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Suarez ML, Angulo R, Suarez AJ, Fullwood D, Allen J, Stern MC, Flores-Rozas H, Wilkie DJ. Cognitive Testing of PAIN Report It-Spanish in Monolingual Hispanic Adults. Cancer Nurs 2023; 46:364-374. [PMID: 37607372 PMCID: PMC10232677 DOI: 10.1097/ncc.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A Spanish language computerized tool would facilitate cancer pain assessment and management for the underserved population of native Spanish speakers who do not speak or lack command of the English language. OBJECTIVE Our aim was to identify Spanish-speaking adults' understanding and interpretation of the PAIN Report It-Spanish items and instructions as well as translation and technical issues. METHODS In a cross-sectional study, 20 mostly monolingual Spanish-speaking adults engaged in 1.5- to 2-hour, audio-recorded cognitive interviews as they completed the multidimensional PAIN Report It-Spanish. Three bilingual researchers conducted content data analysis. RESULTS Sixteen women and 4 men generally understood the translated text, but some had interpretation issues regarding the 0 to 10 number scale and understanding of the pain quality descriptors. Many participants found the program easy to complete, even when they had problems in some areas. Most participants welcomed the opportunity to report pain in their native language and appreciated research to help Hispanics with the management of their pain. CONCLUSION PAIN Report It-Spanish is a valid tool to assess pain in a Spanish-speaking population. Improved orientation to the pain reporting tasks and alternate translations for several problematic/confusing Spanish words require additional study, especially among underrepresented black Hispanics and males. IMPLICATION FOR PRACTICE Findings indicate that Spanish-speaking adults (1) easily use a body outline to report their pain location, (2) may use a 0 to 10 scale differently than other individuals, and (3) may have a limited repertoire of pain quality and pattern descriptors.
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Affiliation(s)
- Marie L Suarez
- Author Affiliations: College of Nursing, University of Illinois Chicago (Dr Suarez, Mr Angulo, and Mr Suarez); Institute on Aging, University of Florida (Dr Fullwood), Gainesville; College of Pharmacy, University of Florida (Dr Allen), Gainesville; Department of Population and Public Health Sciences and Department of Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center (Dr Stern), Los Angeles, CA; College of Pharmacy, Florida Agricultural and Mechanical University (Dr Flores-Rozas), Tallahassee; and College of Nursing, University of Florida (Dr Wilkie), Gainesville
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Desloge AA, Patil CL, Glayzer JE, Suarez ML, Kobak WH, Meinel M, Steffen AD, Burke LA, Yao Y, Takayama M, Yajima H, Kaptchuk TJ, Takakura N, Foster DC, Wilkie DJ, Schlaeger JM. Women's Experience of Living with Vulvodynia Pain: Why They Participated in a Randomized Controlled Trial of Acupuncture. J Integr Complement Med 2023; 29:50-54. [PMID: 36130137 PMCID: PMC9917314 DOI: 10.1089/jicm.2022.0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Vulvodynia is vulvar pain lasting at least 3-months without clear identifiable cause that may have other associated factors. The aim, to explore motivations of women participating in a double-blind randomized controlled trial of acupuncture for vulvodynia. Methods: Responses to the question: "Tell me about why you decided to participate in this study" were analyzed using conceptual content analysis to identify patterns in motivation for study participation. Results: Four patterns emerged: 1) desire to address uncontrolled pain, 2) desire for understanding, 3) wish to contribute to knowledge generation, and 4) need to remove cost barriers. Conclusion: Motivations indicate vulvodynia-specific aspects of acceptability of acupuncture. Clinical Trial Registration: NCT03364127.
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Affiliation(s)
- Allissa A. Desloge
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Crystal L. Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer E. Glayzer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Marie L. Suarez
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - William H. Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Monya Meinel
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Alana D. Steffen
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Larisa A. Burke
- Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Ted J. Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - David C. Foster
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Judith M. Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Schlaeger JM, Suarez ML, Glayzer JE, Kobak WH, Meinel M, Steffen AD, Burke LA, Pauls HA, Yao Y, Takayama M, Yajima H, Kaptchuk TJ, Takakura N, Foster D, Wilkie DJ. Protocol for double-blind RCT of acupuncture for vulvodynia. Contemp Clin Trials Commun 2022; 30:101029. [PMID: 36387991 PMCID: PMC9649367 DOI: 10.1016/j.conctc.2022.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Background Vulvodynia, vulvar pain of unknown origin lasting at least 3 months, affects 7% of American women. Dyspareunia, its frequent companion, renders sexual intercourse virtually impossible. Although few therapies are efficacious and rapid pain relief is rarely possible, there have been no sham/placebo-controlled studies of acupuncture for vulvodynia. Aims are to: 1) determine efficacy of acupuncture for vulvodynia, 2) explore duration of the acupuncture effect. Methods In a pretest/posttest randomized controlled, double-blind (practitioner-patient) efficacy trial of a standardized acupuncture protocol, we will randomize 80 participants 1:1 to either penetrating needle or skin-touch placebo needle groups. Both types of needles are designed to blind both the acupuncturist and participant. Participants with vulvodynia will insert and remove a tampon as a standardized stimulus and complete primary measures of vulvar pain (pain intensity) and secondary measures of dyspareunia (Female Sexual Function Index, FSFI dyspareunia subscale score) and sexual function (FSFI total score) pretreatment, after the 10th acupuncture session, and pain measures weekly until return to pretest levels. Upon study completion control group participants will be offered 10 free real acupuncture sessions. Discussion This is the first multi-needle multi-session RCT using double-blind acupuncture needles as a reliable sham. We hypothesize that controlling for baseline, at posttest there will be statistically significant less vulvar pain and dyspareunia and more sexual function over five weeks in the penetrating needle group compared to the skin touch placebo group. Conclusion This study is responsive to the need for efficacious pain management for women with vulvodynia.ClinicalTrials.gov Identifier: NCT03364127.
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Affiliation(s)
- Judith M Schlaeger
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, USA
| | - Marie L Suarez
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, USA
| | - Jennifer E Glayzer
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, USA
| | - William H Kobak
- University of Illinois Chicago, College of Medicine, Department of Obstetrics and Gynecology, USA
| | - Monya Meinel
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, USA
| | - Alana D Steffen
- University of Illinois Chicago, College of Nursing, Department of Population Health Nursing Science, USA
| | - Larisa A Burke
- University of Illinois Chicago, College of Nursing, Office of Research Facilitation, USA
| | - Heather A Pauls
- University of Illinois Chicago, College of Nursing, Office of Research Facilitation, USA
| | - Yingwei Yao
- University of Florida College of Nursing, Department of Biobehavioral Nursing Science, USA
| | - Miho Takayama
- Tokyo Ariake University of Medical and Health Sciences, Faculty of Health Sciences, Department of Acupuncture and Moxibustion, Japan
| | - Hiroyoshi Yajima
- Tokyo Ariake University of Medical and Health Sciences, Faculty of Health Sciences, Department of Acupuncture and Moxibustion, Japan
| | - Ted J Kaptchuk
- Beth Israel Deaconess Medical Center/Harvard Medical School, Program in Placebo Studies, USA
| | - Nobuari Takakura
- Tokyo Ariake University of Medical and Health Sciences, Faculty of Health Sciences, Department of Acupuncture and Moxibustion, Japan
| | - David Foster
- University of Rochester School of Medicine and Dentistry, USA
| | - Diana J Wilkie
- University of Florida College of Nursing, Department of Biobehavioral Nursing Science, USA
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Moosvi K, Schoppee TM, Xavier S, Henderson K, Suarez ML, Yao Y, Wilkie DJ. Feasibility and Burden of Lay Caregivers Providing Daily Massages to Patients With Cancer Receiving Hospice and Palliative Care. Am J Hosp Palliat Care 2022; 39:1475-1483. [PMID: 35613662 DOI: 10.1177/10499091221105881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Professional massages reduce symptoms experienced by cancer patients, but are costly. A cost-effective way to include this therapy routinely in hospice care is to teach family caregivers to give massages as part of their caregiving activities. However, the burden on caregivers is unknown and might offset patient benefits or cost savings. The pilot study aim was to explore feasibility issues related to licensed massage therapists training caregivers to give massages at home, the burden of giving four daily massages to hospice patients, and feedback about the training and massage delivery. In this pretest/posttest study, caregivers completed the Caregiver Reaction Assessment (CRA), received training on standardized massage techniques from a licensed massage therapist who evaluated their proficiency the following day. Caregivers gave daily massages for 3 days and afterward completed the CRA. Then a researcher interviewed the dyad for feedback about the training and massage delivery. We used paired t tests to evaluate CRA scores and content analysis of interview data. Thirty-nine caregivers (mean age = 46 years, 69% female) completed the study. After training, all but three caregivers provided daily massages. Some caregivers reported minor logistical challenges in massage delivery and documentation, mutual satisfaction, relaxation, and tender moments ranging from laughter and story sharing to closure activities. Mean CRA scores were not significantly different pretest to posttest. We conclude that repeated-dose massages by caregivers to patients dying of cancer is feasible and is worthy of further study to determine the benefits of massage therapy, caregiver and patient experiences, and caregiver burden.
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Affiliation(s)
- Karen Moosvi
- Department of Family, Community and Health System Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Tasha M Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA.,Community Hospice & Palliative Care, Jacksonville, FL, USA.,Center for Palliative Care Research & Education, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Stacy Xavier
- College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | | | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, 14681University of Illinois Chicago, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA.,Center for Palliative Care Research & Education, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA.,Center for Palliative Care Research & Education, College of Nursing, 3463University of Florida, Gainesville, FL, USA
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Glayzer JE, McFarlin BL, Castori M, Suarez ML, Meinel MC, Kobak WH, Steffen AD, Schlaeger JM. High rate of dyspareunia and probable vulvodynia in Ehlers-Danlos syndromes and hypermobility spectrum disorders: An online survey. Am J Med Genet C Semin Med Genet 2021; 187:599-608. [PMID: 34747110 PMCID: PMC8665058 DOI: 10.1002/ajmg.c.31939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/31/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022]
Abstract
Vulvodynia is debilitating vulvar pain accompanied by dyspareunia (pain with sexual intercourse). Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) may represent a predisposing factor for vulvodynia given a high rate of dyspareunia in these conditions. We conducted an online survey of women with EDS or HSD to assess rates of dyspareunia and estimate rates of vulvodynia, report rates of comorbid conditions common to EDS or HSD and vulvodynia, and examine rates of conditions contributing to dyspareunia in women with EDS or HSD. Women with EDS or HSD (N = 1,146) recruited via social media were 38.2 ± 11.5 years old, primarily White (94.4%), and resided in the United States (78.5%). 63.7% of participants reported dyspareunia and 50% screened positive for vulvodynia. The rate of comorbid conditions common to EDS or HSD and vulvodynia were: irritable bowel syndrome, 6.5%; fibromyalgia, 40.0%; temporomandibular joint dysfunction, 56.4%; migraine, 6.7%; interstitial cystitis, 1.7%; and mast cell activation syndrome, 10.2%. Participants reporting dyspareunia also reported ovarian cysts, fibroids, or abdominal or pelvic scars, 47.5%; endometriosis, 26.5%; and genital lacerations, 19.3%. Women with EDS or HSD may have a higher rate of vulvodynia (50.0%) than women in the U.S. population at large (8%) and should be assessed for dyspareunia and vulvodynia.
