitative data were analyzed using descriptive statistics. The study is approved by the UPR-MSC IRB. A total of 120 patients, 59 males and 61 females, with a mean age of 27.00 ± 9.71 were recruited. 91 participants had CD, while 29 had UC. 94% of subjects had some form of income. At the time of interview, 83 patients were working. 19% did not tell the employer of their IBD, while 19% felt discriminated at work due to their condition. 38% said the disease has limited their work goals. Of those working, 74 had to leave early or absent themselves due to disease manifestation. In the last year, 39% of patients had absented themselves for 1-2 days, 27% for 3-4 days, 9% for 5-6 days, 4% for 7-8 days, 3% for 9-10 days and 18% for more than 10 days. The mean of absences from work was 4.4 days. Patients with UC were significantly more prone to work absences than patients with CD (P = 0.0243). 69 patients were studying while having the condition. 67% achieved a college or higher degree, while 33% had high school or less. 34% had to drop a course during their school years. Of the 23 patients who experienced withdrawals, 74% had a total withdrawal from school, while 26% had a partial withdrawal at some point. 14% did not inform of their IBD at school, 12% felt discriminated because of their condition and 32% said the disease has limited their educational goals. 87% of those studying had to miss or leave school early due to disease manifestation. In the last year, 24% of patients had absented themselves for 1-2 days, 29% for 3-4 days, 7% for 5-6 days, 7% for 7-8 days, 3% for 9-10 days and 30% for more than 10 days. The mean of absences was 5.6 days. School absences were not significantly different between subjects with CD and UC (P = 0.384). 22% of participants deemed themselves as a person with a disability given their condition, while 8% did not know whether they should consider themselves as such. Perception of disability was not significantly different between patients with CD and UC (P = 0.870). Absenteeism is a significant factor affecting productivity in patients with IBD. Perception of disability may also impact work and study experiences. Raising awareness is essential for patient support in these settings.

Reasons for Mohs Micrographic Surgery Cancellation: A Retrospective 1-Year Analysis in a Tertiary Care Clinic Before the COVID-19 Pandemic.

Reasons for Mohs Micrographic Surgery Cancellation: A Retrospective 1-Year Analysis in a Tertiary Care Clinic Before the COVID-19 Pandemic.

Obesity and metabolic comorbidity in bipolar disorder: do patients on lithium comprise a subgroup? A naturalistic study

BackgroundBipolar disorders (BD) are associated with increased prevalence of obesity and metabolic syndrome (MetS). Nevertheless, there is a wide range in prevalence estimates, with little known about the contributions of pharmacotherapy. It has been suggested that lithium might have a more favorable metabolic profile. We hypothesized that lithium use is associated with less increased body mass index (BMI), MetS, and type II diabetes, when compared with non-lithium users (those on anticonvulsants, second-generation antipsychotics).MethodsCross-sectional study of 129 patients aged 18–85 with bipolar disorder, followed at tertiary care clinics in Montreal. Patients using lithium were compared with those not on lithium, for body mass index and metabolic syndrome.ResultsThe prevalence of obesity and metabolic syndrome in the sample of lithium-using patients with BD was 42.4 and 35.7% respectively, with an average BMI of 29.10 (+/− 6.70). Lithium and non-lithium groups did not differ in BMI or prevalence of MetS. However, compared to the non-lithium group, lithium users had lower hemoglobin A1C (5.24 +/− 0.53 versus 6.01 +/− 1.83, U = 753.5, p = 0.006) and lower triglycerides (1.46 +/− 0.88 versus 2.01 +/− 1.25, U = 947, p = 0.020).ConclusionsThere is a high prevalence of obesity and metabolic syndrome among patients with bipolar disorder. However, this did not appear to be associated with lithium use, when compared to those not on lithium. The lithium subgroup was also associated with lower prevalence of type II diabetes. Future prospective and intervention studies with larger sample sizes are necessary to further explore the association between lithium and insulin resistance, as well as its underlying mechanisms.

