Search

Background: Several prominent societies have published statements promoting earlier integration of palliative care for patients with advanced lung disease. Our institution recently added palliative care consultation to the lung transplant evaluation process. Study Design: Patients (n=153) who underwent lung transplant evaluation were sent surveys. Of those, 29 had died, 10 asked to be excluded and 45 (36%) completed the survey. This included the 15-item Advance Care Planning (ACP) Engagement survey, a validated tool to assess readiness and self-efficacy. Results: The ACP-engagement survey showed high self-efficacy and readiness. Regarding potential bad outcomes after lung transplant, palliative care helped them feel more informed (63% “extremely”) and ready/prepared (59% “extremely”). A t-test compared mean scores between lung transplant provider team members. Pulmonologists were the most likely to help participants feel both informed and ready & prepared for potential bad outcomes (p=0.02). Overall, participants reported that the palliative care consult had a high impact. Conclusion: The palliative care visit specifically offered benefit in patient and medical decision maker preparation for potential bad outcomes, independent of their ACP engagement and knowledge about the visit beforehand.

The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium.RISE is a population-based, multicenter, prospective longitudinal cohort study of community-dwelling, English- and Spanish-speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross-cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self-administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in-person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow-up is planned at 1 year.Findings from RISE will begin to build the necessary evidence base to support much-needed, new bladder health promotion and LUTS prevention interventions in women.

(s): Existing bladder-specific measures lack ability to assess a range of bladder health from poor to optimal health. We report evidence for validity of the self-administered, multidimensional Bladder Health Scales and Function Indices for research in adult women.A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms surrounding 7 clinical research centers. Construct validity of the Bladder Health Scales and Function Indices was guided by Multitrait-Multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed effects Intraclass Correlation Coefficient models. Mode comparisons used chi-square, Fisher Exact or t-tests. Convergent validity was evaluated using Pearson correlations with the external construct measures and known-group validity was established with comparison of women known and unknown to be symptomatic with urinary conditions.The sample included 1,072 participants. Factor analysis identified ten scales with Cronbach's alpha ranging 0.74-0.94. Intraclass correlation coefficients of scales ranged from 0.55-0.94. Convergent validity of ten scales and six indices ranged from 0.52- 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration.The paper and electronic forms of the Bladder Health Scales and Function Indices are reliable and valid measures of bladder health for use in women's health research.

Summary Background Lower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children. Objective To define normative reference ranges for non-invasive tests of bladder function in healthy, asymptomatic girls and adolescents. Study design A comprehensive search strategy was performed in seven electronic databases through October 2019. English-language studies reporting data on voiding frequency, voided and postvoid residual volumes (PVR) and uroflowmetry results in healthy, asymptomatic girls (mean age ≥ 5 years) were included. Two independent reviewers performed study review, data extraction, and quality assessment. Overall mean estimates and 95% confidence intervals for each bladder function parameter were calculated using random effects models, and 95% normative reference values were estimated. Results Ten studies met eligibility criteria for the meta-analysis (n = 2143 girls, age range: 3–18). Mean estimates of maximum voided volume and PVR were 233.4 ml (95% CI 204.3–262.6; n = 1 study) and 8.6 ml (95% CI 4.8–12.4; n = 2 studies) respectively. Pooled mean estimates for uroflowmetry parameters were: 21.5 ml/s (95% CI 20.5–2.5) for maximum flow rate (n = 6 studies), 12.5 ml/s (95% CI 11.2–13.8) for mean flow rate (n = 6 studies), 6.8 s (95% CI 4.4–9.3) for time to maximum flow (n = 3 studies), 15.7 s (95% CI 13.0–18.5) for flow time (n = 3 studies), and 198.7 ml (95% CI 154.2–234.2) for voided volume (n = 9 studies). No studies reported estimates of voiding frequency. Between-study heterogeneity was high (89.0–99.6%). Conclusions Although we were able to calculate pooled mean estimates for several parameters, the small number of included studies and the wide age ranges of participants preclude generalization of reference values to all healthy girls. Further research is needed to determine normative reference values within specific age groups.

To better characterize patient understanding of their risk of cardiac complications from non-cardiac surgery and to develop a patient driven clinical decision support system for preoperative patient risk management.A patient-driven preoperative self-assessment decision support tool for perioperative assessment was created. Patient' self-perception of cardiac risk and self-report data for risk factors were compared with gold standard preoperative physician assessment to evaluate agreement.The patient generated cardiac risk profile was used for risk score generation and had excellent agreement with the expert physician assessment. However, patient subjective self-perception risk of cardiovascular complications had poor agreement with expert assessment.A patient driven cardiac risk assessment tool provides a high degree of agreement with expert provider assessment demonstrating clinical feasibility. The limited agreement between provider risk assessment and patient self-perception underscores a need for further work including focused preoperative patient education on cardiac risk.

To assess how various stakeholders involved with nursing home care rate the importance of various quality-of-life (QoL) items for hypothetical residents with varying types of impairment.A community-based exploratory description of a convenience sample.Eleven nursing homes in Florida, New Jersey, and Minnesota.Samples of registered and licensed nurses (RNs and LPNs), certified nursing assistants (CNAs), activities personnel, social workers, physicians, residents, and family members.Using a magnitude estimation approach, 17 QoL items were rated in order of importance on each of three hypothetical types of nursing home residents.Overall, there was little variation in the ratings for individual items. Ratings for persons with cognitive impairment were consistently lower. RNs'/LPNs' and CNAs' ratings were generally higher than the others, and physicians' ratings were generally lower. Residents' and families' ratings were generally lower than nurses' ratings.All stakeholders considered QoL to be important and felt that it deserves more attention in practice and regulation. A summary QoL score need not be weighted. Respondents (who were not cognitively impaired) considered QoL less important for residents with cognitive impairment. Value differences between those involved in nursing home care deserve more exploration.

To develop a theoretical foundation for measuring health plan quality from a physician's perspective.Literature review and theory development.We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality.A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed.Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.

To assess the measurement and scaling properties of survey items designed to measure health plan quality from a physician's perspective.Prospective survey design with multivariate regression analysis.Data were from 3798 physicians representing 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington. Scale reliability was assessed by using the Cronbach alpha. Generalist and specialist scales were compared with structural equation modeling. Multivariate analysis was used to examine internal validity by testing theoretically based hypotheses.Scales constructed from the data were reliable, were stable across both generalist and specialist physicians, and demonstrated construct validity. Hypotheses about the relationship between physician experiences with a health plan and physician recommendations of the plan were confirmed, supporting construct validity.The items on the survey instrument can be used with confidence to measure health plan quality from a physician perspective.

To develop principles for measuring the quality of specific health plans from a physician's perspective.Literature review, expert review, cognitive interviews.We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys. Then, an expert review of prior survey efforts to measure health plan quality from the physician's perspective was performed.A survey instrument based on a conceptual model of health plan quality was developed. Its purpose was to measure health plan quality from the physician's perspective. Principles for surveying physicians guided the structure of the survey.Survey instruments can be designed to take into account a physician's unique perspective on health plan quality and can include measures that control for potential biases such as anti-managed care bias.