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Affiliation(s)
- Jennifer E Glayzer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Barbara L McFarlin
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Marie L Suarez
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Monya C Meinel
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - William H Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- Department of Population Health Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Bonner GJ, Freels S, Ferrans C, Steffen A, Suarez ML, Dancy BL, Watkins YJ, Collinge W, Hart AS, Aggarwal NT, Wilkie DJ. Advance Care Planning for African American Caregivers of Relatives With Dementias: Cluster Randomized Controlled Trial. Am J Hosp Palliat Care 2021; 38:547-556. [PMID: 32308012 PMCID: PMC8443116 DOI: 10.1177/1049909120916127] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES African-American family caregivers may have insufficient knowledge to make informed end-of-life (EOL) decisions for relatives with dementias. Advance Care Treatment Plan (ACT-Plan) is a community-based education intervention to enhance knowledge of dementia and associated EOL medical treatments, self-efficacy, intentions, and behavior (written EOL care plan). This study evaluated efficacy of the intervention compared to attention control. RESEARCH DESIGN AND METHODS In a theoretically based, 2-group, cluster randomized controlled trial, 4 similar Midwestern urban megachurches were randomized to experimental or control conditions. Each church recruited African-American caregivers, enrolling concurrent waves of 5 to 9 participants in 4 weekly 1-hour sessions (358 total: ACT-Plan n = 173, control n = 185). Dementia, cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF) treatments were discussed in ACT-Plan classes. Participants completed assessments before the initial class, after the final class (week 4), and at week 20. Repeated measures models were used to test the intervention effect on changes in outcomes across time, adjusting for covariates as needed. RESULTS Knowledge of CPR, MV, TF, and self-efficacy to make EOL treatment decisions increased significantly more in the ACT-Plan group at weeks 4 and 20. Knowledge of dementia also increased more in the ACT-Plan group at both points, reaching statistical significance only at week 20. Intentions to make EOL treatment decisions and actually an advance care plan were similar between treatment arms. DISCUSSION AND IMPLICATIONS Findings demonstrate promise for ACT-Plan to increase informed EOL treatment decisions for African American caregivers of individuals with dementias.
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Affiliation(s)
- Gloria J. Bonner
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Sally Freels
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Carol Ferrans
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Alana Steffen
- Department of Health Systems Science, College of Nursing University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L. Suarez
- Department of Health Systems Science, College of Nursing University of Illinois at Chicago, Chicago, IL, USA
| | - Barbara L. Dancy
- Department of Health Systems Science, College of Nursing University of Illinois at Chicago, Chicago, IL, USA
| | - Yashika J. Watkins
- Department of Health Studies, College of Health Sciences, Chicago State University, Chicago, IL, USA
| | | | - Alysha S. Hart
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Neelum T. Aggarwal
- Department of Neurological Sciences, Alzheimer’s Disease Center and Rush Medical College, Rush University Alzheimer’s Disease Center, Chicago, IL, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Yoon SL, Scarton L, Duckworth L, Yao Y, Ezenwa MO, Suarez ML, Molokie RE, Wilkie DJ. Pain, symptom distress, and pain barriers by age among patients with cancer receiving hospice care: Comparison of baseline data. J Geriatr Oncol 2021; 12:1068-1075. [PMID: 33967022 PMCID: PMC8429256 DOI: 10.1016/j.jgo.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Age group differences have been reported for pain and symptom presentations in outpatient and inpatient oncology settings, but it is unknown if these differences occur in hospice. We examined whether there were differences in pain, symptom distress, pain barriers, and comorbidities among three age groups (20-64 years, 65-84 years, and 85+) of hospice patients with cancer. MATERIALS AND METHODS Participants were recruited from two hospices. Half were women; 49% White and 34% Black. 42% were 20-64 y, 43% 65-84 y, and 15% 85+ y. We analyzed baseline data for 230 hospice patients with cancer (enrolled 2014-2016, mean age 68.2 ± 14.0, 20-100 years) from a stepped-wedge randomized controlled trial. Measures were the Average pain intensity (API, 0-10: current, least and worst pain intensity during the past 24 h), Symptom Distress Scale (SDS, 13-65), Barriers Questionnaire-13 (BQ-13, 0-5), and comorbid conditions. Descriptive, bivariate association, and multiple regression analyses were performed. RESULTS Mean API scores differed (p < .001) among the three age groups (5.6 ± 2.0 [20-64 years], 4.7 ± 2.0 [65-84 years], and 4.4 ± 1.8 [85+], as did the mean SDS scores (36.1 ± 7.3, 33.5 ± 8.1, and 31.6 ± 6.6, p = .004). BQ-13 mean scores (2.6 ± 0.9, 2.7 ± 0.8, and 2.5 ± 0.7) and comorbidities were not significantly different across age groups. In multiple regression analyses, age-related differences in API and SDS remained significant after adjusting for gender, race, cancer, palliative performance score, and comorbidities. Comorbidities were positively associated with SDS (p = .046) but not with API (p = .64) in the regression model. CONCLUSION Older hospice patients with cancer reported less pain and symptoms than younger patients, but all groups reported similar barriers to pain management. These findings suggest the need for age- and race-sensitive interventions to reduce pain and symptom distress levels at life's end.
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Affiliation(s)
- Saunjoo L Yoon
- Department of Biobehavioral Nursing Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
| | - Lisa Scarton
- Department of Family, Community and Health System Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
| | - Laurie Duckworth
- Department of Biobehavioral Nursing Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA.
| | - Robert E Molokie
- College of Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; College of Pharmacy, Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA.
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science and Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, USA.
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Steffen AD, Burke LA, Pauls HA, Suarez ML, Yao Y, Kobak WH, Takayama M, Yajima H, Kaptchuk TJ, Takakura N, Wilkie DJ, Schlaeger JM. Double-blinding of an acupuncture randomized controlled trial optimized with clinical translational science award resources. Clin Trials 2020; 17:545-551. [PMID: 32650673 PMCID: PMC7529889 DOI: 10.1177/1740774520934910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical trial articles often lack detailed descriptions of the methods used to randomize participants, conceal allocation, and blind subjects and investigators to group assignment. We describe our systematic approach to implement and measure blinding success in a double-blind phase 2 randomized controlled trial testing the efficacy of acupuncture for the treatment of vulvodynia. METHODS Randomization stratified by vulvodynia subtype is managed by Research Electronic Data Capture software's randomization module adapted to achieve complete masking of group allocation. Subject and acupuncturist blinding assessments are conducted multiple times to identify possible correlates of unblinding. RESULTS At present, 48 subjects have been randomized and completed the protocol resulting in 87 subject and 206 acupuncturist blinding assessments. DISCUSSION Our approach to blinding and blinding assessment has the potential to improve our understanding of unblinding over time in the presence of possible clinical improvement.
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Affiliation(s)
- Alana D Steffen
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Larisa A Burke
- Office of Research Facilitation, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Heather A Pauls
- Office of Research Facilitation, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - William H Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Powell-Roach KL, Booker SQ, Yao Y, Suarez ML, Ezenwa MO, Fillingim RB, Wang ZJ, Molokie RE, Wilkie DJ. Abstract D044: Age and sex effects on quantitative sensory testing values in healthy African American adults. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-d044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and range of age of participants. The intent of our study was to fill a gap in the understanding of pain and somatosensory function in African Americans by generating QST values for healthy African American adults. In a large cohort of pain-free, healthy African American adults whose past pain experiences and current psychological status were known, our study aim was to determine thermal and mechanical QST values and compare those values at the anterior forearm by age and sex. We also determined the values for 5 other body sites and compared the values for differences by testing site location (upper body versus lower body). Methodology: In this cross-sectional study, 124 pain-free African American adults (age 18 to 69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST included obtaining thermal and mechanical responses and associated pain intensity levels. We applied the Benjamini-Hochberg procedure to adjust the p values to account for the multiple t tests. Results: We found thermal detection values at the anterior forearm were (29.2°C±1.6) for cool detection (CD) and (34.5°C±1.2) for warm detection (WD). At that site, pain thresholds were: cold pain threshold (CPTh) (26.3°C±5.0), heat pain threshold (HPTh) (37.8°C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. Mean pain intensity scores rated immediately after the CPTh and HPTh were 1.9 ± 1.3 to 2.2 ± 1.2 on the 0-10 pain intensity scale. Similarly, after the MPTh tests the mean pain intensity scores were 0.5 ± 0.5 to 0.8 ± 0.6. These scores did not differ significantly by sex or age group and clearly indicate that the participants reported pain threshold at an appropriately low perceptual intensity. Pain intensity values for past pain experiences and low ratings for fatigue, depression and anxiety indicated that these factors were unlikely contributors to their pain threshold reports. Conclusion: The QST values from this protocol at the anterior forearm indicate that healthy African American adults had average thermal pain thresholds within 6°C of the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research. These findings add to the body of literature confirming that African American adults indeed have lower pain thresholds than those reported for White adults. These QST values can be used as controls for African Americans with cancer to understand the neuropathic pain syndromes associated with tumor progression and cancer treatments.
Citation Format: Keesha L. Powell-Roach, Starja Q. Booker, Yingwei Yao, Marie L. Suarez, Miriam O. Ezenwa, Roger B. Fillingim, Zaijie J. Wang, Robert E. Molokie, Diana J. Wilkie. Age and sex effects on quantitative sensory testing values in healthy African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D044.
