Assessment of an electronic daily diary in patients with overactive bladder

Effect of Educational Video on Patient Adherence and Completeness of Voiding Diaries: A Randomized Trial

IMPORTANCE

Voiding diaries are clinically useful tools for elucidating the etiology of lower urinary tract symptoms. The utility of voiding diaries is challenged by low return rate and incomplete or inaccurate data entry.

OBJECTIVE

The objective was to determine the effect of the use of an educational video on patient adherence, completeness of intake and voiding diaries, and patient satisfaction.

STUDY DESIGN

In this trial, patients who were asked to complete an intake and voiding diary in a urogynecology clinic were randomized to receive standard education or enhanced education with an instructional video on how to complete the diary. Patients returned the diaries at their follow-up visits in the clinic. The primary outcome was the return rate of the diaries. Upon follow-up, patients filled out a survey reporting their satisfaction with instructions received. Diaries were graded by 3 blinded experts.

RESULTS

Eighty-five patients were enrolled, 42 in the standardized instructions arm and 43 in the video arm. A total of 26 patients (30.6%) filled out and returned an intake and voiding diary. Between groups, there was no difference in the rate of return of the diaries ( P = 0.59) or in completeness of the returned voiding diaries ( P = 0.60). The educational video did not change satisfaction between the groups; patients reported identical satisfaction between groups.

CONCLUSIONS

The addition of an instructional video on how to complete an intake and voiding diary did not increase patients' rate of return, completeness of diaries, or satisfaction with instructions provided to complete the diary.

Correlation Between Mobile-Application Electronic Bowel Diary and Validated Questionnaires in Women with Fecal Incontinence

INTRODUCTION AND HYPOTHESIS

Despite growing interest in a mobile-app bowel diary to assess fecal incontinence (FI) symptoms, data are limited regarding the correlation between mobile-app diary and questionnaire-based outcomes. The primary aim is to determine whether percentage reduction in FI episodes (FIEs)/week recorded on a mobile-app diary correlates with changes in scores of validated FI-symptom measures from baseline to 12 weeks in women with FI undergoing percutaneous tibial nerve stimulation (PTNS) versus sham.

METHODS

This is a planned secondary analysis of a multicenter randomized trial in which women with FI underwent PTNS or sham. FIEs were collected using a mobile-app diary at baseline and after 12 weekly sessions. FI-symptom-validated measures included St. Mark's, Accidental Bowel Leakage Evaluation, FI Severity Index (FISI), Colorectal Anal Distress Inventory, Colorectal Anal Impact Questionnaire, FI Quality of Life, Patient Global Impression of Improvement (PGI-I), and Patient Global Symptom Control (PGSC) rating. Spearman's correlation coefficient (ρ) was computed between %-reduction in FIEs/week and change in questionnaire scores from baseline to 12 weeks. Significance was set at 0.005 to account for multiple comparisons.

RESULTS

Baseline characteristics of 163 women (109 PTNS, 54 sham) include mean age 63.4±11.6, 81% white, body mass index 29.4±6.6 kg/m2, 4% previous FI surgeries, 6.6±5.5 FIEs/week, and St. Mark's score 17.4±2.6. A significant correlation was demonstrated between %-reduction in FIEs/week and all questionnaires (p<0.005). A moderate-strength correlation (|ρ|>0.4) was observed for St. Mark's (ρ=0.48), FISI (ρ=0.46), PGI-I (ρ=0.51), and PGSC (ρ=-0.43).

CONCLUSIONS

In women with FI randomized to PTNS versus sham, a moderate correlation was noted between FIEs measured via mobile-app diary and FI-symptom-validated questionnaire scores.

Management of mixed urinary incontinence: IUGA committee opinion

INTRODUCTION AND HYPOTHESIS

Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI.

METHODS

A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion.

RESULTS

The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations.

CONCLUSIONS

Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.

Development of urinary diary mobile application and evaluation in patients with urinary incontinence

OBJECTIVE

To develop a feasible smartphone urinary diary application (UDA), and evaluate reliability and patient acceptability as a collection, calculation, and sharing tool.

MATERIALS AND METHODS

We developed the UDA for smartphones, which collects voiding, leakage, fluid intake, and grade of urgency data. A two-way cross-sectional study was conducted with 60 participants, participants split into two groups. Thirty participants completed UDA for 3 days either preceded or followed by a standard paper diary. We assessed the paper app reliability of the UDA with the Kappa variable and internal correlation coefficient (ICC).

RESULTS

29 (96.6%) participants completed the 3-day UDA in the first phase, 92.6% in the second phase, in comparison to 90% and 79.4% in paper form, respectively. Incomplete variable recording was observed at 10.3%-20% in the UDA group in comparison to 33.3%-34.8 % in the PF group. Of the 48 participants who experienced both diaries, 40 (83.3%) preferred the UDA. Paper app correlation was good to very good with ICC ranging from 0.60 to 0.90 for all variables (p < 0.001). Kappa values for incontinence, stress incontinence, urge incontinence, and increased frequency were 0.95, 0.94, 0.82 0.87, and 0.54; respectively (p < 0.001).

CONCLUSION

The performance of developed smartphone UDA is comparable with and highly correlated with paper form with most users finding the app feasible. Convergent validity with urinary incontinence and other lower urinary tract dysfunctions is required.

First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis

BACKGROUND

Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations.

OBJECTIVE

In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow).

METHODS

A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis.

RESULTS

The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was -3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of -19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions.

CONCLUSIONS

Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow.

Comparison of Computer-Assisted Self-Interview Versus Clinician Interview for Self-Reported Vulvovaginal Symptoms

ABSTRACT

This secondary analysis (N = 43) compared computer-assisted self-interview (CASI) to clinician interview for self-report of 8 vulvovaginal symptoms. Concordance was moderate between interview modes (range, 70-86%) with itching and odor having highest agreement. Although prior reports suggest more responses on CASI, we found CASI did not significantly increase self-report of symptoms over clinician interview.