Electronic reminders and rewards to improve adherence to inhaled asthma treatment in adolescents: a non-randomised feasibility study in tertiary care

ObjectiveTo test the feasibility and acceptability of a short-term reminder and incentives intervention in adolescents with low adherence to asthma medications.MethodsMixed-methods feasibility study in a tertiary care clinic. Adolescents recruited...

Right siting of complex acute wound management---preliminary study of teleconsultation wound services between acute and primary care in Singapore

This study aimed to provide preliminary evidence on feasibility of the inaugural use of teleconsultation between acute hospitals and primary care for acute wound management in Singapore. Post-surgical patients with carbuncle wounds, perianal abscess wounds or surgical abdominal dehiscence wounds were recruited from an acute hospital. Instead of receiving their follow up care at the acute care tertiary hospital, patients were given the option to receive their care at primary care facilities instead, supported by teleconsultation wound services provided by wound care nurses from the hospital. The following outcome measures were collected: number of care sessions required (until wound healed), readmissions or referrals back to hospital, cost (patient's and healthcare provider's perspective), patients' and nurses' satisfaction.In total, 18 patients were recruited and completed the study (teleconsult group = 5; tertiary care clinic group = 13). The mean age (SD) of patients were 63.2 (SD 11.5) years old in the teleconsult group and 47.9 years old (SD 11.5) in the tertiary care clinic group. There were 7 female (54%), and 6 male (46%) in the tertiary care clinic group whereas teleconsult group consisted of male only (n = 5). Most had carbuncle wounds (teleconsult group: n = 4; 80%); tertiary care clinic group: (n = 10; 77%). For patients with carbuncle wounds, the average number of care sessions required were 21 and 33 for the tertiary care clinic and teleconsult respectively. None of the patients in the teleconsult group were referred back to the tertiary care hospital. All 16 nurses (n = 6 from acute care hospital, n = 10 from polyclinics) who participated in the feedback survey cited convenience, ease of tracking wound sizes, and closer collaboration between the acute care and primary care nurses as advantages of the service. Wound teleconsultation is feasible and potentially cost savings for patients with acute complex wounds.

27.2 Examining the Psychometric Properties and Clinical Utility of the Toronto Obsessive-Compulsive Scale (TOCS) in a Pediatric Clinical Sample

This session aims to examine the psychometric properties and establish clinical cutoffs for the parent-report version of the Toronto Obsessive-Compulsive Scale (TOCS), a 21-item screening tool that examines obsessive-compulsive traits. Participants had a primary diagnosis of OCD (n = 350; 50% female; ages 6-20 years), ADHD (n = 835; 25% female; ages 5-20 years), autism spectrum disorder (ASD; n = 805; 22% female; ages 2-21 years), or were typically developing controls (n = 398; 51% female; ages 3-21 years). Data were collected from 2 tertiary care clinics as well as from the Province of Ontario Neurodevelopmental Disorders (POND) Network. Confirmatory factor analyses, internal consistency, and convergent and divergent validity of the TOCS were examined in the OCD group. Receiver operating characteristic (ROC) analyses were used to establish a clinical cutoff by splitting the OCD and control groups into a discovery sample (166 OCD cases, 164 controls) and a validation sample (184 OCD cases, 234 controls). TOCS scores were compared across clinical groups using multivariate analysis of variance (MANOVA). The 6-factor structure of the TOCS was confirmed (χ2 [137] = 596.60; CFI = 0.90; RMSEA = 0.09; 90% CI, 0.09-0.10; SRMR = 0.06) with each factor demonstrating strong reliability (α range 0.71-0.92) and validity (eg, r = 0.40 with existing OCD measure). ROC analyses indicated excellent diagnostic discrimination of OCD cases from controls (area under the curve ≥ 0.95), with excellent sensitivity (77%-92%) and specificity (92%-98%) in both the discovery and validation samples. The OCD group scored significantly higher on all TOCS dimensions than the ADHD and ASD groups (all p < 0.001), with the exception of hoarding. The TOCS is a reliable and valid screening tool for pediatric OCD, with a strong ability to discriminate OCD cases. It is a multipurpose quantitative OCD measure that is useful not only for research (including genome-wide association studies), but also as a clinical screening tool.