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Affiliation(s)
| | | | - Yingwei Yao
- 1University of Florida, Gainesville, FL, USA,
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10
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Wilkie DJ, Yao Y, Ezenwa MO, Suarez ML, Dyal BW, Gill A, Hipp T, Shea R, Miller J, Frank K, Nardi N, Murray M, Glendenning J, Perez J, Carrasco JD, Shuey D, Angulo V, McCurry T, Martin J, Butler A, Wang ZJ, Molokie RE. A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice. J Pain Symptom Manage 2020; 59:626-636. [PMID: 31711969 DOI: 10.1016/j.jpainsymman.2019.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Unrelieved cancer pain at the end of life interferes with achieving patient-centered goals. OBJECTIVE To compare effects of usual hospice care and PAINRelieveIt® on pain outcomes in patients and their lay caregivers. METHODS In a five-step, stepped-wedge randomized, controlled study, 234 patients (49% male, 18% Hispanic, 51% racial minorities) and 231 lay caregivers (26% male, 20% Hispanic, 54% racial minorities) completed pre-pain/post-pain measures. They received usual hospice care with intervention components that included a summary of the patient's pain data, decision support for hospice nurses, and multimedia education tailored to the patient's and lay caregiver's misconceptions about pain. RESULTS The intervention effect on analgesic adherence (primary outcome) was not significant. Post-test worst pain intensity was significantly higher for the experimental group, but the difference (0.70; CI = [0.12, 1.27]) was not clinically meaningful. There was nearly universal availability of prescriptions for strong opioids and adjuvant analgesics for neuropathic pain in both groups. Lay caregivers' pain misconceptions (0-5 scale) were significantly lower in the experimental group than the usual care group (mean difference controlling for baseline is 0.38; CI = [0.08, 0.67]; P = 0.01). CONCLUSION This randomized controlled trial was a negative trial for the primary study outcomes but positive for a secondary outcome. The trial is important for clearly demonstrating the feasibility of implementing the innovative set of interventions.
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Affiliation(s)
- Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Marie L Suarez
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Anayza Gill
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Theresa Hipp
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Robert Shea
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Jacob Miller
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Karen Frank
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Nargis Nardi
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Michael Murray
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | | | - Jessica Perez
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | - Jesus D Carrasco
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - David Shuey
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Veronica Angulo
- University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA
| | - Timothy McCurry
- Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA
| | - Joanna Martin
- Horizon Hospice & Palliative Care, Chicago, Illinois, USA
| | | | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Dyal BW, Ezenwa MO, Yao Y, Molokie RE, Wang ZJ, Ballas SK, Suarez ML, Wilkie DJ. Randomized clinical trial of computerized PAINRelieveIt® for patients with sickle cell disease: PAINReportIt® and PAINUCope®. Patient Educ Couns 2020; 103:136-144. [PMID: 31451364 PMCID: PMC6895421 DOI: 10.1016/j.pec.2019.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/24/2019] [Accepted: 08/16/2019] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To compare effects of a tailored multimedia education program versus usual-care on barriers to pain management of adult patients with SCD. METHODS Pretest/posttest randomized controlled trial (RCT) of 228 outpatients with SCD randomized to the tablet-based PAINUCope intervention focused on barriers to pain management, pain, and analgesic adherence or selection of games (control). Outcomes were barriers to pain management, pain, and analgesic adherence. RESULTS The barriers to pain management and pain scores did not change significantly from pretest to posttest for either condition. Changes in analgesic adherence rates from pretest to posttest were statistically significant for the intervention group (p = .046) but not for the usual care group (p = .419). The group difference was not statistically significant. CONCLUSIONS This first RCT of a tailored multimedia education intervention with adult patients with SCD did not significantly reduce the outcomes of interest compared to the control group. Findings provide insights for improving intervention delivery and reinforcement of patient behaviors. PRACTICE IMPLICATIONS Study redesign is warranted with modifications that include theoretical and methodological approaches and patient-centered delivery of the intervention that take advantage of recent technology developments.
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Affiliation(s)
- Brenda W Dyal
- University of Florida, Department of Biobehavioral Nursing Science, Gainesville, FL, United States
| | - Miriam O Ezenwa
- University of Florida, Department of Biobehavioral Nursing Science, Gainesville, FL, United States; University of Illinois at Chicago College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States; University of Illinois at Chicago Comprehensive Sickle Cell Center, Chicago, IL, United States
| | - Yingwei Yao
- University of Florida, Department of Biobehavioral Nursing Science, Gainesville, FL, United States; University of Illinois at Chicago College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Robert E Molokie
- University of Illinois at Chicago Comprehensive Sickle Cell Center, Chicago, IL, United States; University of Illinois at Chicago College of Medicine, Division of Hematology/Oncology, Chicago, IL, United States; Jesse Brown Veteran's Administration Medical Center, Chicago, IL, United States; University of Illinois at Chicago College of Pharmacy, Department of Biopharmaceutical Sciences and Comprehensive Sickle Cell Center Chicago, IL, United States
| | - Zaijie J Wang
- University of Illinois at Chicago College of Pharmacy, Department of Biopharmaceutical Sciences and Comprehensive Sickle Cell Center Chicago, IL, United States
| | - Samir K Ballas
- Thomas Jefferson University, Philadelphia, PA, United States
| | - Marie L Suarez
- University of Illinois at Chicago College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Diana J Wilkie
- University of Florida, Department of Biobehavioral Nursing Science, Gainesville, FL, United States; University of Illinois at Chicago College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States; University of Illinois at Chicago Comprehensive Sickle Cell Center, Chicago, IL, United States.
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Molokie RE, Wang ZJ, Yao Y, Powell-Roach KL, Schlaeger JM, Suarez ML, Shuey DA, Angulo V, Carrasco J, Ezenwa MO, Fillingim RB, Wilkie DJ. Sensitivities to Thermal and Mechanical Stimuli: Adults With Sickle Cell Disease Compared to Healthy, Pain-Free African American Controls. J Pain 2019; 21:957-967. [PMID: 31733363 DOI: 10.1016/j.jpain.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 02/02/2023]
Abstract
Evidence supports, but is inconclusive that sensitization contributes to chronic pain in some adults with sickle cell disease (SCD). We determined the prevalence of pain sensitization among adults with SCD pain compared with pain-free healthy adults. In a cross sectional, single session study of 186 African American outpatients with SCD pain (age 18-74 years, 59% female) and 124 healthy age, gender, and race matched control subjects (age 18-69 years, 49% female), we compared responses to standard thermal (Medoc TSA II) and mechanical stimuli (von Frey filaments). Although we observed no significant differences in thermal thresholds between controls and patients, patients with SCD had lower pain thresholds to mechanical stimuli and reported higher pain intensity scores to all thermal and mechanical stimuli at a non-painful body site. Compared with controls, about twice as many patients with SCD showed sensitization: 12% versus 23% at the anterior forearm site (P = .02), and 16% versus 32% across 3 tested sites (P = .004). Among patients with SCD, 18% exhibited some element of central sensitization. Findings indicate that persistent allodynia and hyperalgesia can be part of the SCD pain experience and should be considered when selecting therapies for SCD pain. PERSPECTIVE: Compared with matched healthy controls, quantitative sensory testing in adults with pain and sickle cell disease (SCD) demonstrates higher prevalence of sensitization, including central sensitization. The findings of allodynia and hyperalgesia may indicate neuropathic pain and could contribute to a paradigm shift in assessment and treatment of SCD pain.
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Affiliation(s)
- Robert E Molokie
- College of Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; College of Pharmacy, Department of Biopharmaceutical Sciences, College of Nursing, College of Nursing, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Zaijie J Wang
- College of Pharmacy, Department of Biopharmaceutical Sciences, College of Nursing, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois; College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida
| | - Keesha L Powell-Roach
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, Illinois; College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida; College of Dentistry, Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - David A Shuey
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Veronica Angulo
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Miriam O Ezenwa
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- College of Dentistry, Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois; College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida.
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Powell-Roach KL, Yao Y, Jhun EH, He Y, Suarez ML, Ezenwa MO, Molokie RE, Wang ZJ, Wilkie DJ. Vasopressin SNP pain factors and stress in sickle cell disease. PLoS One 2019; 14:e0224886. [PMID: 31710639 PMCID: PMC6844466 DOI: 10.1371/journal.pone.0224886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Frequencies of single nucleotide polymorphisms (SNPs) from pain related candidate genes are available for individuals with sickle cell disease (SCD). One of those genes, the arginine vasopressin receptor 1A gene (AVPR1A) and one of its SNPs, rs10877969, has been associated with pain and disability in other pain populations. In patients with SCD, clinical factors such as pain and stress have been associated with increased health care utilization, but it is not known if the presence of the AVPR1A SNP plays a role in this observation. The study purpose was to explore the relationships between rs10877969 and self-reported pain, stress, and acute care utilization events among individuals with SCD. METHODS In a cross-sectional investigation of outpatients with SCD, participants completed PAINReportIt®, a computerized pain measure, to describe their pain experience and contributed blood or saliva samples for genetic analysis. We extracted emergency department and acute care utilization from medical records. RESULTS The SNP genotype frequencies (%) for this sample were CC 30 (28%), CT 44 (41%), TT 33 (31%). Acute care utilization and stress as an aggravator of pain were significantly associated with the rs10877969 genotype (p = .02 and p = .002, respectively). The CT genotype had the highest mean utilization and CC genotype was associated with not citing stress as a pain aggravator. Chronic pain was not associated with rs10877969 (p = .41). CONCLUSION This study shows that rs10877969 is related to indicators of stress and acute pain. Further research is recommended with other measures of stress and acute pain.