Current state of bladder diary: a survey and review of the literature

INTRODUCTION AND HYPOTHESIS

The objectives of this study are (1) to assess practice patterns among urogynecology/female pelvic medicine and reconstructive surgery (FPMRS) providers regarding the use of bladder diaries (BD) and (2) to review the literature regarding BD.

METHODS

For the first objective, a survey was emailed to United States-based urogynecology providers in 2019 querying frequency of use of bladder diaries (F_BD), indications, problems, patient education methods, and perception of utility. Chi-square tests and multiple logistic regression were performed. For the second objective, we reviewed literature published in English by searching the terms "voiding," "bladder," or "incontinence," in combination with "diary," "log," or "questionnaire."

RESULTS

A total of 371 of 851 (43.5%) contacted providers responded. Nearly 80% were attending physicians, 75.5% of whom completed the FPMRS fellowship; 20.8% of all respondents and nearly 25% of fellowship-trained attendings reported F_BD <20% in the last year. FPMRS providers were more likely to report F_BD >80%. A total of 97.5% of respondents cited difficulty in using BD. Most (71.6%) taught patients to use BD themselves or shared responsibility with a nonphysician staff member (53.4%). BD is a validated and valuable instrument; however, there are obstacles to its use. Despite recent innovations including electronic and automated BD, there is a paucity of data regarding the provider-viewed challenges in implementing BD.

CONCLUSIONS

The literature supports the use of BD; however, many survey respondents, including fellowship-trained attendings, never or rarely use BD. Most respondents reported difficulty in using BD. More research is needed to improve the ease, accuracy, and widespread adaptation of BD use in clinical practice.

Challenges in e-Health: The effect of digitalisation of frequency voiding charts on compliance in paediatric patients. Randomised controlled trial comparing digital and versus paper frequency voiding charts

Objective

Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents.

Methods

A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383.

Results

Ninety-seven patients were randomised to either a digital (N = 53) or paper (N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% (N = 18) for digital and 50% (N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart (p < 0.05).

Conclusions

In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out frequency voiding charts. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.

Usability evaluation of the Computer-Based Health Evaluation System (CHES) eDiary for patients with faecal incontinence: a pilot study

Background

Faecal incontinence (FI) is prevalent in 15–20% of elderly individuals and is frequently monitored in clinical trials and practice. Bowel diaries are the most common way to document FI, but, in clinical practice, are mainly used as paper-based versions. Electronic diaries (eDiaries) offer many potential benefits over paper-based diaries. The aim of this study was to develop and test an eDiary to document FI.

Methods

We migrated a paper FI diary to an eDiary app based on the Computer-based Health Evaluation System (CHES). To assess usability, we conducted functionality and usability tests at two time points in a sample of patients with FI. In the first assessment, the eDiary functionalities were tested, patients completed the System Usability Scale (SUS, range 0–100) and compared the paper diary with the eDiary. We set a threshold for minimum acceptable average usability at 70 points. Patients were then instructed to use the eDiary for 2 days at home and contacted to report on their usage and completed the SUS a second time.

Results

We recruited a sample of N = 14 patients to use the eDiary. All patients were able to use all functionalities of the eDiary and only a few patients with lower technological literacy or access to devices (n = 3) needed initial assistance. The mean usability rating given at the first time point was high with 88 points (SD 18, 95% CI 78.2–96.8) and most patients (n = 10) reported they would prefer the eDiary over the paper-based version. Nine patients (n = 9) participated in the follow-up assessment and the mean SUS rating at the second time point was 97 points (SD 7, 95% CI 92.8–100).

Conclusion

The eDiary showed excellent usability scores for the assessment of FI at both assessments. Generally, patients preferred the eDiary over the paper-based version. We recommend the eDiary for usage with patients who own and use a smartphone and discuss potential solutions for patients with lower technological literacy or access.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01818-5.

Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study

Background

Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients.

Objective

The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs.

Methods

A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution.

Results

A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1%), and 38.7% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made.

Conclusions

Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research.

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

This narrative review synthesizes current evidence on the medical management of nocturnal polyuria, including antidiuretic replacement therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel desmopressin acetate nasal spray and orally disintegrating tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting diuretics, pharmacotherapy for hypertension, nonsteroidal anti-inflammatory drugs, and sex hormone replacement therapy are also a focal point of extensive ongoing nocturnal polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal polyuria, and arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal polyuria.

Performance, acceptability, and validation of a phone application bowel diary

AIMS

To assess performance, acceptability, external validity, and reliability of a phone application electronic bowel diary (PFDN Bowel eDiary).

METHODS

Women reporting refractory accidental bowel leakage (ABL) were enrolled in a randomized, crossover trial evaluating paper versus eDiary documentation of bowel movements (BM) and fecal incontinence episodes (FIE). Events were characterized by the presence or absence of urgency and Bristol stool scale consistency. The eDiary entries were date/time stamped and prompted by twice-daily phone notifications. Women were randomized to complete up to three consecutive 14-day diaries in two sequences. Diary events were compared between formats using the Pearson correlation. System usability scale (SUS) assessed eDiary usability. The eDiary test-retest reliability was assessed with intraclass correlations (ICCs).

RESULTS

Paired diary data were available from 60/69 (87%) women 63.8 ± 9.8 years old with mean 13.2 BM per week and 6.5 FIE per week (nearly half with urgency). Among those providing diaries, adherence did not differ by paper or eDiary (93.3% vs. 95.0%). Notifications prompted 29.6% of eDiary entries, improving adherence from 70% to 95%. Paper and eDiaries were moderate to-strongly correlated for BMs per week (r = .61), urgency BMs per week (r = .76), FIE per week (r = .66), urgency FIE per week (r = .72). Test-retest reliability was good (ICC = .81 BMs per week, .79 urgency BMs per week, .74 FIE per week, and .62 urgency FIE per week). The mean SUS score was high, 82.3 ± 17.5 (range, 0-100) with 91.4% rating it easy to use, and 75.9% preferring the eDiary over paper.