Development and validation of a machine-learning ALS survival model lacking vital capacity (VC-Free) for use in clinical trials during the COVID-19 pandemic

Introduction: Vital capacity (VC) is routinely used for ALS clinical trial eligibility determinations, often to exclude patients unlikely to survive trial duration. However, spirometry has been limited by the COVID-19 pandemic. We developed a machine-learning survival model without the use of baseline VC and asked whether it could stratify clinical trial participants and a wider ALS clinic population. Methods. A gradient boosting machine survival model lacking baseline VC (VC-Free) was trained using the PRO-ACT ALS database and compared to a multivariable model that included VC (VCI) and a univariable baseline %VC model (UNI). Discrimination, calibration-in-the-large and calibration slope were quantified. Models were validated using 10-fold internal cross validation, the VITALITY-ALS clinical trial placebo arm and data from the Emory University tertiary care clinic. Simulations were performed using each model to estimate survival of patients predicted to have a > 50% one year survival probability. Results. The VC-Free model suffered a minor performance decline compared to the VCI model yet retained strong discrimination for stratifying ALS patients. Both models outperformed the UNI model. The proportion of excluded vs. included patients who died through one year was on average 27% vs. 6% (VCI), 31% vs. 7% (VC-Free), and 13% vs. 10% (UNI). Conclusions. The VC-Free model offers an alternative to the use of VC for eligibility determinations during the COVID-19 pandemic. The observation that the VC-Free model outperforms the use of VC in a broad ALS patient population suggests the use of prognostic strata in future, post-pandemic ALS clinical trial eligibility screening determinations.

P646 The Loss of Productivity in Employment and Education Associated to Inflammatory Bowel Diseases: A Pilot Study of the Patient’s Perception

Abstract Background Inflammatory Bowel Diseases (IBD) impact vocational, educational, and psychosocial aspects of a patient’s life and may cause patients to miss work or school or underperform. This study describes loss of productivity in Hispanics with IBD in the workplace and educational settings, along with the patient’s perception. Methods Patients with IBD attending a tertiary care clinic were given a self-administered survey related to loss of productivity in employment and education. The questionnaire acquired qualitative and quantitative data about the patients’ past and present work and educational settings. Productivity was determined by the number of absences or early leaves from school or work due to disease manifestations. The patient’s perception regarding psychological aspects of their condition was assessed. Descriptive statistics were used for sociodemographic data, perceptions regarding their condition, and clinical history as captured by the questionnaire. This study is approved by the MSC IRB. Results 100 patients (M/F: 50/50, CD/UC: 72/28, age range: 18–61, mean age: 29.78 ± 9.81) participated. 45 participants were working, 16 were studying, and 25 were working and studying. 89% of those working had to leave early or miss work due to disease manifestations and, among those, 51% had more than two absences in a given month. During their school years, 100% had absences or had to leave class early because of the disease. 61% said that their condition has a negative effect in their daily lives. Furthermore, 61% perceived their disease affects moderately to severely their daily life. However, 61% expressed that their disease has minimal or no effect on their self-esteem, 75% denoted that their disease does not impact their familial relationships and 74% indicated that they manage their disease with a positive mindset. There was no significant association between sex (p=0.71) or diagnosis (p=0.31) and perception of disease severity. Conclusion Work and study absences due to IBD manifestations were frequently reported in the study, translating into decreased productivity. Perception of disease severity was independent of diagnosis and sex. A majority perceived that IBD affected daily life moderately to severely. Strategies to improve work and study conditions may result in improved productivity.

MHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients' Perspectives.

BackgroundPatients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging– or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support.ObjectiveThis study aims to examine patients’ use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering.MethodsA total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients’ experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants’ typical mobile phone use and level of interest in mobile technology–based support for opioid tapering. Semistructured interviews further explored patients’ use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data.ResultsAll participants reported owning and using a mobile phone, and most (17/21, 81%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging–based (17/21, 81%) and app-based (15/21, 71%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement.ConclusionsThe results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging–based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients’ preferences for functionality, content, and design are addressed.