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Affiliation(s)
- Keesha L. Powell-Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
- Center for Palliative Care Research and Education, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
| | - Ellie H. Jhun
- Committee on Clinical Pharmacology and Pharmacogenetics, University of Chicago, Chicago, Illinois, United States of America
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Cancer Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Marie L. Suarez
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
| | - Miriam O. Ezenwa
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Robert E. Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States of America
- Jessie Brown Veteran’s Administration Medical Center, Chicago, Illinois, United States of America
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Cancer Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Diana J. Wilkie
- Center for Palliative Care Research and Education, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
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Dyal BW, Ezenwa MO, Yoon SL, Fillingim RB, Yao Y, Schlaeger JM, Suarez ML, Wang ZJ, Molokie RE, Wilkie DJ. A QST-based Pain Phenotype in Adults With Sickle Cell Disease: Sensitivity and Specificity of Quality Descriptors. Pain Pract 2019; 20:168-178. [PMID: 31553824 DOI: 10.1111/papr.12841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND We sought to refine a screening measure for discriminating a sensitized or normal sensation pain phenotype among African American adults with sickle cell disease (SCD). OBJECTIVE To develop scoring schemes based on sensory pain quality descriptors; evaluate their performance on classifying patients with SCD who had sensitization or normal sensation, and compare with scores on the Self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and the Neuropathic Pain Symptom Inventory (NPSI). METHODS Participants completed PAINReportIt, quantitative sensory testing (QST), S-LANSS, and NPSI. Conventional binary logistic regression and least absolute shrinkage and selection operator (lasso) regression were used to obtain 2 sets of weights resulting in 2 scores: the PR-Logistic (PAINReportIt score weighted by conventional binary logistic regression coefficients) and PR-Lasso (PAINReportIt score weighted by lasso regression coefficients). Performance of the proposed scores and the existing scores were evaluated. RESULTS Lasso regression resulted in a parsimonious model with non-zero weights assigned to 2 neuropathic descriptors, cold and spreading. We found positive correlations between the PR-Lasso and other scores: S-LANSS (r = 0.22, P < 0.01), NPSI (r = 0.22, P < 0.01), and PR-Logistic (r = 0.35, P < 0.01). The NPSI and PR-Lasso performed similarly at different levels of required specificity and outperformed the S-LANSS and PR-Logistic at the various specificity points. CONCLUSION The PR-Lasso offers a way to discriminate a SCD pain phenotype.
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Affiliation(s)
- Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Saunjoo L Yoon
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, U.S.A
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Robert E Molokie
- Department of Medicine College of Medicine, University of Illinois at Chicago, Chicago, IL, U.S.A.,Jesse Brown VA Medical Center, Chicago, Illinois, U.S.A,
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
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Suarez ML, Schlaeger JM, Angulo V, Shuey DA, Carrasco J, Roach KL, Ezenwa MO, Yao Y, Wang ZJ, Molokie RE, Wilkie DJ. Keys to Recruiting and Retaining Seriously Ill African Americans With Sickle Cell Disease in Longitudinal Studies: Respectful Engagement and Persistence. Am J Hosp Palliat Care 2019; 37:123-128. [PMID: 31394904 PMCID: PMC6933076 DOI: 10.1177/1049909119868657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Sickle cell disease (SCD) is a serious illness with disabling acute and chronic pain that needs better therapies, but insufficient patient participation in research is a major impediment to advancing SCD pain management. The purpose of this article is to discuss the challenges of conducting an SCD study and approaches to successfully overcoming those challenges. DESIGN In a repeated-measures, longitudinal study designed to characterize SCD pain phenotypes, we recruited 311 adults of African ancestry. Adults with SCD completed 4 study visits 6 months apart, and age- and gender-matched healthy controls completed 1 visit. RESULTS We recruited and completed measures on 186 patients with SCD and 125 healthy controls. We retained 151 patients with SCD with data at 4 time points over 18 months and 125 healthy controls (1 time point) but encountered many challenges in recruitment and study visit completion. Enrollment delays often arose from patients' difficulty in taking time from their complicated lives and frequent pain episodes. Once scheduled, participants with SCD cancelled 49% of visits often because of pain; controls canceled 30% of their scheduled visits. To facilitate recruitment and retention, we implemented a number of strategies that were invaluable in our success. CONCLUSION Patients' struggles with illness, chronic pain, and their life situations resulted in many challenges to recruitment and completion of study visits. Important to overcoming challenges was gaining the trust of patients with SCD and a participant-centered approach. Early identification of potential problems allowed strategies to be instituted proactively, leading to success.
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Affiliation(s)
- Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Judith M Schlaeger
- Department of Women, Children & Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Veronica Angulo
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - David A Shuey
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Keesha L Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL
| | - Yingwei Yao
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL
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Powell-Roach KL, Yao Y, Rutherford JN, Schlaeger JM, Patil CL, Suarez ML, Shuey D, Angulo V, Carrasco J, Ezenwa MO, Fillingim RB, Wang ZJ, Molokie RE, Wilkie DJ. Thermal and mechanical quantitative sensory testing values among healthy African American adults. J Pain Res 2019; 12:2511-2527. [PMID: 31496792 PMCID: PMC6693422 DOI: 10.2147/jpr.s211855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and age of participants. The study purpose was to characterize QST values in healthy, pain-free African American adults and older adults whose prior pain experiences and psychological status were also measured. We examined the QST values for differences by sex, age, and body test site. PATIENTS AND METHODS A cross-sectional sample of 124 pain-free African American adults (age 18-69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST was performed to obtain thermal and mechanical responses and associated pain intensity levels. RESULTS We found thermal detection values at the anterior forearm were (29.2 °C±1.6) for cool detection (CD) and (34.5 °C±1.2) for warm detection (WD). At that site the sample had cold pain threshold (CPTh) (26.3 °C±5.0), heat pain threshold (HPTh) (37.8 °C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. CONCLUSION The QST values from this protocol at the anterior forearm indicate that the healthy African American adults had average thermal pain thresholds close to the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research.
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Affiliation(s)
- Keesha L Powell-Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Julienne N Rutherford
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - David Shuey
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Veronica Angulo
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
- Department of Hematology/Oncology, Jessie Brown Veteran’s Administration Medical Center, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Schlaeger JM, Pauls HA, Powell-Roach KL, Thornton PD, Hartmann D, Suarez ML, Kobak WH, Hughes TL, Steffen AD, Patil CL. Vulvodynia, "A Really Great Torturer": A Mixed Methods Pilot Study Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies. J Sex Med 2019; 16:1255-1263. [PMID: 31204266 DOI: 10.1016/j.jsxm.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with vulvodynia, a chronic pain condition, experience vulvar pain and dyspareunia. Few studies examine the range and combination of treatment strategies that women are actually using to reduce vulvodynia. AIM To describe pain experiences and pain relief strategies of women with vulvodynia. METHODS Convenience sample, 60 women with vulvodynia (median age 32.5 [interquartile range {IQR} 8.5] years; 50 white, 10 racial/ethnic minorities) completed PAINReportIt and reported use of drugs and alcohol and responded to open-ended questions. Univariate descriptive statistics and bivariate inferential tests were used to describe average pain intensity scores, alcohol use, smoking, number of pain relief strategies, and their associations. Women's open-ended responses about their pain experiences and drug and non-drug pain relief strategies (NDPRS) were analyzed for patterns. OUTCOMES Our mixed methods analysis connected data from pain measures, prescribed treatments and self-reported behaviors with women's free responses. This enabled nuanced insights into women's vulvodynia pain experiences. RESULTS Women's descriptions of their pain and suffering aligned with their reported severe pain and attempts to control their pain, with a median pain intensity of 6.7 (IQR 2.0) despite use of adjuvant drugs (median 2.0 [IQR 2.0]), and opioids (median 1.0 [IQR 2.0]). 36 women (60%) used alcohol to lessen their pain. 26 women (43%) listed combining analgesics and alcohol to relieve their pain. 30 women (50%) smoked cigarettes. 54 women (90%) used ≥1 NDPRS. The mean number of NDPRS used was 2.1 ± 1.3 (range 0-6). The 5 most common NDPRS from women's comments were herbal medicine (40%), acupuncture (27%), massage (22%), hypnosis (15%), and mental healthcare (13%). CLINICAL IMPLICATIONS Severe pain in women with vulvodynia may be a clinical indicator of those at higher risk of combining prescription pain medications with alcohol, which are all central nervous system depressants and may potentiate overdose. STRENGTHS AND LIMITATIONS This pilot study demonstrated that the mixed methods approach to help understand the complexity of vulvodynia was feasible. We identified data showing a reliance on a high-risk mix of prescriptions and alcohol to reduce vulvodynia pain and a high prevalence of cigarette smoking. However, as a pilot study, these results are considered preliminary; the sample may not be representative. Perhaps only women at the extreme end of the pain continuum participated, or women took the survey twice because identifiers were not collected. CONCLUSION Despite attempts to reduce pain using multiple therapies, including alcohol, women's vulvodynia pain is severe and not controlled. Schlaeger JM, Pauls HA, Powell-Roach KL, et al. Vulvodynia, "A Really Great Torturer": A Mixed Methods Pilot Study Examining Pain Experiences and Drug/Non-drug Pain Relief Strategies. J Sex Med 2019;16:1255-1263.
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Affiliation(s)
- Judith M Schlaeger
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA.
| | - Heather A Pauls
- University of Illinois at Chicago, College of Nursing, Office of Research Facilitation, Chicago, IL, USA
| | - Keesha L Powell-Roach
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Patrick D Thornton
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
| | - Dee Hartmann
- Dee Hartmann Physical Therapy, Effingham, IL, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
| | - William H Kobak
- University of Illinois at Chicago, College of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, New York, NY, USA
| | - Alana D Steffen
- University of Illinois at Chicago, College of Nursing, Department of Health Systems Science, Chicago, IL, USA
| | - Crystal L Patil
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
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18
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Powell-Roach K, Yao Y, Ezenwa MO, Schlaeger JM, Suarez ML, Molokie RE, Wang ZJ, Wilkie DJ. Neuropathic Pain Screening: Construct Validity in Patients With Sickle Cell Disease. West J Nurs Res 2019; 42:125-130. [PMID: 30900520 DOI: 10.1177/0193945919836446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with pain from sickle cell disease (SCD) are often treated for nociceptive pain, but recent findings indicate they may also have neuropathic pain. PAINReportIt, a computerized version of the McGill Pain Questionnaire, provides a potential subscale that is the summed number of selected neuropathic pain quality words (PR-NNP), but it lacks construct validity. The study purpose was to ascertain PR-NNP construct validity in adults with SCD and chronic pain. In an outpatient setting, 186 participants completed the PAINReportIt, Neuropathic Pain Symptom Inventory (NPSI), and Leeds Assessment for Neuropathic Symptoms and Signs (S-LANSS). PR-NNP was moderately correlated with NPSI (r = .33, p < .001) and S-LANSS (r = .40, p < .001). Regression analysis indicated that PR-NNP and pain intensity, but not a nociceptive pain subscale, were significant predictors of NPSI and S-LANSS. Findings support construct validity of PR-NNP, which may be useful as a screening tool for neuropathic pain in patients with SCD.
