Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study.

Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with OI symptoms and comorbidities. Participants with a diagnosis of long covid were recruited from eight UK long covid clinics, and healthy volunteers from general population. All undertook standardized National Aeronautics and Space Administration Lean Test (NLT). Participants' history of typical OI symptoms (e.g., dizziness, palpitations) before and during the NLT were recorded. Two hundred seventy-seven long covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or symptoms during NLT or PoTS, 10% had asymptomatic OH. One hundred thirty (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. Forty-one (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS, and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive abnormal readings to one abnormal reading during the NLT, resulted in 11% of long covid participants (an additional 4%) meeting criteria for PoTS, but not in healthy volunteers. More than half of long covid patients experienced OI symptoms during NLT and more than one in 10 patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We therefore recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.

English translation and cross-cultural validation of the patient-reported outcome measurement-haemorrhoidal impact and satisfaction score (PROM-HISS).

AIM: The aim of this study was to translate the Dutch patient-reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS) to English and perform a cross-cultural validation. METHOD: The ISPOR good practice guidelines for the cross-cultural validation of PROMs were followed and included two steps: (1) Two forward and two backward translations. The forward translation concerned the translation from the source language (Dutch) to the target language (English), performed by two independent English speakers, one medical doctor and one nonmedical. Subsequently, a discussion about discrepancies in the reconciled version was performed by a stakeholder group. (2) Cognitive interviews were held with patients with haemorrhoidal disease (HD), probing the comprehensibility and comprehensiveness of the PROM-HISS. RESULTS: Discrepancies in the reconciled forward translation concerned the terminology of HD symptoms. Furthermore, special attention was paid to the response options, ranging from "not at all", indicating minor symptoms, to "a lot", implying many symptoms. Consensus among the stakeholder group about the final version of the translated PROM-HISS was reached. Interviews were conducted with 10 native English-speaking HD patients (30% female), with a mean age of 44 years (24-83) and primarily diagnosed with grade II HD (80%). The mean time to complete the PROM-HISS was 1 min 43 s. Patients showed a good understanding of the questions and response options, found all items relevant and did not miss important symptoms or topics. CONCLUSION: The translated English language PROM-HISS is a valid tool to assess symptoms of HD, its impact on daily activities and patient satisfaction with HD treatment.

Evaluation of myCOPD Digital Self-management Technology in a Remote and Rural Population: Real-world Feasibility Study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease affecting 1.2 million people in the United Kingdom alone. Acute COPD exacerbations requiring hospitalization place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities. OBJECTIVE: myCOPD is a commercial, digital health, self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real-world feasibility study, we aimed to evaluate myCOPD use and its clinical effectiveness at reducing hospitalizations, inpatient bed days, and other National Health Service (NHS) resource use. METHODS: myCOPD engagement and NHS resource use was monitored for up to 1 year after myCOPD activation and was compared against health service use in the year prior to activation. A total of 113 participants from predominantly remote and rural communities were recruited via community-based care settings, including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There were no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria. RESULTS: Out of 113 participants, 89 activated myCOPD (78.8%), with 56% (50/89) of those participants doing so on the day of enrollment and 90% (80/89) doing so within 1 month. There was no correlation between participant enrollment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least one myCOPD module and entered their symptom scores at least once (79/89, 89%). A subgroup (15/89, 17%) recorded their symptom scores very frequently (>1 time every 5 days), 14 of whom (93%) also used four or five myCOPD modules. Overall, there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did, however, identify a trend toward reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage. CONCLUSIONS: Our results suggest that neither age, wealth, nor geographical location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services, such as hospital admissions or inpatient bed days. Subgroup analysis did, however, suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population-wide basis, our results do indicate that highly engaged patients may derive benefits.

Event-related potentials reveal modelling of auditory repetition in the brain.

Two auditory event-related potential (ERP) waveforms, mismatch negativity (MMN) and repetition positivity (RP), are sensitive to repetition of auditory stimuli. Increasing repetition of standards produces larger MMN amplitudes to deviant stimuli in an oddball paradigm, known as the memory trace effect, and attributed to increasing strength of the memory trace for standards. RP to standards also increases as a function of repetition in a 'roving' oddball paradigm where the standard changes in pitch following presentation of a deviant tone. As the sensory memory trace representing standard stimuli must be continually updated in the roving paradigm, RP has been proposed to reflect memory trace formation. Given that RP to date has only been observed in roving oddball paradigms, we examined whether RP and the MMN memory trace effect are present in both roving and standard oddball paradigms in 24 young adults (mean age: 22.4±5years). Four, 8, or 16 standards preceded a deviant. We observed RP at Fz in standard ERPs in the roving but not constant paradigm. At mastoid sites, RP was observed in both paradigms. A memory trace effect was not observed at Fz in either paradigm. Our findings suggest that different generator sites in the brain model local and global auditory information with generators of mastoid activity primarily sensitive to local or short term stimulus history of auditory regularities while generators of frontal site activity retain more global information regarding stimulus history over a longer time period.

Auditory sensory memory and the aging brain: A mismatch negativity study.

The mismatch negativity (MMN) component of the auditory event-related potential has been used in the past to study between group differences in the accuracy and retention of information in auditory sensory memory (ASM). The MMN is elicited by infrequent 'deviant' tones that differ from a repeating 'standard' tone. In the present study, the type of deviant and the time interval between tones (stimulus-onset asynchrony: SOA) were manipulated in a study of normal aging. MMN responses of an elderly (mean age = 69) and a young group (mean age = 21) to both a duration and a frequency deviant tone were measured at a short (450 ms) and long (3 s) SOA. A smaller and later MMN (recorded at Fz) was observed in the elderly relative to the young group across SOA and Deviant conditions. The results are consistent with an age-related deficit in the encoding of sound properties in ASM. However, analysis of the MMN reversal at the mastoids provides some support for the proposal that the elderly have an additional deficit related to the retention of information in ASM.