CONCLUSION

The PFDN Bowel eDiary correlated well with paper diary was considered easy to use, preferred to paper diaries, had high rates of confirmed real-time diary completion that obviated staff data entry.

Content and functionality features of voiding diary applications for mobile devices in Brazil: a descriptive analysis

INTRODUCTION AND HYPOTHESIS

A voiding diary is a method to investigate lower urinary tract symptoms. The purpose was to elaborate a descriptive analysis of nonpaid voiding diaries for mobile applications and to compare them regarding their quality.

METHODS

We searched the platforms of iTunes (Apple Inc., Brazil) and Google Play (Google Inc., Brazil) using the keywords: "voiding diary," "bladder diary," "urinary diary," "urinary incontinence," and "pelvic floor." Inclusion criteria were: apps free of charge and specific for voiding diaries in the Portuguese, Spanish, French, or English language. Exclusion criteria were: access or technical problems and pediatric apps. We quantitatively analyzed and compared the apps with each other according to their functionality features and voiding diary topics (type and volume of fluid intake, voiding episodes and volume, type and episodes of incontinence, amount of leakage, urgency, and use of pads and nocturia). We rated the apps using the Mobile App Rating Scale (MARS), whose scores for each feature vary from 1 (worst score) to 5 (best score).

RESULTS

Fifty-five apps were eligible; 16 were included for analyses. None presented all 11 topics of the voiding diary, and the median number of available features was 6 (3.75-7). "Incontinence episodes" was present in eight apps, and "nocturia" was present in five. The mean score of apps ranged between 1.7 and 4.5.

CONCLUSION

There is variation in the content of voiding topics among the apps. Patients and professionals should choose the app based on the topics of most or particular interest.

Urodynamics in patients with multiple sclerosis: A consensus statement from a urodynamic experts working group

AIMS

Urodynamics (UDS) is often indicated for multiple sclerosis (MS) patients either at presentation to specialized medical centers or after failure of conservative management of lower urinary tract dysfunction (LUTD). However, the ideal moment and context to indicate this exam in this group of patients remain controversial. We aimed to establish a consensus panel to address the role of UDS in MS patients.

METHODS

A panel representing urology, rehabilitation medicine, and neurology skilled in neuro-urology participated in a consensus-forming project using a Delphi method to reach consensus on the role of UDS in MS patients.

RESULTS

In total, five experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥70% of the experts agreed on recommendations. To facilitate a common understanding among all experts, a face-to-face consensus meeting was held in Florence in September 2017 and then with a follow-up teleconference in March 2018. By the end of the Delphi process, formal consensus was achieved for 100% of the items and an algorithm was then developed in a face-to-face meeting in Philadelphia in August 2018. The final expert opinion recommendations were approved by the unanimous consensus of the panel.

CONCLUSIONS

UDS represents an important diagnostic tool for MS patients and is particularly useful to evaluate the pattern of LUT dysfunction in high-risk patients. There is a lack of high-evidence level studies to support an optimal urodynamic long-term follow-up protocol.

Patterns in On-time, Daily Submission of a Short Web-Based Personal Behavior Survey in a Longitudinal Women's Health Study

We evaluated compliance with submitting a short Web-based personal behavior survey daily during a 10-week study (n = 52 women/3419 diaries). Time-stamped forms revealed that 50% of diaries were submitted within 24 hours of the email prompt, and 19% were missing or submitted more than 3 days late. Late submissions may affect data quality.

Electronic Versus Traditional Data Collection: A Multicenter Randomized Controlled Perioperative Pain Trial

Background: Electronic data collection is increasingly available as a means to collect pain-related clinical trial data; however, effectiveness and costs relative to traditional data collection are uncertain. Aims: The aim of this study was to evaluate data quality, protocol adherence, satisfaction, and resource requirements of electronic data collection (i.e., Internet-based electronic submission) compared to traditional data collection methods (i.e., paper-based diaries and telephone interviews) in a perioperative factorial randomized controlled trial. Methods: This study was an open-label two-arm parallel randomized controlled trial. Women (18-75 years) undergoing breast cancer surgery were allocated to either electronic or traditional data collection and completed pain-related questionnaires at baseline, postoperative period, and 3-month follow-up (NCT02240199). Results: We acquired outcome data at all time points from 78 randomized patients, 38 in the electronic group and 40 in the traditional group. The number of data queries (e.g., erroneously entered data) per patient was higher in the electronic data group (4.92 [SD = 4.67] vs. 1.88 [SD = 1.51]; P < 0.001). No between-group differences were observed for compliance with medications, data completeness, loss to follow-up, or patient or research assistant satisfaction. More research assistant time per patient was spent collecting data in the traditional group (42.6 min [SD = 12.8] vs. 9.92 min [SD = 7.6]; P < 0.001); however, costs per patient were higher in the electronic group ($176.85 [SD = 2.90] vs. $16.33 [SD = 4.90]; P < 0.001). Conclusion: Electronic data collection is feasible for perioperative pain clinical trials. Additional trials, including different surgical populations, are needed to confirm our findings and optimize use of electronic data capture methods.

Development of a Standardized Approach for the Assessment of Bowel and Bladder Dysfunction

Introduction

Bowel and bladder dysfunction (BBD) is a common pediatric condition that describes a constellation of lower urinary tract symptoms (LUTS) associated with constipation. Many children with BBD have comorbid neuropsychiatric and psychosocial concerns that are not routinely assessed. The aim of quality improvement (QI) was to establish a comprehensive assessment for BBD by developing and evaluating (1) a standardized clinician assessment form and (2) parent-reported questionnaire.

Methods

From July 2017 to April 2018, a prospective QI study was conducted in the BBD network. A standardized assessment form was developed based on literature review and expert opinions, with targeted sections for LUTS, constipation, and psychosocial history. Before clinic, families of children referred for BBD were given a questionnaire to clarify voiding, stooling, and dietary patterns. Physicians utilized the assessment form for new referrals. Afterward, both physicians and parents evaluated the assessment process anonymously.

