Flora Hoodin

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.

Psychosocial influences on 305 adults' survival after bone marrow transplantation Depression, smoking, and behavioral self-regulation

OBJECTIVE The role of psychological factors in adult survival after bone marrow transplant (BMT) has not been adequately established. BMT survival rates have been shown to depend largely on disease and demographic variables. With sample sizes no larger than 123, the majority of psychosocial studies found little definitive statistical evidence that mood, marital/cohabiting status, coping styles, or smoking affect survival. The purpose of this study was to comprehensively examine the relative contribution of psychological variables to survival after BMT in a unified model, controlling for medical and demographic variables. METHODS Pre-BMT, 305 consecutive patients were psychologically assessed with interview and Minnesota Multiphasic Personality Inventory (MMPI). Transplant Evaluation Rating Scale (TERS) ratings were assigned retrospectively by two raters (interrater reliability r=.89). We employed a fully parametric, accelerated failure time regression model (Weibull), which provides richer extrapolation and interpretation than the semiparametric Cox proportional hazards regression model. RESULTS Overall our results indicate that for a given medical condition, the type of BMT patient likely to survive longest was a young, married, educated, European-American, nonsmoker who was more defiant, better adjusted, and less depressed. Moreover, the longer a patient survived, the smaller the probability of dying in the short run. CONCLUSIONS This study, the first large-scale statistical analysis using a fully parametric model (Weibull), provides evidence that select psychosocial variables can affect BMT survival. Future investigations could explore possible mediating variables, and whether identifying high-risk individuals pretreatment could enhance resource allocation, psychological intervention, and possibly even survival itself.

Do negative or positive emotions differentially impact mortality after adult stem cell transplant

Multiple diverse biomedical variables have been shown to affect outcome after hematopoietic stem cell transplantation (HSCT). Whether psychosocial variables should be added to the list is controversial. Some empirical reports have fueled skepticism about the relationship between behavioral variables and HSCT survival. Most of these reports have methodological shortcomings. Their samples were small in size and included heterogeneous patient populations with different malignant disease and disease stages. Most data analyses did not control adequately for biomedical factors using multivariate analyses. The pre-transplant evaluations differed from study to study, making cross-study generalizations difficult. Nevertheless, a few recently published studies challenge this skepticism, and provide evidence for deleterious effects of depressive symptomatology on HSCT outcome. This mini review integrates the new data with previously reviewed data, focusing on the differential impact of negative and positive emotional profiles on survival. Pre-transplant negative emotional profiles are associated with worse survival in the long term, whereas pre-transplant optimism about transplant appears to affect survival in the short term. These data have practical implications for transplant teams. Pre-transplant psychological evaluation should assess for specific adverse behavioral risk factors, particularly higher levels of depression and lower levels of optimistic expectations about transplant. Transplant centers should develop collaborative studies to further test the effects of these adverse behavioral risk factors, and run multicenter hypothesis-driven clinical trials of psychological intervention protocols. Such studies should aim to better define pragmatics of assessment and intervention (timing, assessment tools, personnel), and evaluate their contribution to improving outcome after transplant.

The relationship between binge eating and weight status on depression, anxiety, and body image among a diverse college sample: A focus on Bi/Multiracial women

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating based on weight status within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating, depression, anxiety, and body image dissatisfaction than other groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Participants included White, Black, and Bi/Multiracial college students. Findings highlighted sex and racial differences based on binge eating and weight status. Notably, Bi/Multiracial women who endorsed binge eating behavior and who were overweight reported greater levels of anxiety than all other groups and greater levels of depression than White women and White men. Additionally, Bi/Multiracial women and White women who endorsed binge eating behavior and who were overweight reported greater body image dissatisfaction relative to Black women and White men. Future research should further explore the nature and impact of sex and race differences on binge eating.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.

Factors contributing to physical activity in a chronic low back pain clinical sample: a comprehensive analysis using continuous ambulatory monitoring.

Summary Chronic back pain patients indicated that a composite operant model significantly predicted physical activity as measured by actigraphy, while fear‐avoidance and pain models did not. ABSTRACT Back pain is one of the most common causes of disability in industrialized nations. Despite this, the variables that contribute to disability are not well understood and optimal measurement strategies of disability have not yet been determined. The present study sought to comprehensively assess the strongest predictors of physical activity as a proxy for disability. New patients in a chronic pain specialty clinic completed questionnaires to assess the predictors of physical activity and engaged in 5 days of home data collection wearing an accelerometer to assess physical activity in daily life, which is how disability was operationalized in this study. Analysis of repeated measures patient data revealed that, of 3 composite variables each representing a theoretical model, the model representative of operant factors significantly predicted physical activity. Subsequent analyses showed that pain sensitivity, fear avoidance, and solicitous spousal responses account for a significant amount of the variance in physical activity. These findings suggest that external sources of reinforcement or punishment may serve to influence physical behavior beyond that of internal cues such as fear avoidance or pain. Implications for treatment are discussed, including the potential benefits of specifically incorporating the patient’s sources of operant reinforcement or punishment into treatment.

Ambulatory monitoring as a measure of disability in chronic low back pain populations.

PurposeThe link between chronic back pain and disability is well established. Despite this, the literature also reflects an inconsistency in methods of assessing disability, as studies interchangeably use self-report measures, clinical tests, and electronic monitoring. The purpose of this study was to conduct a multimethod comparison of disability measures to identify similarities and differences in the constructs measured by each. MethodTwenty chronic back pain patients participated in a clinic visit to complete questionnaires and clinical tests, followed by 5 days of wearing a wrist-worn electronic ambulatory monitoring device to measure activity. ResultsMultiple regression analyses were conducted to identify the significant predictors of each disability assessment. Results showed that operant variables were predictive of physical activity, cognitive-behavioral variables were predictive of perceived disability, and no variables were predictive of physical ability. DiscussionThe results indicate substantial differences in the types of variables that predict disability when measured through 3 different methods. This is suggestive of differences in the constructs measured by each type of disability assessment. The implications for researchers who assess predictors of disability and clinicians who use disability measures in their assessment of patients are that the measures of disability they select should be carefully matched to the proposed purposes. Strong theoretical and practical considerations support using electronic ambulatory monitoring in future research and clinical service.

Increasing Daily Water Intake and Fluid Adherence in Children Receiving Treatment for Retentive Encopresis

OBJECTIVE To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. METHODS Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. RESULTS Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3-4) and 2 (Weeks 5-6) of fluid intervention, respectively (both p ≤ .001). CONCLUSIONS Enhanced education and behavioral strategies were efficacious in increasing childrens intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness.

Rapid Assessment for Psychopathology in a College Health Clinic: Utility of College Student Specific Questions

Abstract Objective: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. Participants: One hundred nine patients participated in the study during their medical appointments. Methods: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. Results: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. Conclusions: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.

Psychological Care of Adult Allogeneic Transplant Patients

Allogeneic Hematopoietic Stem Cell Transplant (HCT) is a complex and intense physical treatment, accompanied by intense psychological reactions, which can be further complicated by pre-morbid psychopathology or lingering and latent long-term psychological difficulties. The challenge in the clinical management of HCT patients is to accurately recognize psychological presentations that exceed normative responses to HCT and to draw on the strengths and expertise of psychosocial members of the multidisciplinary symptom management team for assessment and treatment.