ABSTRACT
OBJECTIVE: To assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs). DESIGN: Two data sources were used. The first, a cross-sectional database of patients with breast cancer who completed functional PROs and were administered the FIM, was used to examine whether average pain intensity (as measured with an 11-point numeric rating scale [NRS]) and Rand Mental Health inventory scores differed among those rating their functional independence as different than clinicians. The second, a longitudinal database of 311 adults with late-stage lung cancer who completed the Activity Measure for Post Acute Care Computer Adaptive Test (AM PAC CAT) with differences between their expected and actual responses as reflected in their AM PAC CAT SEs. SETTING: Two tertiary medical centers. PARTICIPANTS: Data source #1, 163 women with stage IV breast cancer; data source #2, 311 adults with late-stage lung cancer. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data source #1, FIM, pain NRS, Older Americans Resource Study activities of daily living subscale, Physical Function-10, Mental Health Inventory-17. Data source #2, AM PAC CAT and NRS symptom ratings. RESULTS: Pain intensity was significantly higher when clinicians and patients disagreed regarding a patient's independence in the ability to transfer (NRS pain severity, 3.78 vs 2.40; P=.014), groom (3.71 vs 2.36, P=.009), bathe (3.76 vs 2.40, P=.016), and dress (3.09 vs 2.44, P=.034). The magnitude of AM PAC CAT SEs was significantly associated with the severity of participants' pain, dyspnea, and fatigue, as well as the presence of musculoskeletal disorders and coronary artery disease. Neither mood nor emotional distress was associated with clinician-patient agreement or AM PAC CAT SE. CONCLUSIONS: Pain intensity is associated with disagreement between patients and clinicians about the patient's level of functioning. Moreover, physical symptoms (pain, dyspnea, fatigue) as well as specific medical comorbidities (musculoskeletal disorders, coronary artery disease), but not mood, are associated with inconsistency in patients' assessment of their functional abilities.
Subject(s)
Breast Neoplasms/rehabilitation , Lung Neoplasms/rehabilitation , Outcome Assessment, Health Care/methods , Pain/psychology , Professional-Patient Relations , Adult , Affect , Aged , Aged, 80 and over , Breast Neoplasms/complications , Breast Neoplasms/psychology , Comorbidity , Cross-Sectional Studies , Disability Evaluation , Female , Health Status , Humans , Lung Neoplasms/complications , Lung Neoplasms/psychology , Male , Mental Health , Middle Aged , Pain/etiology , Physical Therapy Modalities , Tertiary Care CentersABSTRACT
OBJECTIVE: To achieve a low respondent burden and increase the responsiveness of functional measurement by using an item response theory-based computer adaptive test (CAT), the Activity Measure for Post-Acute Care (AM-PAC) CAT. DESIGN: Two-year prospective cohort study. SETTING: Telephonic assessments from a quaternary medical center. PARTICIPANTS: Patients (N=311) with late-stage lung cancer (LC). INTERVENTIONS: Monthly assessments for up to 2 years. Disease progression was determined via record abstraction. Anchor-based responsiveness techniques were used to compare AM-PAC-CAT score changes between global rating of change (GRC) question response levels, as well as between intervals when adverse clinical events or symptom worsening did and did not occur. Distribution-based responsiveness assessments included calculation of the standardized effect size (SES) and standardized response mean (SRM). MAIN OUTCOME MEASURES: AM-PAC-CAT, symptom numerical rating scales, and a GRC. RESULTS: Administration time averaged 112 seconds over 2543 interviews. AM-PAC-CAT score changes became more positive as GRC responses reflected more improved states: a lot worse (-11.62), a little worse (-1.92), the same (-.10), a little better (1.01), and a lot better (2.82). Score changes were negative when associated with adverse clinical events. The SES and SRM for score differences between 1 to 2 and 9 to 10 months prior to death were -.87 and -1.13, respectively. The minimally important difference estimate was defined by the mean CAT session SE at 2.0. CONCLUSIONS: The AM-PAC-CAT imposes a low, <2-minute, respondent burden, and distribution- and anchor-based methods suggest that is moderately responsive in patients with late-stage LC.
Subject(s)
Activities of Daily Living , Carcinoma, Non-Small-Cell Lung/therapy , Continuity of Patient Care , Lung Neoplasms/therapy , Medical Records Systems, Computerized/statistics & numerical data , Monitoring, Physiologic/methods , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Cohort Studies , Disability Evaluation , Disease Progression , Disease-Free Survival , Female , Follow-Up Studies , Humans , Linear Models , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Male , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness/pathology , Neoplasm Staging , Odds Ratio , Prospective Studies , Risk Assessment , Sickness Impact Profile , Survival Rate , Time FactorsABSTRACT
El tumor pseudopapilar sólido del páncreas (TPS) o también llamado tumor de Frantz es una rara afección neoplásica del páncreas con distintas características clínicas-patológicas. El diagnóstico puede ser difícil, pero debe ser sospechado como una posibilidad en mujeres jovenes quienes presentan una masa abdominal que envuelve el páncreas. En este reporte se describe la clínica, estudios imageneológicos y las características patológicas de dos pacientes jóvenes a quienes se les diagnósticaron un TPS del páncreas en forma incidental. La mayoría de los TPS tienen un comportamiento "benigno", solamente un pequeño número recurre o desarrollan metástasis después de la resección, pero aun en casos que metastizan tienen un crecimiento lento y son clasificados como de bajo grado de malignidad.
Subject(s)
Humans , Adult , Female , Abdominal Pain/diagnosis , Endosonography , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Tomography/methods , Ultrasonography , Biopsy, Needle/methods , Histological Techniques/methodsABSTRACT
La frecuencia de la malignidad en el quiste de colédoco es una rara condición y debe ser sospechada en paciente con síntomas de colangitis, pérdida de peso y anemia. El pronóstico de esta entidad es pobre, su incidencia aumenta con la edad, y el diagnóstico casi siempre es tardío. Se han establecido algunas teorías con base a su oncogénesis. El tipo histológico más frecuente es el adenocarcinoma y muy raro la variedad escamosa. Presentamos el caso de una paciente a quien a los 49 años se le diagnosticó esta afección en la pared posterior de un quiste del colédoco tipo 1 según la clasificación de Todani