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Affiliation(s)
| | - Yingwei Yao
- University of Florida, Gainesville, FL, USA.,The University of Illinois at Chicago, IL, USA
| | | | | | | | - Robert E Molokie
- The University of Illinois at Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | | | - Diana J Wilkie
- University of Florida, Gainesville, FL, USA.,The University of Illinois at Chicago, IL, USA
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19
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Ezenwa MO, Molokie RE, Wang ZJ, Yao Y, Suarez ML, Dyal B, Abudawood K, Wilkie DJ. Differences in Sensory Pain, Expectation, and Satisfaction Reported by Outpatients with Cancer or Sickle Cell Disease. Pain Manag Nurs 2018; 19:322-332. [PMID: 29501359 DOI: 10.1016/j.pmn.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) report pain scores that appear greater than those reported in a meta-analysis for patients with cancer, but statistical comparisons of the pain scores from both populations have not been published. AIMS The goal of the study described here was to compare pain outcomes reported by outpatients with cancer or SCD. DESIGN Descriptive comparative study. SETTING Outpatient oncology or sickle cell clinics. SUBJECTS The participants were outpatients (N = 415) from three studies: (1) 106 patients with SCD, 93% African-American (referent group); (2) 140 patients with cancer, 90% Caucasian (race discordant); (3) 169 patients with cancer, 20% Caucasian, 65% African-American (race concordant). METHODS Patients completed the PAINReportIt including pain location, quality, pattern, intensity, expectation, satisfaction, and demographic questions. Analyses included the χ2 test, analysis of variance, and regression. RESULTS Outpatients with SCD reported more pain location sites than the race-discordant (p < .001) and race-concordant (p < .001) cancer groups; higher pain quality than the race-discordant (p < .001) and race-concordant (p < .001) groups; and greater pain pattern scores than the race-discordant (p < .001) and race-concordant (p < .001) groups. The race-concordant group reported higher worst pain intensity than the SCD (p < .001) and race-discordant (p = .002) groups. The three groups did not differ significantly on pain expectation (p = .06). Regarding satisfaction with pain level, there was a significant difference between the race-concordant and SCD (p = .006) groups, but not between the race-discordant and SCD (p = .12) groups or between the race-discordant and race-concordant (p = .49) groups. CONCLUSIONS Outpatients with SCD reported three of four sensory pain parameters that were greater than those reported by outpatients with cancer. A better understanding of these differences is pertinent to improving pain outcomes.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Robert E Molokie
- College of Medicine, College of Pharmacy, and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, Cancer Center and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Marie L Suarez
- Department of Biobehavioral Health Science (MC 802), University of Illinois at Chicago, College of Nursing, Chicago, Illinois
| | - Brenda Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Khulud Abudawood
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida.
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20
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Molokie RE, Montminy C, Dionisio C, Farooqui MA, Gowhari M, Yao Y, Suarez ML, Ezenwa MO, Schlaeger JM, Wang ZJ, Wilkie DJ. Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit. Am J Emerg Med 2017; 36:88-92. [PMID: 28802541 DOI: 10.1016/j.ajem.2017.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. METHODS In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. FINDINGS Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. CONCLUSIONS Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
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Affiliation(s)
- Robert E Molokie
- University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States; Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States; University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States.
| | - Chariz Montminy
- University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States.
| | - Corissa Dionisio
- Riley Hospital for Children at Indiana University Health Department of Psychiatry, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States.
| | | | - Michel Gowhari
- University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States.
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States.
| | - Miriam O Ezenwa
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
| | - Judith M Schlaeger
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States.
| | - Zaijie J Wang
- University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States.
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
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21
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Choi H, Park H, Suarez ML, Park C, Zhao Z, Wilkie DJ. Feasibility of a web-based suicide awareness programme for Asian American college students. BMJ Open 2016; 6:e013466. [PMID: 28003296 PMCID: PMC5223721 DOI: 10.1136/bmjopen-2016-013466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/28/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The Truth about Suicide video has been widely used but has never been empirically tested regarding its cultural appropriateness for Asian Americans. The purpose of the study was to determine the feasibility of using the video in a web-based suicide awareness programme for Asian American and non-Hispanic white college students. METHODS A cross-sectional, comparative, web-based study was conducted with 227 Asian Americans and 204 non-Hispanic whites at a university in the Midwest region of the USA. Study participants completed a questionnaire measuring their cultural orientation and attitudes towards suicide, watched the 27 min video, completed a debriefing session and evaluated the video's overall suitability. RESULTS Asian Americans rated the suicide awareness video significantly lower for cultural relevance than did non-Hispanic whites (F=5.479, p=0.02). Collectivist cultural orientation was a significant predictor for cultural relevance, credibility and appeal; however, evaluation of the video's cultural relevance was negatively affected by Asian ethnicity. CONCLUSIONS Cultural orientation and race/ethnicity should be strongly considered when web-based suicide awareness programmes are developed for college students.
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Affiliation(s)
- Heeseung Choi
- College of Nursing and the Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Hanjong Park
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Marie L Suarez
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Zhongsheng Zhao
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Diana J Wilkie
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Biobehavioral Nursing Science, Center of Excellence in Palliative Care Research, College of Nursing, University of Florida, Gainesville, Florida, USA
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Ezenwa MO, Suarez ML, Carrasco JD, Hipp T, Gill A, Miller J, Shea R, Shuey D, Zhao Z, Angulo V, McCurry T, Martin J, Yao Y, Molokie RE, Wang Z(J, Wilkie DJ. Implementing the PAINRelieveIt Randomized Controlled Trial in Hospice Care: Mechanisms for Success and Meeting PCORI Methodology Standards. West J Nurs Res 2016; 39:924-941. [DOI: 10.1177/0193945916668328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This purpose of this article is to describe how we adhere to the Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards relevant to the design and implementation of our PCORI-funded study, the PAIN RelieveIt Trial. We present details of the PAIN RelieveIt Trial organized by the PCORI methodology standards and components that are relevant to our study. The PAIN RelieveIt Trial adheres to four PCORI standards and 21 subsumed components. The four standards include standards for formulating research questions, standards associated with patient centeredness, standards for data integrity and rigorous analyses, and standards for preventing and handling missing data. In the past 24 months, we screened 2,837 cancer patients and their caregivers; 874 dyads were eligible; 223.5 dyads consented and provided baseline data. Only 55 patients were lost to follow-up—a 25% attrition rate. The design and implementation of the PAIN RelieveIt Trial adhered to PCORI’s methodology standards for research rigor.
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Affiliation(s)
| | | | | | | | - Anayza Gill
- Rainbow Hospice and Palliative Care, Mount Prospect, IL, USA
| | | | - Robert Shea
- Rainbow Hospice and Palliative Care, Mount Prospect, IL, USA
| | | | | | | | - Timothy McCurry
- Rainbow Hospice and Palliative Care, Mount Prospect, IL, USA
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McCurry T, Yao Y, Ezenwa MO, Gill A, Hipp T, Shea R, Miller J, Carrasco J, Shuey D, Frank K, Nardi N, Murray M, Glendenning J, Bagcus C, Perez J, Angulo V, Suarez ML, Wang ZJ, Molokie RE, Wilkie DJ. Patient reported outcomes using Internet-based tablets to inform hospice care for minority and nonminority patients with cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - David Shuey
- University of Illinois at Chicago, Chicago, IL
| | | | | | | | | | | | | | | | | | - Z Jim Wang
- University of Illinois at Chicago, Chicago, IL
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24
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Hershberger PE, Gallo AM, Molokie R, Thompson AA, Suarez ML, Yao Y, Dallas CM, Wilkie DJ. Toward understanding family-related characteristics of young adults with sickle-cell disease or sickle-cell trait in the USA. J Clin Nurs 2016; 25:1587-97. [PMID: 26970444 DOI: 10.1111/jocn.13144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the family-related characteristics of young adults with sickle-cell disease or sickle-cell trait prior to taking part in a randomised controlled trial on sickle-cell reproductive health education. BACKGROUND There is a critical need for educational programmes that target the reproductive needs of young adults with sickle-cell disease or trait. However, little is known about the family-related characteristics (i.e., demographic attributes and reproductive health behaviours) in which these young adults live. DESIGN A descriptive cross-sectional analysis. METHOD At study enrolment, 234 young adults (mean age = 25·9 years, 65% female) completed the SCKnowIQ questionnaire. Descriptive statistics depict the demographic attributes and reproductive health behaviours of young adults with sickle-cell disease (n = 138) or trait (n = 96). For group comparisons, independent t tests or Fisher's tests were used, as appropriate. RESULTS Young adults with sickle-cell trait had significantly higher education, income and health insurance than those with sickle-cell disease. Both groups believed that sickle-cell disease was a severe condition. A majority of young adults with sickle-cell disease (65%) had no children compared to 42% of those with sickle-cell trait. Most young adults (85% sickle-cell disease, 82% sickle-cell trait) were not planning a pregnancy in the next six months, and many used condoms, withdrawal or oral contraceptives. CONCLUSIONS Socioeconomic disparities exist between young adults with sickle-cell disease and sickle-cell trait. Future research that advances education about how and when to communicate appropriate genetic risk information to partners and children especially for young adults with sickle-cell trait would be beneficial. RELEVANCE TO CLINICAL PRACTICE Awareness of the similarities and differences in the family-related characteristics among young adults with sickle-cell disease or trait can allow for more tailored reproductive education.
