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PurposeThe EPIC-26 (Expanded Prostate Cancer Index Composite-Short Form) is a validated questionnaire for measuring health related quality of life. However, the relationship between domain scores and functional outcomes remains unclear, leading to potential confusion about expectations after treatment. For instance, does a sexual function domain score of 80 mean that a patient can achieve erection sufficient for intercourse? Consequently we sought to determine the relationship between the domain score and the response to obtaining the best possible outcome for each question.Materials and methodsUsing data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a multicenter, prospective study of men diagnosed with localized prostate cancer, we analyzed 11,464 EPIC-26 questionnaires from a total of 2,563 men at baseline through 60 months of followup who were treated with robotic prostatectomy, radiotherapy or active surveillance. We dichotomized every item into its best possible outcome and assessed the percent of men at each domain score who achieved the best result.ResultsFor every EPIC-26 item the frequency of the best possible outcome was reported by domain score category. For example, a score of 80 to 100 on sexual function corresponded to 97% of men reporting erections sufficient for intercourse while at a score of 40 to 60 only 28% reported adequate erections. Also, at a score of 80 to 100 on the urinary incontinence domain 93% of men reported rarely or never leaking vs 6% at a score of 61 to 80.ConclusionsOur findings indicate a novel way to interpret EPIC-26 domain scores, demonstrating large variations in the percent of respondents reporting the best possible outcomes over narrow domain score differences. This information may be valuable when counseling men on treatment options.

ObjectiveRepetitive behaviors in autism spectrum disorders (ASD) range from motor stereotypy to immersion in restricted interests. The modified Children's Yale-Brown Obsessive Compulsive Scale for children with autism spectrum disorder (CYBOCS-ASD) includes a Symptom Checklist (behavior present or absent) and 5 severity scales (Time Spent, Interference, Distress, Resistance and Control).MethodWe assembled CYBOCS-ASD data from 3 Research Units on Pediatric Psychopharmacology Autism Network trials to explore the component structure of repetitive behaviors in children with ASD. Raters trained to reliability conducted the CYBOCS-ASD in 272 medication-free subjects. Fifteen Symptom Checklist items were endorsed for less than 5% of the sample and were dropped. Principal component analysis was used to explore the clustering of 23 checklist items. Component scores computed for each subject were correlated with other measures. We also examined the distribution of severity scales.ResultsThe subjects (229 boys and 43 girls; mean age = 7.8 ± 2.6 years) met criteria for an ASD; half were intellectually disabled. The PCA resulted in a 5-component solution to classify repetitive behaviors (34.4% of the variance): hoarding and ritualistic behavior; sensory and arranging behavior; sameness and self-injurious behavior; stereotypy; restricted interests. Sensory and arranging and stereotypy components were associated with lower adaptive functioning (Pearson r = 0.2-0.3; p < .003). The resistance scale showed little variation, with more than 60% of the sample with the highest score.ConclusionsRarely endorsed items can be dropped from the Checklist. The resistance item does not appear to be relevant for children with ASD.

Purpose: The purpose of this study was to perform a comprehensive systematic review of the literature on voice-related patient-reported outcome (PRO) measures in adults and to evaluate each instrument for the presence of important measurement properties. Method: MEDLINE, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument databases were searched using relevant vocabulary terms and key terms related to PRO measures and voice. Inclusion and exclusion criteria were developed in consultation with an expert panel. Three independent investigators assessed study methodology using criteria developed a priori. Measurement properties were examined and entered into evidence tables. Results: A total of 3,744 studies assessing voice-related constructs were identified. This list was narrowed to 32 PRO measures on the basis of predetermined inclusion and exclusion criteria. Questionnaire measurement properties varied widely. Important thematic deficiencies were apparent: (a) lack of patient involvement in the item development process, (b) lack of robust construct validity, and (c) lack of clear interpretability and scaling. Conclusions: PRO measures are a principal means of evaluating treatment effectiveness in voice-related conditions. Despite their prominence, available PRO measures have disparate methodological rigor. Care must be taken to understand the psychometric and measurement properties and the applicability of PRO measures before advocating for their use in clinical or research applications.