Results

A total of 15 physicians and 45 parents responded, with 67% of patients being between 4 and 10 years old and 51% male. Physicians responded that the assessment form reminded them to ask about specific LUTS (93%), constipation (87%), and psychosocial history (87%). Parents responded positively by agreeing that they felt included in care decisions (96%) and had questions answered appropriately (100%). Only 47% found the previsit package easy to complete.

Conclusions

In pediatric BBD consultations, a standardized assessment form can guide clinicians to efficiently gather a comprehensive history and screen for psychosocial risk factors. It can empower more pediatricians to evaluate BBD in the future.

Validation of a novel digital health monitoring system to measure the volume of voided urine

AIM

To validate a novel digital health monitoring system to measure the volume of voided urine.

METHODS

Micturition volume was calculated using our novel digital self-health monitoring system of urine excretion (s-HMSU) in 18 participants (16 women and 2 men; average age, 40.8 years), without a history of voiding symptoms. Participants completed a self-reported questionnaire regarding their medical history and water intake during the period of observation, as well as the Core Lower Urinary Tract Symptom Score (CLSS) questionnaire. To assess the reliability of the voided volumes measured using the s-HMSU, the intraclass correlation coefficient (ICC) was calculated between the volume and the change in body weight before and after micturition.

RESULTS

The CLSS questionnaire confirmed the absence of urinary system diseases in all participants. The medical history was also negative with the exception of hypertension in one participant. The ICC (1,1) between the measured volume of urine excretion using the s-HMSU and the change in body weight was 0.972 (95% confidence interval, 0.957-0.982).

CONCLUSIONS

The s-HMSU system provides a reliable measure of voiding volume and is appropriate for home use. It has the potential to facilitate large-scale clinical research to examine the relationship between medical diseases and voiding dysfunction.

Validation of a 3 day electronic bladder diary as an app for smart-phone

AIM

To validate an electronic 3-day bladder diary (BD) as an easy-to-use app for smart-phone (eDM3d).

METHODS

Descriptive and cross-sectional prospective study. One hundred and thirty-six patients with overactive bladder syndrome (OABs) or nocturia who had a smart-phone and attended the urology clinics of a tertiary hospital from June to November 2017 were included. Patients filled the eDM3d (test) and the Spanish validated paper BD (DM3d) and questionnaires ICIQ-UISF and BASQ during the first week. Two weeks later, they repeated the eDM3d (retest). We assessed feasibility of the eDM3d (percentage of variables completed), test-retest reliability (qualitative variables: McNemar test; quantitative variables: ICC), paper-app correlation (qualitative variables: Kappa index; quantitative variables: ICC) and convergent validity (correlation between eDM3d and questionnaires, Spearman's rank test). Patients answered a question about satisfaction: "If you had to repeat a BD again, would you choose paper or the app version?"

RESULTS

One hundred and twenty-three (90.4%) participants completed all the variables of the first eDM3d. There were no significant differences in the proportion of patients classified as positive for each symptom between test and retest. ICC ranged from 0.73 to 0.94 for all variables (P < 0.001) in the test-retest assessment. Paper-app correlation was good to excellent for all variables (ICC 0.76-0.95, P < 0.001; Kappa index 0.56-0.84, P < 0.001). Correlation between the eDM3d and the questionnaires ranged from 0.23 to 0.6 (P < 0.01). 120 (88.2%) patients would choose the eDM3d if they had to repeat a BD.

CONCLUSION

The eDM3d presents suitable feasibility, reliability, and validity to assess patients with OABs or nocturia who have a smart-phone.

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

BACKGROUND AND OBJECTIVES

CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: - Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD. - Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD.

METHODS

A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool.

RESULTS

Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The Computer- Assisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%.

DISCUSSION

With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol.

CONCLUSIONS

We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.

[Reproducibility of bladder diary in patients with multiple sclerosis]

INTRODUCTION

Multiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors.

METHODS

The MS patient provided a 21 days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15 %) and instable BD group (CV>15 %). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week.

RESULTS

Thirty-one patients were included (mean age 51.06 years, SD 11.33) with 65 % of women. Mean CV is 23 % (SD 0.11). The mean completion of BD was 19.35 days (SD 3.99). 8 patients had a CV≤15 %. Stable group was older than instable group (P=0.03). There was no other difference between the 2 groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified.

CONCLUSION

BD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population.

LEVEL OF EVIDENCE

4.

Development and feasibility assessment of a 3 day electronic bladder diary as an app for smart-phone

AIMS

To develop a 3 day bladder diary (BD) as an easy-to-use application for smart-phone (eDM3d). To test its feasibility and acceptance in a reduced number of patients.

METHODS

An external agency developed the eDM3d following the structure of the Spanish validated 3 day BD (DM3d©), which includes a frequency-volume chart, the assessment of the grade of urgency, the incontinence events and fluid intake. The eDM3d consisted in a main interface of four buttons ("wake up," "go to bed," "urinate," "drink") which had to be clicked to create an event. Results were automatically transferred to an internet server to obtain an electronic report. We recruited 25 patients with overactive bladder syndrome or nocturia and previous experience on paper BD. They were asked to complete the eDM3d. Finally, a direct question about satisfaction was answered: "If you had to complete a BD again, would you choose the paper or the app version?"

RESULTS

Three patients (12%) did not complete the eDM3d, 1 patient (4%) completed 2 days of the eDM3d and did not register volumes of micturition nor fluid intake, 1 patient (4%) completed all 2 days variables and 20 patients (80%) completed all 3 day variables. Regarding satisfaction, 19 patients (86.4%) would choose the app version, 2 patients (9.1%) would choose a paper version and 1 patient (4.5%) would choose either indistinctly.

CONCLUSIONS

The eDM3d is a useful tool easily filled in by patients with a high satisfaction rate. Adequate validation of the eDM3d is required.