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Affiliation(s)
- Patricia E Hershberger
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Agatha M Gallo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert Molokie
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Alexis A Thompson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marie L Suarez
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, FL, USA.,Prairieview Trust, College of Nursing, University of Florida, Gainesville, FL, USA.,Center of Excellence in Palliative Care Research, College of Nursing, University of Florida, Gainesville, FL, USA
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25
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Ezenwa MO, Yao Y, Engeland CG, Molokie RE, Wang ZJ, Suarez ML, Wilkie DJ. A randomized controlled pilot study feasibility of a tablet-based guided audio-visual relaxation intervention for reducing stress and pain in adults with sickle cell disease. J Adv Nurs 2016; 72:1452-63. [PMID: 26768753 DOI: 10.1111/jan.12895] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 01/09/2023]
Abstract
AIM To test feasibility of a guided audio-visual relaxation intervention protocol for reducing stress and pain in adults with sickle cell disease. BACKGROUND Sickle cell pain is inadequately controlled using opioids, necessitating further intervention such as guided relaxation to reduce stress and pain. DESIGN Attention-control, randomized clinical feasibility pilot study with repeated measures. METHODS Randomized to guided relaxation or control groups, all patients recruited between 2013-2014 during clinical visits, completed stress and pain measures via a Galaxy Internet-enabled Android tablet at the Baseline visit (pre/post intervention), 2-week posttest visit and also daily at home between the two visits. Experimental group patients were asked to use a guided relaxation intervention at the Baseline visit and at least once daily for 2 weeks. Control group patients engaged in a recorded sickle cell discussion at the Baseline visit. Data were analysed using linear regression with bootstrapping. RESULTS At baseline, 27/28 of consented patients completed the study protocol. Group comparison showed that guided relaxation significantly reduced current stress and pain. At the 2-week posttest, 24/27 of patients completed the study, all of whom reported liking the study. Patients completed tablet-based measures on 71% of study days (69% in control group, 72% in experiment group). At the 2-week posttest, the experimental group had significantly lower composite pain index scores, but the two groups did not differ significantly on stress intensity. CONCLUSION This study protocol appears feasible. The tablet-based guided relaxation intervention shows promise for reducing sickle cell pain and warrants a larger efficacy trial. TRIAL REGISTRATION The ClinicalTrials.gov Identifier is: NCT02501447.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert E Molokie
- College of Medicine, College of Pharmacy and Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA.,Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, Cancer Center, and Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Pharmacy, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- Center for End-of-Life Transition Research, Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Cancer Center and Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Nursing, Illinois, USA
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Gallo AM, Wilkie DJ, Yao Y, Molokie RE, Stahl C, Hershberger PE, Zhao Z, Suarez ML, Johnson B, Angulo R, Carrasco J, Angulo V, Thompson AA. Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years. J Genet Couns 2015; 25:325-36. [PMID: 26310871 DOI: 10.1007/s10897-015-9874-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 08/07/2015] [Indexed: 01/31/2023]
Abstract
Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n = 138) or SCT (n = 96) (age 18-35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p = .004) but not intention (p = .18) or behavior (p = .69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p = .04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.
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Affiliation(s)
- Agatha M Gallo
- Department of Women, Family and Children Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, MC 802, Chicago, IL, 60612-7352, USA.
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA.,Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA.,Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Robert E Molokie
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Christiane Stahl
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Patricia E Hershberger
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Zhongsheng Zhao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Bonnye Johnson
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Rigoberto Angulo
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Veronica Angulo
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis A Thompson
- Division of Hematology/Oncology/Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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Hershberger PE, Gallo AM, Molokie R, Thompson AA, Suarez ML, Yao Y, Wilkie DJ. Perception of young adults with sickle cell disease or sickle cell trait about participation in the CHOICES randomized controlled trial. J Adv Nurs 2015; 72:1430-40. [PMID: 26073718 DOI: 10.1111/jan.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS To gain an in-depth understanding of the perceptions of young adults with sickle cell disease and sickle cell trait about parenthood and participating in the CHOICES randomized controlled trial that used computer-based, educational programmes. BACKGROUND In the USA, there is insufficient education to assure that all young adults with sickle cell disease or sickle cell trait understand genetic inheritance risks and reproductive options to make informed reproductive decisions. To address this educational need, we developed a computer-based, multimedia program (CHOICES) and reformatted usual care into a computer-based (e-Book) program. We then conducted a two-year randomized controlled trial that included a qualitative component that would deepen understanding of young adults' perceptions of parenthood and use of computer-based, educational programmes. DESIGN A qualitative descriptive approach completed after a randomized controlled trial. METHODS Sixty-eight men and women of childbearing age participated in semi-structured interviews at the completion of the randomized controlled trial from 2012-2013. Thematic content analysis guided the qualitative description. RESULTS/FINDINGS Three main themes were identified: (1) increasing knowledge and new ways of thinking and behaving; (2) rethinking parenting plans; and (3) appraising the program design and delivery. Most participants reported increased knowledge and rethinking of their parenting plans and were supportive of computer-based learning. Some participants expressed difficulty in determining individual transmission risks. CONCLUSION Participants perceived the computer programs as beneficial to their learning. Future development of an Internet-based educational programme is warranted, with emphasis on providing tailored education or memory boosters about individual transmission risks.
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Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois at Chicago, College of Medicine, Illinois, USA
| | - Agatha M Gallo
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Robert Molokie
- University of Illinois at Chicago, College of Medicine, Illinois, USA.,University of Illinois at Chicago, College of Pharmacy, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
| | - Alexis A Thompson
- Northwestern University-Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Hematology/Oncology/Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
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Ezenwa MO, Molokie RE, Wang ZJ, Suarez ML, Yao Y, Wilkie DJ. Satisfied or not satisfied: pain experiences of patients with sickle cell disease. J Adv Nurs 2015; 72:1398-408. [PMID: 25916256 DOI: 10.1111/jan.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
AIMS To examine the relationship between pain and satisfaction in patients with sickle cell disease. BACKGROUND Frequency and severity of unrelieved sickle cell pain are positively associated with mortality. Yet, information is scarce on whether sickle cell patients are satisfied with their pain level. DESIGN A cross-sectional, correlational analysis of baseline data from a randomized clinical trial. METHODS A randomized sample of adult outpatients was recruited between February 2007-March 2011. Patients completed the PAINReportIt(®) , containing measures of pain, satisfaction and socio-demographics. We analysed data using Kendall's rank correlations, analysis of variance, Tukey-Kramer post hoc tests, Fisher's tests and proportional odds logistic regression. RESULTS There were statistically significant correlations between pain outcomes and satisfaction with pain level, but average pain intensity more strongly discriminated groups based on satisfaction with pain level. Among pain variables bivariately associated with patient satisfaction with pain level, only pain expectation maintained its significant relationship with satisfaction with pain level when average pain intensity was controlled. A smaller percentage of our sickle cell patients reported moderate to severe pain intensity (28%) or high composite pain index (39%), while reporting being satisfied with pain their level than reported in earlier studies using different measures and populations (70-94%). CONCLUSION Satisfaction with pain level was an unambiguous measure of patient satisfaction and a promising indicator of pain that did not show the paradoxical relationship between satisfaction and pain seen with past measures.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Robert E Molokie
- College of Medicine, University of Illinois at Chicago, Illinois, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Center for End-of-Life Transition Research, Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
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Wilkie DJ, Molokie RE, Suarez ML, Ezenwa MO, Wang ZJ. Composite Pain Index: Reliability, Validity, and Sensitivity of a Patient-Reported Outcome for Research. Pain Med 2015; 16:1341-8. [PMID: 25712169 DOI: 10.1111/pme.12703] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A single score that represents the multidimensionality of pain would be an innovation for patient-reported outcomes. Our aim was to determine the reliability, validity, and sensitivity of the Composite Pain Index (CPI). DESIGN Methodological analysis of data from a randomized controlled, pretest/post-test education-based intervention study. SETTING The study was conducted in outpatient oncology clinics. SUBJECTS The 176 subjects had pain, were 52 ± 12.5 years on average, 63% were female, and 46% had stage IV cancers. METHODS We generated the CPI from pain location, intensity, quality, and pattern scores measured with an electronic version of Melzack's McGill Pain Questionnaire. RESULTS The internal consistency values for the individual scores comprising the CPI were adequate (0.71 baseline, 0.69 post-test). Principal components analysis extracted one factor with an eigenvalue of 2.17 with explained variance of 54% at baseline and replicated the one factor with an eigenvalue of 2.11 at post-test. The factor loadings for location, intensity, quality, and pattern were 0.65, 0.71, 0.85, and 0.71, respectively (baseline), and 0.59, 0.81, 0.84, and 0.63, respectively (post-test). The CPI was sensitive to an education intervention effect. CONCLUSIONS Findings support the CPI as a score that integrates the multidimensional pain experience in people with cancer. It could be used as a patient-reported outcome measure to quantify the complexity of pain in clinical research and population studies of cancer pain and studied for relevance in other pain populations.
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Affiliation(s)
- Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois, Chicago College of Nursing Chicago, Illinois, USA.,University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Robert E Molokie
- University of Illinois Cancer Center, Chicago, Illinois, USA.,Division of Hematology/Oncology, University of Illinois, Chicago College of Medicine, Chicago, Illinois, USA.,Jesse Brown Veteran's Administration Medical Center, Chicago, Illinois.,Department of Biopharmaceutical Sciences, University of Illinois, Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois, Chicago College of Nursing Chicago, Illinois, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois, Chicago College of Nursing Chicago, Illinois, USA
| | - Zaijie J Wang
- University of Illinois Cancer Center, Chicago, Illinois, USA.,Department of Biopharmaceutical Sciences, University of Illinois, Chicago College of Pharmacy, Chicago, Illinois, USA
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Ezenwa MO, Molokie RE, Wang ZJ, Yao Y, Suarez ML, Pullum C, Schlaeger JM, Fillingim RB, Wilkie DJ. Safety and Utility of Quantitative Sensory Testing among Adults with Sickle Cell Disease: Indicators of Neuropathic Pain? Pain Pract 2015; 16:282-93. [PMID: 25581383 DOI: 10.1111/papr.12279] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/27/2014] [Accepted: 11/18/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Pain is the hallmark symptom of sickle cell disease (SCD), yet the types of pain that these patients experience, and the underlying mechanisms, have not been well characterized. The study purpose was to determine the safety and utility of a mechanical and thermal quantitative sensory testing (QST) protocol and the feasibility of utilizing neuropathic pain questionnaires among adults with SCD. METHODS A convenience sample (N = 25, 18 women, mean age 38.5 ± 12.5 [20-58 years]) completed self-report pain and quality-of-life tools. Subjects also underwent testing with the TSA-II NeuroSensory Analyzer and calibrated von Frey microfilaments. RESULTS We found that the QST protocol was safe and did not stimulate a SCD pain crisis. There was evidence of central sensitization (n = 15), peripheral sensitization (n = 1), a mix of central and peripheral sensitization (n = 8), or no sensitization (n = 1). The neuropathic pain self-report tools were feasible with evidence of construct validity; 40% of the subjects reported S-LANSS scores that were indicative of neuropathic pain and had evidence of central, peripheral or mixed sensitization. DISCUSSION The QST protocol can be safely conducted in adults with SCD and provides evidence of central or peripheral sensitization, which is consistent with a neuropathic component to SCD pain. These findings are novel, warrant a larger confirmatory study, and indicate the need for normative QST data from African American adults and older adults.
