PURPOSE There is increasing interest in implementing digital systems for remote monitoring of patients’ symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090 ). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.
Objective To examine objectively measured physical activity levels by age, sex, and BMI for children and adolescents in a nationally representative sample. Methods Data were from the 2003–2004 and 2005–2006 National Health and Nutrition Examination Surveys, which included physical activity assessment by accelerometer and measured height and weight. The authors calculated minutes of moderate and vigorous activity. Results Boys were more active than girls, and activity levels were lower at older ages. Younger children met daily recommendations for physical activity, whereas older children, especially girls, did not. Typically, weight status was inversely related to activity, though differences were less apparent among boys. Underweight children were not always more active than heavier peers.
Objective Recent public health and media attention on child obesity may have altered accuracy of self-perception of obesity and associated weight control behaviors in children and adolescents. Thus, we examined whether accuracy of weight perceptions were associated with weight loss behaviors. Study design We examined children 8–15 year olds in the National Health and Nutrition Examination Survey (2005–2010) who reported themselves as: “overweight/too fat,” “about right,” or “underweight/too thin.” Children reported on efforts to lose weight and engagement in specific weight control behaviors, including how frequently he/she had “been on a diet, starved, cut back on eating, skipped meals, or exercised” to lose weight. We categorized obesity based on measured BMI, and determined accuracy of weight perceptions. We used chi-squared tests to examine age- and sex-based differences in accuracy of perceptions and relationship to weight loss behaviors. Results Girls and older children more accurately perceived weight status. Both girls and boys of all ages who perceived themselves as overweight were more likely to engage in weight loss behaviors. Children who were overweight engaged in more weight loss behaviors than healthy weight children perceiving themselves as overweight. Among children who reported themselves as “about right,” overweight children engaged in more weight loss behaviors than healthy weight children but less so than those who accurately perceived being overweight. Conclusions The perception of being overweight and actual overweight status are both strongly associated with weight loss behaviors. These findings have important implications for counseling patients who may have inaccurate weight perceptions.
P ain constitutes one of the most prevalent diagnoses in primary care settings (1), and is the complaint presented by nearly two-thirds of emergency department patients treated in the United States (US) (2). Estimates of the prevalence of all chronic pain in the US population range considerably, from 8% to 48%, depending on the stringency of the definitions used. One recent review offered a weighted estimate of 22% (3); a somewhat more dated review provided an estimate of 15% (4). Opioid analgesics are the mainstay for pharmacological treatment for moderate to severe pain and have improved the quality of life for many (5-7). However, in the first decade of the 21st century, the amount of prescription analgesics, such as fentanyl, hydrocodone, methadone, oxymorphone and oxycodone, increased by a factor of four (8), and deaths due to the abuse and misuse of such analgesics nearly doubled (9). In 2009, poisoning deaths became the leading cause of injury-related death in the US (10).The BACkgRouND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians' opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown. oBjECTIvE: To examine the relationships between physicians' and other providers' primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP). METHoDS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ 2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients' pain diagnoses and demographic characteristics. RESuLTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8). CoNCLuSIoNS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.
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