Noninvasive Medical Tools for Evaluating Voiding Pattern in Real Life

Voiding dysfunction is a common disease that contributes to a lower quality of life and has an increased prevalence in the elderly population. Noninvasive and objective methods such as uroflowmetry (UFM) and voiding diaries (VDs) are essential for exact diagnosis and effective treatment of this condition because patients with different causes of voiding dysfunction can complain of the same lower urinary tract symptoms. Further, different treatment options can be determined based on the diagnosis made from these symptoms. In order to improve the quality of UFM and VDs and to provide a convenient testing environment, several advances have been made by previous investigators. In this study, we investigate the history and technological mechanisms of UFM and VDs. We also aim to review UFM from the viewpoint of clinical and at-home uses, including the recently proposed toilet-shaped UFM and electronic VDs.

Utilising daily diaries to examine oral health experiences associated with dentine hypersensitivity

Background

The current investigation examined the determinants of oral health experiences associated with dentine hypersensitivity using prospective diary methodology.

Methods

Staff and students from a large UK university who had self-diagnosed dentine hypersensitivity completed an online daily diary and text survey for 2 weeks recording their mood, oral health-related coping behaviours, coping and pain appraisals, pain experiences and functional limitations. Cross sectional and lagged path analyses were employed to examine relationships.

Results

One hundred one participants took part in the diary study. Participants had a mean age of 26.3 years (range = 18–63) and most were female (N = 69). Individuals who used more oral health-related coping behaviours predicted and experienced greater levels of pain on subsequent days. Negative mood also predicted worse pain outcomes. The daily diary method provided a useful avenue for investigating variations in oral health experiences and relationships between variables that can fluctuate daily.

Conclusions

Psychological variables such as coping and mood play an important role in the pain experiences of people with dentine hypersensitivity. The study highlights the benefits of using prospective methods to elucidate the experiences of people with oral conditions.

Mobile phone applications in management of enuresis: The good, the bad, and the unreliable!

INTRODUCTION

The proliferation of medical-type applications or 'apps' on smartphones is a typical example of the impact technology has had on medical practice. Maintaining a bladder diary is a recommended part of evaluating the effect of interventions for patients suffering from enuresis. Traditional pen-and-paper bladder diaries have poor completion rates, inconsistent patterns in data entry, and are deficient in validation. Electronic bladder diaries have been proposed to overcome these obstacles. With increasing numbers of smartphone apps available to the general public, it is important to distinguish well-designed apps for childhood enuresis.

PURPOSE

To identify, evaluate, and rank all available mobile-phone apps for the management of childhood enuresis.

METHODS

On August 21, 2014, a search was conducted on iTunes, Android Play Store, and BlackBerry World for smartphone apps using the following search terms: bladder, bedwetting, bladder diary, enuresis, incontinence, and wetting. Apps that did not have a bladder diary function and that were unrelated to the investigation, follow-up, and treatment of childhood enuresis were excluded. Apps were rated by a paediatric urology consultant, fellow, registrar, and resident medical officer using standardised criteria including: design; ease of use; languages; quality of instructions; security; accordance with ICCS definition of enuresis; and ability to store histories; record bowel habits; transfer data to other devices; and print data.

RESULTS

Across all three search platforms, a total of 1041 apps were identified. Only 24 were included and reviewed based on exclusion criteria. Average ratings for apps ranged from 10 to 30.75 out of 50 based on standardised criteria.

DISCUSSION

Smartphone apps are playing an increasingly significant role in the management of enuresis in place of pen-and-paper bladder diaries. Apps available to the general public vary in quality and it can be difficult for patients to identify one appropriate for use. We found apps with higher ratings consistently had engaging interfaces, were easy to use, and defined the primary purpose clearly. Lower ratings and performance often was caused by poor quality of experience through "freezing"/"crashing."

CONCLUSION

Bladder diary apps can eliminate disadvantages of pen-and-paper diaries in the management of enuresis. Currently, apps available vary in quality. The three best-rated apps currently available are My Dryness Tracker, Bedwetting Tracker, and HapPee Time. There is room for medical associations to collaborate with developers for further app development.

Electronic bladder diaries of differing duration versus a paper diary for data collection in overactive bladder

AIMS

This observational study compared data values, reliability, consistency and compliance collected by electronic and paper diaries of differing durations.

METHODS

Subjects ≥18 years with overactive bladder (OAB) on stable antimuscarinic treatment for ≥12 weeks were assigned to one of five, 15-week diary schedules in this randomized, parallel-group observational study. Sample size was sufficient to assess reliability and consistency of diary data with adequate precision. Reliability was assessed via intraclass correlation coefficients, variability with ANCOVAs, and consistency using Cronbach's alpha.

RESULTS

Demographic characteristics of randomized subjects were representative of OAB trial populations. For mean volume voided, reliability was comparable across diary groups. For incontinence, reliability improved with increasing diary duration. For micturition frequency, electronic 7-day diary results had highest reliability and lowest variability. Lowest overall reliability was observed in the 3-day paper diary. Consistency was highest in the electronic continuous groups; Cont A (daily measurements throughout the study period [fully Continuous]) and Cont B (daily measurements for some but not all endpoints of interest [Partially Continuous]). Compliance was generally high; across groups ≥90% of diaries had at least one entry per day. There was no significant change in average micturition frequency with diary duration, suggesting no diary fatigue. One-third of subjects in the electronic Cont B group also reported micturitions as incontinence when they only needed to report incontinence; they also reported lowest satisfaction with the study. The electronic 7-day and electronic Cont A schedules (who reported incontinence and micturitions throughout the study) had lowest residual errors.

CONCLUSIONS

For future OAB trials, 7-day or continuous electronic diaries may improve accuracy and reliability of micturition and incontinence frequency data compared with shorter collection periods and paper diaries. Neurourol. Urodynam. 35:743-749, 2016. © 2015 Wiley Periodicals, Inc.