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Affiliation(s)
- Miriam O Ezenwa
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A.,University of Illinois at Chicago, Comprehensive Sickle Cell Center, Chicago, Illinois, U.S.A
| | - Robert E Molokie
- University of Illinois at Chicago, Comprehensive Sickle Cell Center, Chicago, Illinois, U.S.A.,College of Medicine, College of Pharmacy, Jesse Brown VA Medical Center, Chicago, Illinois, U.S.A
| | - Zaijie Jim Wang
- University of Illinois at Chicago, Comprehensive Sickle Cell Center, Chicago, Illinois, U.S.A.,Department of Biopharmaceutical Sciences and Cancer Center, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A.,University of Illinois at Chicago, Center of Excellence for End-of-Life Transition Research, Chicago, Illinois, U.S.A
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A
| | - Cherese Pullum
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A
| | - Judith M Schlaeger
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A
| | - Roger B Fillingim
- College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, U.S.A
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing Department of Biobehavioral Health Science, Chicago, Illinois, U.S.A.,University of Illinois at Chicago, Comprehensive Sickle Cell Center, Chicago, Illinois, U.S.A.,University of Illinois at Chicago, Center of Excellence for End-of-Life Transition Research, Chicago, Illinois, U.S.A
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Ezenwa MO, Molokie RE, Wilkie DJ, Suarez ML, Yao Y. Perceived injustice predicts stress and pain in adults with sickle cell disease. Pain Manag Nurs 2014; 16:294-306. [PMID: 25439119 DOI: 10.1016/j.pmn.2014.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
Research evidence shows that perceived injustice is a context-based unfair treatment that has negative influence on health outcomes. We examined the contribution of patients' perceived injustice regarding interactions with health care providers to stress and pain in adults with sickle cell disease (SCD). This study was a cross-sectional correlational pilot study. Included in the study were adults with SCD who received their care from a university-affiliated comprehensive sickle cell clinic. Participants were 52 adults whose mean age was 34 ± 11 years (minimum [min] 20 years, maximum [max] 70 years). Most of the patients were African American (n = 48, 92%) and female (n = 41, 79%). Forty-eight patients (92%) reported having a high school diploma or higher. Participants completed the perceived injustice questionnaire, perceived stress questionnaire, and the PAINReportIt, which includes questions to measure pain and demographics. We analyzed the data using the linear regression analyses. Perceived injustice from doctors was a significant predictor of perceived stress (p < .001) and pain (p = .002). Perceived injustice from nurses also was a significant predictor of perceived stress (p < .001) and pain (p = .02). The procedural, distributive, and informational domains of perceived injustice attributed to both doctors and nurses consistently predicted patients' perceived stress, but only the procedural and distributive domains of perceived injustice consistently predicted patients' pain. Findings suggest that perceived injustice was negatively associated with stress and pain in adults with SCD and warrant further investigation in a larger sample.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois.
| | - Robert E Molokie
- University of Illinois at Chicago, College of Medicine Department of Medicine, Division of Hematology/Oncology College of Pharmacy Department of Biopharmaceutical Sciences, and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
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Ezenwa MO, Molokie RE, Wang ZJ, Yao Y, Suarez ML, Angulo V, Wilkie DJ. Outpatient pain predicts subsequent one-year acute health care utilization among adults with sickle cell disease. J Pain Symptom Manage 2014; 48:65-74. [PMID: 24636960 PMCID: PMC4082743 DOI: 10.1016/j.jpainsymman.2013.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD. OBJECTIVES To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent 1-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU. METHODS Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: 1) zero events (zero), 2) 1 to 3 events (low), or 3) 4 to 23 events (high). RESULTS The initial CPI scores differed significantly by the three groups (F(2,134) = 7.38, P = 0.001). Post hoc comparisons showed that the zero group had lower CPI scores than both the low (P < 0.01) and high (P < 0.001) groups. In multivariate overdispersed Poisson regression analyses, age and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not. CONCLUSION Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA; Comprehensive Sickle Cell Center, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA
| | - Robert E Molokie
- Comprehensive Sickle Cell Center, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA; Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA; Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Veronica Angulo
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA.
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Molokie RE, Wilkie DJ, Wittert H, Suarez ML, Yao Y, Zhao Z, He Y, Wang ZJ. Mechanism-driven phase I translational study of trifluoperazine in adults with sickle cell disease. Eur J Pharmacol 2013; 723:419-24. [PMID: 24211787 DOI: 10.1016/j.ejphar.2013.10.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 01/07/2023]
Abstract
Recent evidence of neuropathic pain among adults with sickle cell disease (SCD) reveals a need for adjuvant analgesic treatments for these patients. Ca(2+)/calmodulin protein kinase IIα (CaMKIIα) has a known role in neuropathic pain and trifluoperazine is a potent CaMKIIα inhibitor. The study aim was to determine trifluoperazine's acute effects, primarily on adverse effects and secondarily on pain intensity reduction, in adults with SCD. In a phase I, open-label study of 6 doses of trifluoperazine (0.5, 1, 2, 5, 7.5, 10mg), we obtained 7-hourly and 24-h repeated measures of adverse effects, pain intensity, and supplemental opioid analgesics in 18 adults with SCD (18 hemoglobin SS disease, 15 women, average age 35.8±8.9 years, ranged 23-53) each of whom received a single dose. Data were analyzed with descriptive statistics. Subjects reported moderate to severe sedative effects at 7.5 and 10mg doses, respectively. Eight subjects reported 50% reduction in chronic pain without severe sedation or supplemental opioid analgesics; one of these subjects had dystonia 24.5h after the 10mg dose. The analgesic effect lasted for at least 24h in 3 subjects. Sedation resolved with caffeine and dystonia resolved with diphenhydramine. Adults with SCD experienced minimal adverse effects at doses under 10mg. In this molecular mechanism-driven translational study, trifluoperazine shows promise as an analgesic drug that is worthy of further testing in a randomized controlled study of adults with SCD starting at a dose of 1mg in repeated doses to determine long-term adverse and analgesic effects.
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Affiliation(s)
- Robert E Molokie
- University of Illinois at Chicago, College of Medicine, Division of Hematology/Oncology, Chicago, IL, USA; Jesse Brown Veteran's Administration Medical Center, Chicago, IL, USA; University of Illinois at Chicago College of Pharmacy Department of Biopharmaceutical Sciences, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
| | - Diana J Wilkie
- University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Science, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Harriett Wittert
- University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Marie L Suarez
- University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Yingwei Yao
- University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Zhongsheng Zhao
- University of Illinois at Chicago College of Nursing Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Ying He
- University of Illinois at Chicago College of Pharmacy Department of Biopharmaceutical Sciences, Chicago, IL, USA
| | - Zaijie J Wang
- University of Illinois at Chicago College of Pharmacy Department of Biopharmaceutical Sciences, Chicago, IL, USA; Comprehensive Sickle Cell Center, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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Gallo AM, Wilkie DJ, Wang E, Labotka RJ, Molokie RE, Stahl C, Hershberger PE, Zhao Z, Suarez ML, Johnson B, Pullum C, Angulo R, Thompson A. Evaluation of the SCKnowIQ tool and reproductive CHOICES intervention among young adults with sickle cell disease or sickle cell trait. Clin Nurs Res 2013; 23:421-41. [PMID: 23572406 DOI: 10.1177/1054773813479377] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study purpose was to evaluate a computer-based questionnaire (SCKnowIQ) and CHOICES educational intervention using cognitive interviewing with childbearing-aged people with sickle cell disease (SCD) or trait (SCT). Ten control group participants completed the SCKnowIQ twice. Ten intervention group participants completed the SCKnowIQ before and after the CHOICES intervention. Most participants found the questionnaire items appropriate and responded to items as the investigators intended. Participants' responses indicated that the information on SCD and SCT and reproductive options was understandable, balanced, important, and new to some. Internal consistency and test-retest reliability were adequate (.47 to .87) for 4 of the 6 scales, with significant within-group changes in knowledge scores for the intervention group but not for the control group. Findings show evidence for potential efficacy of the intervention, but proof of efficacy requires a larger randomized study.
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Affiliation(s)
- Agatha M Gallo
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA Basic and Translational Research Program, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA Basic and Translational Research Program, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Wang
- University of Illinois at Chicago, College of Applied Health Sciences,Department of Biomedical and Health Information Sciences, Chicago, IL, USA
| | - Richard J Labotka
- University of Illinois at Chicago Department of Pediatrics, Chicago, IL, USA
| | - Robert E Molokie
- University of Illinois at Chicago, College of Medicine, Department of Medicine, Division of Hematology/Oncology, Chicago, IL, USA Jesse Brown Veteran's Administration Medical Center, Chicago, IL, USA Basic and Translational Research Program, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Christiane Stahl
- University of Illinois at Chicago, College of Medicine, Department of Pediatrics, General Pediatrics and Adolescent Medicine, Chicago, IL, USA
| | - Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, Chicago, IL, USA
| | - Zhongsheng Zhao
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Bonnye Johnson
- Basic and Translational Research Program, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Cherese Pullum
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Rigoberto Angulo
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, USA
| | - Alexis Thompson
- Northwestern University Feinberg School of Medicine, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Wilkie DJ, Molokie R, Boyd-Seal D, Suarez ML, Kim YO, Zong S, Wittert H, Zhao Z, Saunthararajah Y, Wang ZJ. Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease. J Natl Med Assoc 2010; 102:18-27. [PMID: 20158132 DOI: 10.1016/s0027-9684(15)30471-5] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite frequent episodes of severe recurrent pain in sickle cell disease (SCD), sensory pain in outpatient adults with SCD lacks sufficient characterization. Furthermore, pivotal barriers may interfere with these patients' adherence to prescribed analgesic therapies but have not been studied systematically. We describe sensory pain characteristics, barriers, and analgesic use reported by adults with SCD during routine clinic visits. Patients (N = 145; 67% female, 94% African American) completed measures on a pen-tablet computer. Patients reported an average of 3.6 +/- 2.3 pain sites; mean current pain intensity (3.3 +/- 3.2), least (3.0 +/- 2.7) and worst (4.9 +/- 3.5) pain intensity in 24 hours on a 0 to 10 scale, multiple neuropathic (4.5 +/- 3.4, 8.3% selected none) and nociceptive (6.8 +/- 4.0) pain descriptors, and continuous pain pattern (59%). Their mean pain barriers score was 2.2 +/- 0.9, and 33% were dissatisfied with their pain levels. Only 14% reported taking at least 1 adjuvant drug, 82% were taking nonopioids, 85% step 2 opioids, and 65% step 3 opioids. Patients reported using, on average, 4.9 +/- 2.7 analgesics. Their pain barriers scores were similar to or greater than people with cancer. Importantly, their pain may be both nociceptive and neuropathic, contrary to common expectations that SCD pain is only nociceptive. Few patients, however, took drugs effective for neuropathic pain.
