Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0.

INTRODUCTION: There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the prevalence of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). MATERIALS AND METHODS: We recruited patients referred to a limb-preservation clinic. Patients self-reported their disability status using the 12-domain WHODAS 2.0. Severity of disability in each domain was scored from 1 = none to 5 = extreme and the total normalized to a 100-point scale (total score ≥25 = clinically significant disability). We also asked patients about wound-specific concerns and wound-related discomfort or distress. RESULTS: We included 162 patients. Reasons for clinic referral included arterial-insufficient (37.4%), postoperative (25.9%), and mixed etiology (10.8%) wounds. The mean WHODAS 2.0 disability score was 35.0 (standard deviation = 16.0). One-hundred-and-nineteen (73.5%) patients had clinically significant disability. Patients reported they had the greatest difficulty walking a long distance (mean score = 4.2), standing for long periods of time (mean score = 3.6), taking care of household responsibilities (mean score = 2.7), and dealing with the emotional impact of their health problems (mean score = 2.5). In the two-weeks prior to presentation, 87 (52.7%) patients expressed concern over their wound(s) and 90 (55.6%) suffered a moderate amount or great deal of wound-related discomfort or distress. In adjusted ordinary least squares regression models, although WHODAS 2.0 disability scores varied with changes in wound volume (p = 0.03) and total revised photographic wound assessment tool scores (p<0.001), the largest decrease in disability severity was seen in patients with less wound-specific concerns and wound-related discomfort and distress. DISCUSSION: The majority of people at risk of limb loss report suffering a substantial burden of disability, pain, and wound-specific concerns. Research is needed to further evaluate the WHODAS 2.0 in a multicenter fashion among these patients and determine whether care and interventions may improve their PROs.

Potential harms associated with routine collection of patient sociodemographic information: A rapid review.

BACKGROUND: Health systems are recommended to capture routine patient sociodemographic data as a key step in providing equitable person-centred care. However, collection of this information has the potential to cause harm, especially for vulnerable or potentially disadvantaged patients. OBJECTIVE: To identify harms perceived or experienced by patients, their families, or health-care providers from collection of sociodemographic information during routine health-care visits and to identify best practices for when, by whom and how to collect this information. SEARCH STRATEGY: We searched OVID MEDLINE, PubMed "related articles" via NLM and healthevidence.org to the end of January 2018 and assessed reference lists and related citations of included studies. INCLUSION CRITERIA: We included studies reporting on harms of collecting patient sociodemographic information in health-care settings. DATA EXTRACTION AND SYNTHESIS: Data on study characteristics and types of harms were extracted and summarized narratively. MAIN RESULTS: Eighteen studies were included; 13 provided patient perceptions or experiences with the collection of these data and seven studies reported on provider perceptions. Five reported on patient recommendations for collecting sociodemographic information. Patients and providers reported similar potential harms which were grouped into the following themes: altered behaviour which may affect care-seeking, data misuse or privacy concerns, discomfort, discrimination, offence or negative reactions, and quality of care. Patients suggested that sociodemographic information be collected face to face by a physician. DISCUSSION AND CONCLUSIONS: Overall, patients support the collection of sociodemographic information. However, harms are possible, especially for some population subgroups. Harms may be mitigated by providing a rationale for the collection of this information.

Effectiveness of a computerized drug-monitoring program to detect and prevent adverse drug events and medication non-adherence in outpatient ambulatory care: study protocol of a randomized controlled trial.