Validating of a Novel Method for Electronically Recording Overactive Bladder Symptoms in Men

OBJECTIVE

The goal of this study was to compare a novel wireless phone and web based technology to record and store overactive bladder symptoms (OAB-S) to a traditional pen and paper micturition chart.

METHODS

Overactive bladder symptoms were recorded over a period of 3 days using both an electronic micturition chart (EMC) and the standard pen and paper micturition chart (MC). Twenty-nine men, with lower urinary tract symptoms (LUTS), were included in the study. Dropout rate, patient's preference, and correlation between the quality of life measures (QoL) and symptoms recorded with EMC versus MC, were assessed and compared.

RESULTS

Of the total number of 29 patients enrolled into the study, 24 completed the full 3-day trial using MC and 27 using EMC. MC was preferred by 50%, while EMC was preferred by 50% of participants. Using MC, 21% of patients forgot to record at least one episode of urgency, versus 17% using EMC, 17% forgot to record at least one micturition using MC versus 8% using EMC. A statistically significant correlation was found between lower severity of OAB-S and higher QoL, using both recording methods.

CONCLUSIONS

In this study population, recording symptoms with EMC did not prove to be preferable compared to MC; however, EMC provided the same level of accuracy with the same or better adherence to the study protocol.

Evaluation of a mobile voiding diary for pediatric patients with voiding dysfunction: a prospective comparative study

PURPOSE

One potential strategy for improving voiding diary completion rates and data quality is use of a mobile electronic format. We evaluated the acceptability and feasibility of mobile voiding diaries for patients with nonneurogenic lower urinary tract dysfunction, and compared mobile and paper voiding diaries.

MATERIALS AND METHODS

We prospectively enrolled children presenting with daytime symptoms of lower urinary tract dysfunction between July 2012 and April 2013. We enrolled an initial cohort of patients who were provided a paper voiding diary and a subsequent cohort who were provided a mobile voiding diary. We conducted in person interviews and assessed completion rates and quality, comparing paper and mobile voiding diary groups.

RESULTS

We enrolled 45 patients who received a paper voiding diary and 38 who received a mobile voiding diary. Completion rates were 78% for paper voiding diaries and 61% for mobile voiding diaries (p = 0.10). Data quality measures for patients completing paper vs mobile voiding diaries revealed a larger proportion (63% vs 52%) providing a full 5 days of data and a smaller proportion (20% vs 65%) with data gaps. However, the paper voiding diary also demonstrated a lower proportion (80% vs 100%) that was completely legible and a lower proportion (40% vs 65%) with completely prospective data entry.

CONCLUSIONS

The use of a mobile voiding diary was acceptable and feasible for our patients with lower urinary tract dysfunction, although completion rates were somewhat lower compared to paper voiding diaries. Data quality was not clearly better for either version. The mobile voiding diary format may offer data quality advantages for select groups but it did not display significant superiority when provided universally.

Customized-Language Voice Survey on Mobile Devices for Text and Image Data Collection Among Ethnic Groups in Thailand: A Proof-of-Concept Study

Background

Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys.

Objective

This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants’ satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness.

Methods

Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants.

Results

The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities.

Conclusions

To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings.

Development of two electronic bladder diaries: a patient and healthcare professionals pilot study

AIMS

Assess patients' preferences in a pilot crossover study of two different electronic voiding diaries against a standard paper diary. Assess urological health professional (HP) opinions on the electronic bladder diary reporting system.

METHODS

Two different electronic diaries were developed: (1) electronically read diary-a card with predefined slots read by a card reader and (2) e-diary-a handheld touch screen device. Data uploaded from either electronic diary produced an electronic report. We recruited 22 patients split into two cohorts for each electronic diary, 11 completed each type of electronic diary for 3 days either preceded or followed by a standard paper diary for 3 days. Both diaries were completed on the 7th day. Patients' perceptions of both diaries were recorded using a standardized questionnaire. A HP study recruited 22 urologists who were given the paper diary and the electronic reports. Time taken for analysis was recorded along with accuracy and HP preferences.

RESULTS

The majority of patients (82%) preferred the e-diary and only 1/11 found it difficult to use. Patients had the same preference for the electronically read diary as the paper diary. The paper diary took 66% longer to analyze than the electronic report (P < 0.001) and was analyzed with an accuracy of 58% compared to 100%. Slightly more HP (9%) preferred the electronic report to the paper diary.

CONCLUSIONS

This proposed e-diary with its intuitive interface has overcome previous deficiencies in electronic diaries with most patients finding the format user-friendly. Electronic reports make analysis and interpretation by HP quicker and more accurate.

Darifenacin for the treatment of overactive bladder

Overactive bladder is a debilitating disorder affecting 16.5% of adults and increasing in prevalence with age. Symptoms, including urgency, urge incontinence and frequency can result from detrusor overactivity with contraction of the bladder mediated primarily by activation of muscarinic M(3) receptors. Antimuscarinic agents are therefore an important approach to treating overactive bladder, but a lack of M(3) receptor subtype selectivity with these agents can generate a range of side effects that limits their effectiveness. This review describes an alternative approach to treating overactive bladder using the selective muscarinic M(3) receptor antagonist darifenacin. The M(3) receptor selectivity of darifenacin improves the symptoms of overactive bladder while reducing the potential for deleterious effects of non-M(3) muscarinic receptor antagonism in the brain or heart. The pharmacology and pharmacokinetics of darifenacin are summarized, and the its clinical efficacy and demonstrated safety profile are described.

Smartphone versus pen-and-paper data collection of infant feeding practices in rural China

Background

Maternal, Newborn, and Child Health (MNCH) household survey data are collected mainly with pen-and-paper. Smartphone data collection may have advantages over pen-and-paper, but little evidence exists on how they compare.

Objective

To compare smartphone data collection versus the use of pen-and-paper for infant feeding practices of the MNCH household survey. We compared the two data collection methods for differences in data quality (data recording, data entry, open-ended answers, and interrater reliability), time consumption, costs, interviewers’ perceptions, and problems encountered.