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Affiliation(s)
- Diana J Wilkie
- Department of Biobehavioral Health Science, College of Nursing, (MC 802), University of Illinois at Chicago, 845 S Damen Ave, Rm 660, Chicago, IL 60612-7350, USA.
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Wilkie DJ, Kim YO, Suarez ML, Dauw CM, Stapleton SJ, Gorman G, Storfjell J, Zhao Z. Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes. J Palliat Med 2009; 12:599-602. [PMID: 19594343 DOI: 10.1089/jpm.2009.0006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We aimed to determine the acceptability and feasibility of a pentablet-based software program, PAINReportIt-Plus, as a means for patients with cancer in home hospice to report their symptoms and differences in acceptability by demographic variables. Of the 131 participants (mean age = 59 +/- 13, 58% women, 48.1% African American), 44% had never used a computer, but all participants easily used the computerized tool and reported an average computer acceptability score of 10.3 +/- 1.8, indicating high acceptability. Participants required an average of 19.1 +/- 9.5 minutes to complete the pain section, 9.8 +/- 6.5 minutes for the medication section, and 4.8 +/- 2.3 minutes for the symptom section. The acceptability scores were not statistically different by demographic variables but time to complete the tool differed by racial/ethnic groups. Our findings demonstrate that terminally ill patients with cancer are willing and able to utilize computer pentablet technology to record and describe their pain and other symptoms. Visibility of pain and distress is the first step necessary for the hospice team to develop a care plan for improving control of noxious symptoms.
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Affiliation(s)
- Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Weng LC, Huang HL, Wilkie DJ, Hoenig NA, Suarez ML, Marschke M, Durham J. Predicting survival with the Palliative Performance Scale in a minority-serving hospice and palliative care program. J Pain Symptom Manage 2009; 37:642-8. [PMID: 18823751 PMCID: PMC2699378 DOI: 10.1016/j.jpainsymman.2008.03.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 03/27/2008] [Accepted: 04/03/2008] [Indexed: 10/21/2022]
Abstract
Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in Caucasian samples, but have not been studied for prognostic value in cancer patients from minority groups. Using data obtained from a retrospective chart audit of 492 cancer patients admitted over an 18-month period to a minority-serving home-based hospice and palliative care program, we examined the relationship between PPS scores and length of survival (survival days). Patients with PPS scores of 10% to 30% had fewer survival days than those with scores of 40% and those with scores of 50% to 100% (median=6, 19, and 34 days, respectively; F=25.02, P<0.001). A PPS score of 40% serves as a reliable inclusion criterion for a study requiring two weeks for completion, whereas 50% to 100% is required for a three-week study. Findings from a predominantly minority sample are similar to those from predominantly Caucasian samples.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan
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Espino L, Suarez ML, Santamarina G, Goicoa A, Fidalgo LE. Effects of Dietary Cation-Anion Difference on Blood Cortisol and ACTH Levels in Reproducing Ewes. ACTA ACUST UNITED AC 2005; 52:8-12. [PMID: 15703004 DOI: 10.1111/j.1439-0442.2004.00677.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Formulation of rations to induce a compensated metabolic acidosis in the post-partum cow has proved a useful strategy for prevention of milk fever. Such acidification improves the ability of the animal to maintain calcium homeostasis by promoting the absorption of calcium from the intestine and mobilization of calcium from the bone. In humans, an acidogenic diet results in mild metabolic acidosis in association with a state of cortisol excess and this increase in plasma cortisol may increase bone catabolism. The objective of our experiment was to induce acidification by anionic salt supplementation and to study the effects of anionic supplementation on plasma cortisol and adrenocorticotropic hormone (ACTH) levels in sheep. Twenty-seven twin-bearing sheep were assigned to two experimental groups and a control group, depending on dietary cation-anion difference (DCAD) (+272.6, -88.9 and +164.5 mEq/kg DM respectively). Sheep assigned to each dietary treatment received their respective rations beginning 6 weeks pre-partum and continuing until 12 days post-partum. Anionic diet induced a non-respiratory systemic acidosis in association with a mild increase in plasma cortisol concentration without changes in plasma ACTH levels. Our data suggest that the mild hypercortisolism observed in sheep fed the anionic diet may not be an effector for bone resorption induced by anionic salts. A mild hypercortisolism of this magnitude may lead to osteoporosis but this might require many years of adrenal hypersecretion while anionic salts are only used during the last weeks of pregnancy.
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Affiliation(s)
- L Espino
- Departamento de Ciencias Clínicas Veterinarias, Facultad de Veterinaria, Campus Universitario s/n, 27002 Lugo, Spain.
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Espino L, Guerrero F, Suarez ML, Santamarina G, Goicoa A, Fidalgo LE. Long-term effects of dietary anion-cation balance on acid-base status and bone morphology in reproducing ewes. ACTA ACUST UNITED AC 2004; 50:488-95. [PMID: 15157015 DOI: 10.1111/j.1439-0442.2004.00590.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The beneficial effects of anionic salts on calcium metabolism have been shown by supplementing rations with such salts during the last 3 weeks of pre-partum. However, there are few reports on the effects of anionic salts supplementation for periods of 4 weeks or longer on acid-base status, mineral metabolism and bone morphology. This study was conducted to evaluate the effects of the long-term dietary supplementation of anionic salts on the acid-base status, plasma minerals concentrations and bone morphology in sheep. Twenty-seven twin-bearing sheep were assigned to two experimental groups and a control group, depending on dietary cation-anion difference (DCAD) (+272.6, -88.9 and + 164.5 mEq/kg DM, respectively). Sheep assigned to each dietary treatment received their respective rations beginning 6 weeks prepartum and continuing until 12 days post-partum. Diets containing anionic salts induced a mild metabolic hyperchloraemic acidosis from 1 week pre-partum to 2 days post-partum that was completely compensated by non-respiratory mechanisms. These changes on acid-base status were accompanied by an increase of plasma ionized calcium levels. Plasma total calcium, phosphorus and magnesium concentrations were not affected by dietary treatment. Parathyroid hormone concentrations were related to the concentration of ionized calcium of plasma and were higher in sheep fed the cationic diet. Plasma osteocalcin levels were increased in sheep fed the anionic diet and cortical bone remodelling occurred in all the animals during late pregnancy in light and electron microscopy observation, but was particularly evident in the sheep fed the anionic diet. Bone turnover might be stimulated because of the role of the bone in buffering systemic acidosis. The data suggest that anionic salts ameliorated calcium metabolism around parturition by increasing bone resorption and the concentration of ionised calcium in plasma, possibly mediated by a mild hyperchloraemic metabolic acidosis induced by the salts.
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Affiliation(s)
- L Espino
- Departamento de Ciencias Clínicas Veterinarias, Facultad de Veterinaria, Campus Universitario s/n, 27002 Lugo, Spain.
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Espino L, Suarez ML, Miño N, Goicoa A, Fidalgo LE, Santamarina G. Suspected lasalocid poisoning in three dogs. Vet Hum Toxicol 2003; 45:241-2. [PMID: 14513890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The ionophore lasalocid has been used as a feed additive for broilers chickens and for improving feed efficiency in ruminants. Although dogs appear to be more sensitive to lasalocid intoxication than other species, there is only 1 report in the veterinary literature about lasalocid poisoning in dogs. We describe the clinical signs, treatment and resolution of 3 hunting dogs that developed acute neurological signs consistent with lasalocid poisoning after the consumption of several broilers that had died on a nearby farm.
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Affiliation(s)
- L Espino
- Neurology Service, Veterinary Clinical Hospital Rof Codina, Faculty of Veterinary Medicine, University of Santiago de Compostela, Estrada da Granxa s/n, 27003 Lugo, Spain
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Abstract
Urinary tract infection (UTI) caused by Corynebacterium urealyticum is a rarely recognised condition in veterinary medicine. This report describes a case in a 13-month-old dog which presented with a history of dysuria and haematuria. C urealyticum was identified as the cause of UTI. The clinical, radiological and ultrasonographic features and the results of urinalysis and urine bacteriological culture are described, as are the therapeutic challenges presented by this particular infection.
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Affiliation(s)
- M L Suarez
- Departamento de Patología Animal, Faculty of Veterinary, University of Santiago de Compostela, Lugo, Spain
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Abstract
A case of a partial atrial canal defect is described in a nine-month-old female English setter. The patient had a large ostium primum atrial septal defect and a concurrent malformation of the mitral valve. Electrocardiographic and radiographic findings were suggestive of marked enlargement of the right heart and pulmonary overcirculation. Definitive diagnosis and assessment of the haemodynamic consequences were made using echocardiography. The magnitude of the left-to-right intracardiac shunt was estimated by measuring the pulmonary to systemic flow ratio (Qp/Qs) from Doppler-derived pulmonary and aortic blood flow. The results of this report suggest that dogs with a partial atrioventricular canal defect and concurrent mild mitral regurgitation may exhibit no clinical signs during the first years of life, even in cases with a Qp/Qs ratio of greater than 2.
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Affiliation(s)
- G Santamarina
- Departamento de Patologia Animal, Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
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Abstract
Electrocardiographic parameters were measured in 28 free-ranging roe deer (Capreolus capreolus). The electrocardiograms (ECGs) were recorded in base-apex lead, standard bipolar limb leads (I, II, III), and augmented unipolar limb leads (aVR, aVL, aVF). Morphology and amplitude of P waves, QRS complexes, and T waves were analyzed in all seven leads. Cardiac rhythm, heart rate, and durations of P, QRS, and T waves, PR interval, QTc interval, and ST segment were calculated in the base-apex lead. The mean electrical axis for each individual was determined from the net amplitude of the QRS complex in leads I and II. All of the animals had a sinus rhythm. Heart rates ranged from 60-180 beats per minute, with a mean +/- SD of 104.8 +/- 44.1. The electrical axis was 100 degrees-220 degrees, with a mean +/- SD of 169.5 degrees +/- 40.8 degrees. The base-apex lead provided the most uniform ECG patterns and higher mean amplitudes than did standard leads.
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Affiliation(s)
- G Santamarina
- Departamento de Patologia Animal, Facultad de Veterinaria, Universidad de Santiago de Compostela, Campus Universitario s/n, 27002 Lugo, Spain
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Affiliation(s)
- M L Suarez
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Santiago de Compostela, Lugo, Spain
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Galmarini JA, Suarez ML, Moize G. [Inflammation and dilatation of the salivary ducts]. Trib Odontol (B Aires) 1971; 55:82 passim. [PMID: 5284810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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