Health literacy in women with chronic pelvic pain.

INTRODUCTION AND HYPOTHESIS: Limited health literacy (HL) is a risk factor for poor patient outcomes, including pain. Chronic pelvic pain (CPP) is a prevalent disorder affecting up to 25% of women and coexists with multiple overlapping conditions. This study aimed to describe health literacy in women with CPP, primarily correlate HL to pain intensity and pain duration, and secondarily correlate HL to mood symptoms and pain catastrophizing. We hypothesized that women with CPP with higher HL would report lower levels of pain intensity and duration. METHODS: This was a prospective, cross-sectional study. Forty-five women with CPP were recruited from outpatient Physical Medicine & Rehabilitation and Female Pelvic Medicine & Reconstructive Surgery clinics. Validated questionnaires were administered to evaluate pain intensity and duration, pain disability, psychological symptoms, pain catastrophizing, and health literacy. Statistical analyses included descriptive statistics of patient characteristics and summary scores, as well as Spearman's rank correlation coefficients (rho) to assess the strength of associations between summary scores and health literacy. RESULTS: Forty-five women with CPP were enrolled with mean age of 49 years, majority non-Hispanic White, and median chronic pelvic pain duration of 7 years. Possible or high likelihood of limited health literacy was identified in 20% women with CPP (11.1% and 8.9%, respectively). Limited health literacy was moderately correlated with pain intensity, depressive symptoms, and pain catastrophizing. Pain duration was not significantly correlated with health literacy. The remaining 80% of women with CPP were likely to have adequate health literacy. CONCLUSIONS: A majority of women with CPP in this single center study were likely to have adequate health literacy. Limited health literacy was seen in a minority of women with CPP but was moderately correlated with greater pain intensity, more depressive symptoms, and higher pain catastrophizing. This study identified that women with CPP were likely to have adequate HL, but underscores the importance of considering HL screening and interventions in those with higher pain intensity, depression, and pain catastrophizing.

Potential role of abbreviated MRI for breast cancer screening in an academic medical center.

The purpose is to determine whether an abbreviated MRI protocol (ABMR) is ready to be used for breast cancer screening in an academic practice setting. Two hundred and fifty nine breast MRIs from 1/1/2012 to 6/30/2012 were retrospectively reviewed using ABMR (MIP, Pre-contrastT1, single dynamic post-contrastT1, and subtraction). Five breast radiologists (4-28 year-expr) participated in this reader study performed in two phases: Phase1 - radiologist's privy to clinical history but not to comparison imaging. Phase2 - radiologists provided comparison imaging. For phase1, studies were reviewed using three steps: (a) MIP only (positive/negative/intermediate); (b) ABMR (recall/no recall) and (c) With T2 (for changes in recommendations). Radiologist also recorded total time for interpretation. In Phase2 the MRIs coded as "recall" were re-reviewed with available comparison studies, noting changes in final recommendation. The abnormal interpretation rates (AIRs) were calculated for phase1 and phase2 results with comparison to the original full protocol. Of the 259 patients (avg. age-52 years; range 26-78), there were seven cancers (three invasive, three DCIS and one breast lymphoma). Acquisition time for ABMR was 3 minutes, ABMR + T2-8 minutes, and original full protocol 16 minutes. Average MIP was positive or indeterminate in 86% (6/7) and negative in 14% (1/7) cancers. The average AIR for MIP only was 20.8% (sens-77.1%; spec-80.8%. The AIR w/o comparisons was 25.6% (sens-91.4%; spec- 76.2%); however the average AIR decreased in phase 2 with comparisons to 13.7% (sens-91.4%; spec-88.5%). The AIR of the original full protocol read was 16.2% (sens-100%; spec-85.7%). Addition of T2 changed assessment in only 3% (1.2%-6.5%). Avg. read time for ABMR including T2 was 2.5 minutes (1.6-4.0 minutes). ABMR is reliable for breast cancer screening, with acceptable interpretation time and acceptable AIR.

A telehealth intervention to promote weight loss and physical activity in overweight primary care patients.

INTERVENTION: This pilot study was a 16-week Telehealth intervention using wearable devices, automated text messaging, and trained health coaching, in primary care clinics of an academic medical center. Thirty patients were enrolled in three cohorts, ages 18-64, BMI > 27, and MVPA < 150 minutes per week. The primary outcome was weight loss per week. RESULTS: Twenty-two participants had a significant median weight loss of -0.29 kg per week and mean change of -3.9 kg in total weight, -1.8 in BMI, and -3.8% of total bodyweight (all P<.001). MVPA increased 67 min per week (P=.003). CONCLUSION: This pilot telehealth intervention suggests that, when combined, these tools may be used effectively by primary care teams to promote weight loss and physical activity in their patients.

Educational Videos: An Effective Tool to Improve Training in Interventional Breast Procedures.

PURPOSE: Using the iPad application Explain Everything™, the authors created a "how to" video for stereotactic breast core biopsy to enhance their breast imaging curriculum. The objective was to show that video integration into residency training enhances resident learning. METHODS: A pretest was provided to all 40 radiology residents (postgraduate years 2-5) at the authors' institution. The test included 20 questions on the video content, 15 similarly framed control questions on material that was not included in the video, and four demographic questions. Questions were randomly ordered, and trainees were not informed that both types of questions were included. Residents were given one week to watch the 20-minute video before completing a posttest that included the same 35 content questions presented in a different order. Three logistical questions were also included. Results for the video and the control questions were analyzed separately and compared. RESULTS: Thirty of 40 residents (75%) participated (6-9 residents each year). The average scores for the video and control pretest were 7.7 of 20 (38.5%) and 7.8 of 15 (52%) and for the posttest were 13.8 of 20 (69%) and 7.8 of 15 (52%), respectively. This corresponds to a 30.7% mean improvement on the video-content questions compared with a 0% improvement for the control test (P < .001). Similar improvement was seen across all four postgraduate years and on an individual level. CONCLUSIONS: This instructional video added significantly to resident learning in the short term. Further study on the long-term role of educational videos in radiology residency training seems warranted.

Bleb morphology characteristics and effect on positional intraocular pressure variation.

BACKGROUND AND OBJECTIVE: To study bleb morphology and positional intraocular pressure (IOP) change (IOP supine to IOP sitting). PATIENTS AND METHODS: In this observational case series, blebs were graded for height, extent, vascularity, microcysts, and "ring of steel." Positional IOP change was analyzed using the paired t test. Associations between IOP change and bleb morphologies were evaluated by regression adjusting for inter-eye dependency. RESULTS: Ninety-five eyes of 68 subjects were included. Decreased bleb height (P = .05), absence of microcysts (P = .02), and increased bleb vascularity (P = .02) were associated with larger positional IOP change. Twenty patients with a filter in one eye and a medically treated fellow eye had larger positional IOP change in the medically treated eye (6.1 vs 4.6 mm Hg, respectively; P = .01). CONCLUSION: Successful filtration surgery results in both lower IOP and less positional IOP change compared with medically treated eyes. Bleb features associated with smaller positional IOP change include higher elevation, microcysts, and less vascularity.