Methods

We recruited mothers of infants aged 0 to 23 months in four village clinics in Zhaozhou Township, Zhao County, Hebei Province, China. We randomly assigned mothers to a smartphone or a pen-and-paper questionnaire group. A pair of interviewers simultaneously questioned mothers on infant feeding practices, each using the same method (either smartphone or pen-and-paper).

Results

We enrolled 120 mothers, and all completed the study. Data recording errors were prevented in the smartphone questionnaire. In the 120 pen-and-paper questionnaires (60 mothers), we found 192 data recording errors in 55 questionnaires. There was no significant difference in recording variation between the groups for the questionnaire pairs (P = .32) or variables (P = .45). The smartphone questionnaires were automatically uploaded and no data entry errors occurred. We found that even after double data entry of the pen-and-paper questionnaires, 65.0% (78/120) of the questionnaires did not match and needed to be checked. The mean duration of an interview was 10.22 (SD 2.17) minutes for the smartphone method and 10.83 (SD 2.94) minutes for the pen-and-paper method, which was not significantly different between the methods (P = .19). The mean costs per questionnaire were higher for the smartphone questionnaire (¥143, equal to US $23 at the exchange rate on April 24, 2012) than for the pen-and-paper questionnaire (¥83, equal to US $13). The smartphone method was acceptable to interviewers, and after a pilot test we encountered only minor problems (eg, the system halted for a few seconds or it shut off), which did not result in data loss.

Conclusions

This is the first study showing that smartphones can be successfully used for household data collection on infant feeding in rural China. Using smartphones for data collection, compared with pen-and-paper, eliminated data recording and entry errors, had similar interrater reliability, and took an equal amount of time per interview. While the costs for the smartphone method were higher than the pen-and-paper method in our small-scale survey, the costs for both methods would be similar for a large-scale survey. Smartphone data collection should be further evaluated for other surveys and on a larger scale to deliver maximum benefits in China and elsewhere.

A multicenter, double-blind, randomized, placebo-controlled trial of the β3-adrenoceptor agonist solabegron for overactive bladder

BACKGROUND

β-Adrenoceptor agonists are effective in animal models of bladder dysfunction, and the human bladder primarily expresses the β3 receptor subtype.

OBJECTIVE

To evaluate the efficacy and tolerability of the highly selective and potent β3-adrenoceptor agonist solabegron in a clinical proof-of-concept study in incontinent women with overactive bladder (OAB).

DESIGN, SETTING, AND PARTICIPANTS

This was a randomized, double-blind trial in adult women with OAB (one or more 24-h incontinence episodes and eight or more average 24-h micturitions).

INTERVENTIONS

Solabegron 50 mg (n=88), solabegron 125 mg (n=85), or placebo (n=85)-all twice daily-were administered.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary efficacy end point was percentage change from baseline to week 8 in the number of incontinence episodes over 24 h. Secondary end points included actual change and percentage change from baseline to week 4 and week 8 in micturitions per 24 h, urgency episodes per 24 h, and volume voided per micturition. Adverse events (AEs) were assessed, as well.

RESULTS AND LIMITATIONS

Solabegron 125 mg produced a statistically significant difference in percent change from baseline to week 8 in incontinence episodes over 24h when compared with placebo (p=0.025). Solabegron 125 mg treatment also showed statistically significant reductions from baseline to weeks 4 and 8 in micturitions over 24 h and a statistically significant increase from baseline to week 8 in urine volume voided. Solabegron was well tolerated, with a similar incidence of AEs in each treatment group. There were no significant treatment differences for mean changes from baseline to week 8 in systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), or heart rate during the 24-h ambulatory measurement.

CONCLUSIONS

Solabegron significantly reduced the symptoms of OAB in women with moderate to severe OAB. Solabegron was safe, well tolerated, and did not demonstrate significant differences in AEs as compared to placebo. β3-Adrenoceptor agonists may represent a new therapeutic approach for treating OAB symptoms.

Computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of type 2 diabetes mellitus

BACKGROUND

Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Because diabetes tends to run in families, the collection of data is an important tool for identifying people with elevated risk of type2 diabetes. Traditionally, oral-and-written data collection methods are employed but computer-assisted history taking systems (CAHTS) are increasingly used. Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on family history taking, clinical care and patient outcomes such as health-related quality of life. 

OBJECTIVES

To assess the effectiveness of computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of developing type 2 diabetes mellitus.

SEARCH METHODS

We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status.

SELECTION CRITERIA

Randomised controlled trials of computer-assisted versus oral-and-written history taking in adult participants (16 years and older).

DATA COLLECTION AND ANALYSIS

Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently.

MAIN RESULTS

We found no controlled trials on computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of type 2 diabetes mellitus.

AUTHORS' CONCLUSIONS

There is a need to develop an evidence base to support the effective development and use of computer-assisted history taking systems in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted family history taking for identifying people with elevated risk of type 2 diabetes may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.

Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

BACKGROUND

Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. 

OBJECTIVES

To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus.

SEARCH METHODS

We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status.

SELECTION CRITERIA

Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus.

DATA COLLECTION AND ANALYSIS

Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently.

MAIN RESULTS

Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study.

AUTHORS' CONCLUSIONS

Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.

Patient-reported outcomes and different approaches to urinary parameters in overactive bladder: what should we measure?

Overactive bladder (OAB) is highly prevalent and associated with considerable impact on patient health-related quality of life (HRQoL). Assessment of HRQoL can reveal the burden of disease and post-intervention improvement. This review aims to highlight the importance of HRQoL assessment and outline the tools available for use in clinical trials and real-world clinical practice. A number of validated measures of HRQoL specific to OAB have been developed, offering greater sensitivity and responsiveness over generic instruments. These condition-specific, multi-dimensional and single-item global questionnaires are particularly useful for the multiple and varied symptoms of OAB, as they reflect the patient's needs, concerns and values. Measurements for lower urinary tract symptoms, e.g. bladder diaries, are being compared with HRQoL instruments to provide greater understanding of the disease and treatment from the patient's perspective. Therapeutic interventions to improve OAB symptoms should also be evaluated for their effect on the patient's HRQoL.