The Oral Manifestation of Hepatitis Patients Visiting Tertiary Care Clinics of Karachi

Background: The present study aimed to find out the most frequent Oral lesions in hepatitis B and C patients in the local population and correlate it with age and gender. Materials and Methods: A retrospective study was designed at Sindh Institute of Oral Health Sciences at the department of Oral medicine. We studied the records of patients coming to OPD from 2016 till 2021 diagnosed with hepatitis B and C for treatment. Convenience sampling was done. Incomplete forms and data of the patients with comorbid conditions such as Diabetes, Rheumatoid Arthritis or Hypertension were removed as a part of the protocol. Results: Data of sixty-seven patients was included in the study. Data analysis was done through SPSS ver.18. Frequency of the oral lesions in hepatitis B and C was assessed and the relationship between hepatitis and oral lesions was also explored by applying t-test. Male to female ratio was 1: 1.5. The most frequent lesion in both hepatitis B and C was Periodontitis followed by gingivitis and oral lichen planus. Also, the relationship between hepatitis C and oral lesions was significant at the level of p-value of 0.05% while for hepatitis B and effect on the treatment of hepatitis was no significant. Conclusion: The findings of the study show that the Hepatitis C has a significant relationship with oral lesions and presence of chronic periodontitis or gingivitis and oral lichen planus requires further testing for HCV and HBV status which would result in early diagnosis and treatment decreasing the chances of complications such as liver cirrhosis in long term and spread of infection. Keywords: Periodontitis, Oral lesions, Hepatitis B, Hepatitis C, Gingivitis.

Characterization of people living with HIV in a Montreal-based tertiary care center with COVID-19 during the first wave of the pandemic

ABSTRACT People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm3 [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.

The chicken or the egg: Longitudinal changes in pain and catastrophizing in women with interstitial cystitis/bladder pain syndrome.

Evidence-based psychological strategies are being used as clinicians look for helpful interventions for patients diagnosed with the enigmatic chronic urological pelvic pain condition of interstitial cystitis/bladder pain syndrome (IC/BPS). Pain and pain catastrophizing are associated with chronic pelvic pain outcomes but the longitudinal role of catastrophizing on patient pain in IC/BPS remains unknown. Women with IC/BPS were recruited from tertiary care clinics across North America and completed a battery of questionnaires, including demographics, pain, depression, catastrophizing at baseline, six months, and one year. A total of 226 patients completed baseline questions, 183 completed the six-month survey, and 151 completed the one-year survey. Using a cross-lagged analysis, early changes in pain catastrophizing predicted later changes in pain, but not vice versa. Followup subscale analyses revealed that early changes in magnification predicted later changes in pain, early changes in pain predicted later changes in rumination, and that there was a recursive relationship between changes in helplessness and changes in pain across the study. Pain catastrophizing should be considered a prime target in psychological treatment for chronic pain in patients with IC/BPS, particularly those thinking styles associated with pain onset and maintenance. Future research should be conducted with constructs such as pain catastrophizing in samples prioritizing diversity of patients with IC/BPS and mechanisms as to how to effectively decrease catastrophizing.

Cannabis Consumption Among Patients With a Voice Disorder: A Multicenter E-Survey Study