BACKGROUND: Medications are an effective intervention for managing and preventing health problems but their benefit can be undermined by non-adherence or adverse drug events (ADEs). Since these issues may be interconnected, efforts to improve non-adherence should also include reduction of ADEs. We have developed the ISTOP-ADE system (Information Systems-enabled Outreach for Preventing Adverse Drug Events), which enables timely monitoring and managing of ADEs. The objectives of this study are to determine whether the ISTOP-ADE system, compared to routine care, will reduce: a) the probability of discontinuing the use of prognosis-altering medications; b) the probability of a patient experiencing a severe ADE; c) the proportion of patients experiencing ADEs, preventable ADEs and ameliorable ADEs; and d) health services utilization. METHODS/DESIGN: We will randomly assign 2,200 adult ambulatory patients in the province of Québec who have been prescribed an incident medication for the management or prevention of a chronic health condition, to routine care or the ISTOP-ADE system. The ISTOP-ADE system consists of an interactive voice response system (IVRS) paired with pharmacist support. The IVRS will call patients at 3 and 17 days post-prescription to determine if they are experiencing any problems and connect them with a pharmacist when required or desired by the patient. We will evaluate medication persistence at 180 days and health-care utilization using provincial administrative data. Two blinded physicians will ascertain ADE status through a case review. DISCUSSION: We expect the ISTOP-ADE intervention to be feasible and to improve the quality of patient care through improved medication adherence, reduced ADE duration and reduced number of ADEs resulting in an emergency department or inpatient encounter. This in turn could lower health-care utilization, saving costs and lowering the burden on emergency departments and family practices. The success of ISTOP-ADE would present opportunities to implement this intervention through health systems, health insurance agents and commercial pharmacies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02059044. Date registered: 10 January 2014.

Radiographic monitoring of incidental abdominal aortic aneurysms: a retrospective population-based cohort study.

BACKGROUND: An abdominal aortic aneurysm (AAA) that is identified when the abdomen is imaged for some other reason is known as an incidental AAA. No population-based studies have assessed the management of incidental AAAs. The objective of this study was to measure the completeness of radiographic monitoring of incidental AAAs by means of a population-based analysis. METHODS: We linked a cohort of patients with incidental AAA (defined as a previously unidentified aortic enlargement exceeding 30 mm in diameter found in an imaging study performed for another reason) to various population-based databases. We followed the patients to elective repair or rupture of the aneurysm, death or 31 Mar. 2009. We used evidence-based monitoring guidelines to calculate the proportion of observation time during which each incidental AAA was incompletely monitored. We used negative binomial regression to determine the association of patient-related factors with this outcome. RESULTS: For the period between January 1996 and September 2008, we identified 191 patients with incidental AAA (mean diameter 37.6 mm, 95% confidence interval [CI] 36.6-38.6 mm; median follow-up 4.4 [range 0.6-12.7] years). Fifty-six of these patients (29.3%) had no radiographic monitoring of the aneurysm. Overall, patients spent one-fifth of their time with incomplete monitoring of the AAA (median 19.4%, interquartile range 0.3%-44.0%). Factors independently associated with incomplete monitoring included older age (relative rate [change in proportion of time with incomplete monitoring] [RR] 1.27, 95% CI 1.10-1.47, per decade), larger size (RR 1.65, 95% CI 1.38-2.01, per 10-mm increase) and detection of the aneurysm while the patient was in hospital or the emergency department (RR 1.34, 95% CI 1.00-1.79). Comorbidities were not associated with monitoring. INTERPRETATION: Radiographic monitoring of incidental AAAs was incomplete, and almost one-third of patients underwent no monitoring at all. Incomplete monitoring did not appear to be related to patients' comorbidity.

Correlation between serial tests made disease probability estimates erroneous.

BACKGROUND: The probability of a disease, given the result of two diagnostic tests, can be calculated by multiplying the odds of disease after the first test by the likelihood ratio of the second test. OBJECTIVE: To illustrate the error that occurs when calculating disease probability by combining the results of tests that are correlated. METHODS: Simulation study in which we randomly generated disease status and the results of two binary tests for a range of disease prevalence, test-operating characteristics, and correlation between tests. The primary outcome was the absolute difference between calculated and true probability of disease after two positive tests. RESULTS: When the tests were correlated, the calculated probability of a disease exceeded the true probability of the disease. With perfect correlation, the true probability of the disease after two positive tests equaled that after a single positive test. Error arising from correlated tests increased as the difference in the calculated probability between the first and second positive tests increased. We noted several combinations of disease prevalence, test-operating characteristics, and test correlation where the absolute difference between calculated and true probability of disease exceeded 25%. CONCLUSION: Disease probability is overestimated when the results of correlated tests are combined. Clinicians must consider the correlation between serial tests when calculating the posttest probability.