The development and evaluation of a PDA-based method for public health surveillance data collection in developing countries

BACKGROUND AND PURPOSE

EpiData and Epi Info are often used together by public health agencies around the world, particularly in developing countries, to meet their needs of low-cost public health data management; however, the current open source data management technology lacks a mobile component to meet the needs of mobile public health data collectors. The goal of this project is to explore the opportunity of filling this gap through developing and trial of a personal digital assistant (PDA) based data collection/entry system. It evaluated whether such a system could increase efficiency and reduce data transcription errors for public surveillance data collection in developing countries represented by Fiji.

METHODS

A generic PDA-based data collection software eSTEPS was developed. The software and the data collected using it directly interfaces with EpiData. A field trial was conducted to test the viability of public health surveillance data collection using eSTEPS. The design was a randomised, controlled trial with cross-over design. 120 participants recruited from the Fiji School of Medicine were randomly assigned to be interviewed by one of six interviewers in one of the two ways: (1) paper-based survey followed by PDA survey and (2) PDA survey followed by paper-based survey. Data quality was measured by error rates (logical range errors/inconsistencies, skip errors, missing values, date or time field errors and incorrect data type). Work flow and cost were evaluated in three stages of the survey process: (1) preparation of data collection instrument, (2) data collection and (3) data entry, validation and cleaning. User acceptance was also evaluated in the two groups of participants: (1) data collectors and (2) survey participants.

RESULTS

None of the errors presented in 20.8% of the paper questionnaires was found in the data set collected using PDA. Sixty-two percent of the participants perceived that the PDA-based questionnaire took less time to complete. Data entry, validation and cleaning for the PDA-based data collection from 120 participants took a total of 1.5h, a 93.26% reduction of time from 20.5h required using paper and pen. The cost is also significantly reduced with PDA-based protocol. Both data collectors and participants prefer to use PDA instead of paper for data collection. The trial results prove that eSTEPS is a feasible solution for public health surveillance data collection in the field. Several deficiencies of the software were also identified and would be addressed in the next version.

CONCLUSION

eSTEPS offers the potential to meet the need for an effective mobile public health data collection tool for use in the field. The eSTEPS field trial proves that PDA was more efficient than paper for public health survey data collection. It also significantly reduced errors in data entry. The later benefit was derived from the software providing its users with the flexibility of building their own constraints to control the data type, range and logic of data entry.

Are electronic diaries useful for symptoms research? A systematic review

OBJECTIVE

The objective of this study was to evaluate electronic diaries as a tool for investigating associations between physical symptoms and psychological variables.

METHODS

A qualitative systematic review of electronic diary studies in pain and symptoms research was performed.

RESULTS

Studies of electronic diary use report good acceptability and accuracy of data recording. A descriptive classification of the findings of electronic diary studies yielded five categories: experience, recording data when symptoms were present; interaction, testing the relationship between variables at different levels; sequential, observing associations at different time lags; process, recording possible mediating constructs such as catastrophization and self-efficacy; and intervention, recording during treatment to identify trends. Most data from diary studies suggest relatively weak associations between variables.

CONCLUSION

Electronic diaries are a potentially valuable tool for psychosomatic research. We suggest further possibilities for their use.

Daily health status registration (patient diary) in patients with rheumatoid arthritis: a comparison between personal digital assistant and paper-pencil format

OBJECTIVE

The patient perspective workshops at the Outcome Measures in Rheumatology Clinical Trials have included daily measures of health status (patient diary) and use of electronic tools for data collection in the research agenda. The objective of this study was to compare daily and weekly registrations of self-reported health status measures between personal digital assistant (PDA) and paper-pencil (PP) format regarding scores, variation, and feasibility.

METHODS

Thirty-eight patients with stable rheumatoid arthritis recorded their health status during 84 days in a repeated crossover design, using PDA or PP format during four 21-day periods. Visual analog scales (VAS) for pain, fatigue, and global disease and the Rheumatoid Arthritis Disease Activity Index were scored daily; the Short Form 36 and Modified Health Assessment Questionnaire were scored weekly.

RESULTS

The average scores and measures of variation of the 4 daily health status measures over 21 days did not differ significantly between PDA and PP formats in either of the 2 crossover periods. The values for the average range between the maximum and minimum values for daily measures were similar between the 2 formats, but showed considerable variation (e.g., range for pain VAS was 19-28 mm over each 21-day period). The time to complete the instruments was similar between the 2 formats. Missing daily data entries were generally low for both periods and somewhat higher for PDA. The majority of patients (82.9%) preferred using PDA.

CONCLUSION

Daily assessments with PDA may be efficiently used for frequent data collection because this format performs similarly to the traditional PP format.

Despite technical problems personal digital assistants outperform pen and paper when collecting patient diary data

OBJECTIVES

To assess how personal digital assistants (PDAs) perform as collection tools of patient-reported outcomes in clinical research compared to pen and paper (P&P) diaries in terms of feasibility, protocol compliance, data accuracy, and subject acceptability.

STUDY DESIGN AND SETTING

A systematic review of randomized and quasi-randomized controlled trials comparing the PDA and P&P methods in a health diary context involving repeated measures in persons with chronic health problems.

RESULTS

Nine studies were included. Their methodological quality was variable. Five studies reported on feasibility, and all reported technical difficulties with the PDA technology. Two studies reported that electronic collection leads to a substantial reduction in time used for data handling. Five studies reported that the PDA method results in better compliance, whereas one study reported the opposite. All three articles reporting on data accuracy indicated that there are fewer errors in the PDA records. Four articles scrutinized subject preference, and the PDA method came out favorably in all four.

CONCLUSION

The PDA method seems to perform better than P&P in most of the selected outcomes. Technical malfunction is the chief disadvantage with the PDA method. Further research comparing PDA with paper data collection using more stringent methodology is needed.