Legalization of cannabis consumption in the United States (U.S.) has increased rapidly, impacting consumption rates in the general U.S. The objective of this survey study was to establish prevalence estimates of cannabis consumption among voice patients, in addition to characterizing patterns of cannabis consumption. A multicenter, anonymous survey study of cannabis consumption took place at multidisciplinary tertiary voice care clinics in Portland, Oregon (PDX) and Pittsburgh, Pennsylvania (PIT) between April 2017 and December 2018. A convenience sample of 300 consecutively enrolled English-speaking patients 21 years and older with a voice disorder completed the survey. Data were obtained on the prevalence of cannabis consumption, frequency and methods of cannabis consumption, in addition to health impacts and demographics. Agresti-Coull prevalence proportion estimates for cannabis consumption were higher among voice patients in PDX compared to PIT. Current consumers in PDX and PIT showed a similar frequency of cannabis consumption. Combustion methods (eg, joint) were more popular than non-combustion methods (eg, vaping) among current consumers; inhaled methods (eg, joint) were more popular than non-inhaled methods (eg, edibles). Though vocal handicap scores for current consumers were similar across sites and comparable to lifetime non-consumers who also were non-smokers of tobacco, a lifetime history of cannabis consumption was associated with vocal and overall health impacts. Prevalence estimates for current cannabis consumption among voice patients from tertiary voice care clinics mirrored prevalence estimates reported for large, representative samples from Oregon and Pennsylvania. These findings provide valuable insight on the extent of cannabis consumption among voice patients.

Clinical Correlates of Health-Related Quality of Life in Adults With Chronic Tic Disorder.

Tics are the hallmark feature of Tourette syndrome (TS), but psychiatric and sensory symptoms are widely prevalent and increasingly recognized as core manifestations of the disorder. Accumulating evidence suggests that these psychiatric and sensory symptoms exert greater influence on quality of life (QOL) than tics themselves. However, much remains uncertain about determinants of QOL in TS due to the complexity of the clinical presentation. Here, we sought to clarify the association between health-related QOL (HRQOL) and common psychiatric and sensory symptoms in adults with TS and other chronic tic disorders. To do so, we prospectively recruited 52 patients from a tertiary care clinic to complete self-report measures assessing HRQOL (Gilles de la Tourette-Quality of Life Scale, GTS-QOL), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder Scale-7, GAD-7), obsessive-compulsive symptoms (Dimensional Obsessive-Compulsive Scale, DOCS), attention deficit hyperactivity disorder symptoms (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V), and premonitory urge (Premonitory Urge to Tic Scale, PUTS). All participants were also administered the Yale Global Tic Severity Scale (YGTSS) to quantify tic severity. Using correlational analysis and multivariable linear regression modeling, we found that GTS-QOL score was significantly associated with scores from all other rating scales, with the exception of the PUTS. GTS-QOL was most strongly associated with PHQ-9, followed by ASRS-V, GAD-7, DOCS, and YGTSS total tic score. The regression model including these five independent variables, as well as sex, explained 79% of GTS-QOL score variance [F(6,40) = 29.6, p < 0.001]. Specific psychiatric symptoms differentially impacted physical, psychological, and cognitive HRQOL. Systematic assessment of psychiatric comorbidities is imperative for clinical care and clinical research efforts directed at improving QOL in adults with chronic tic disorders.

Usefulness of Exam Questions and Vital Signs for Predicting the Outcome of Objective Vestibular Tests

To determine the value of standard clinic screening questions and vital signs in predicting abnormal vestibular function, indicated by standard objective diagnostic tests. Retrospective records review. We reviewed electronic medical records of 150 patients seen by the neurotologists or the physician assistant they supervised, in an out-patient tertiary care clinic, between June 2018 and March 2020, and subsequently referred for the complete objective vestibular test battery (VB). Of standard questions asked during the initial exam about vertigo, disequilibrium, lightheadedness and oscillopsia, only vertigo predicted an abnormal response on the VB. More males than females had abnormal VB responses, P < .05. Pulse was not related to VB score. Significantly more subjects with blood pressure in the range for stage 2 hypertension (blood pressure [BP] stage 2) had abnormal than normal results on the VB, P < .00001. Subjects with BP stage 2 had high rates of diabetes (34.2%) and hypertension (68.4%) as diagnosed by their primary care physicians or cardiologists. Complaints of subjective vertigo and BP in the range of hypertension stage 2 are most likely to predict abnormal findings on the VB. Therefore, during an examination of a patient who comes in complaining of dizziness, two measures may be the most useful for screening: BP in the range of hypertension type 2, when BP is taken by a nurse, and a question to determine whether or not the patient has true vertigo. 3 Laryngoscope, 131:1382-1385, 2021.