Introduction: Data on long‐term outcomes following A2/A2B to B kidney transplants since the 2014 kidney allocation system (KAS) changes are few. The primary aim of this study is to report our 7‐year experience with A2/A2B to B kidney transplants and to compare post‐transplant outcomes of A2/A2B to a concurrent group of B to B kidney transplants. Additionally, the study evaluates the impact of pre‐transplant anti‐A1 titers on survival outcomes in A2/A2B transplants. Methods: This retrospective, single‐center analysis included all adults who received A2/A2B to B deceased donor kidney transplants from December 2014 to June 2021 compared to B to B recipients. The effects of pre‐transplant IgM/IgG titers, stratified as ≤1:8 and ≥1:16, on death‐censored, rejection‐free, and overall graft survival were tested. Results: Fifty‐three A2/A2B and 114 B to B adults were included with a median follow‐up time of 32 months. Overall graft survival, patient survival, and rejection‐free graft survival did not differ between the two groups. There were no differences between the groups' overall kidney function values (p >.80) or their temporal trajectories (time by group interaction p >.11). Unadjusted death‐censored graft survival was lower in A2/A2B to B compared to B recipients (p =.03), but the effect was not significant (p =.195) after adjusting for any readmissions (p =.96), rejection episodes (p <.001) or BK infection (p =.76). We did not detect an effect of pre‐transplant titer group on death‐censored (p =.59), rejection‐free (p =.61), or overall graft survival (p =.26) Conclusions: A2/A2B to B kidney transplants have comparable overall patient and graft survival, rejection‐free graft survival, and longitudinal renal function compared to B to B transplants at our center. Allograft survival outcomes were not significantly different between patients with low and high pre‐transplant anti‐A1 IgM/IgG titers. [ABSTRACT FROM AUTHOR]

Introduction: Utilization of hepatitis C viremic (HCV+) deceased donor kidneys (DDKT) for aviremic recipients increases opportunities for transplantation with excellent short‐term outcomes. Our primary aim was to understand longer‐term outcomes, specifically assessing kidney and liver function in the first year posttransplant. Methods: This was a retrospective single‐center study of adult DDKT recipients of HCV+ kidneys (cases) matched 1:1 to recipients of HCV‐ kidneys (comparators). Between‐group outcomes were analyzed using comparisons of means and proportions, survival analysis methods, and multivariable mixed effects models. Results: Sixty‐five cases and 65 comparators had statistically comparable demographic and clinical characteristics. There were no between‐group differences in serum creatinine or estimated glomerular filtration rate at month 12 (p =.662) or in their trajectories over months 1–12 (p >.292). Within the first 60 days, rates of liver function values >3 times upper limit of normal among cases were comparable to comparators for aspartate aminotransferase (AST) (14% vs. 6%, p =.242) and higher for alanine transaminase (ALT) (23% vs. 6%, p =.011). AST declined during the first 8 weeks (p =.005) and stabilized for both groups (p =.406) during the following 10 months. ALT declined during the first 8 weeks (p <.001), continued to decline over months 3–12 (p =.016), and the trajectory was unrelated to antiviral therapy initiation among cases. Conclusions: Aviremic recipients of HCV+ kidneys had comparable kidney outcomes to matched recipients of HCV‐ kidneys. Despite more HCV+ recipients having an elevation in ALT within the first 60 days, ALT values normalized with no identified liver complications attributed to HCV. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic allowed for the rapid implementation of telemedicine for kidney transplant patients; however, widespread adoption may worsen existing health care inequities among vulnerable populations. This study aimed to characterize telemedicine utilization by kidney transplant patients during the early pandemic with particular attention to healthcare equity. Methods: A retrospective analysis of kidney transplant patients interacting with telemedicine was performed. Patient demographic data and distance to the transplant center were obtained. The National Center for Health Statistics (NCHS) Urban‐Rural Classification Scheme for Counties and Brokamp Neighborhood Deprivation Index (NDI) score were used to characterize patients' counties of residence. Multivariable logistic regression evaluated associations between patient and community characteristics and the likelihood of an encounter being telemedicine. Results: This study included 1033 patients who participated in 3727 encounters from March 11 through October 2020. Characteristics associated with decreased likelihood of telemedicine use were increased age (OR =.993; 95% CI =.986‐.999, P =.022), non‐White vs. White race (OR =.826, 95% CI =.697‐.979; P =.028), male vs. female sex (OR =.746, 95% CI =.632‐.880; P <.001), and a higher Brokamp Neighborhood Deprivation Index score (OR =.159; 95% CI =.029‐.873; P =.034). The effect of distance to the transplant center on the likelihood of a telemedicine encounter differed by NCHS Urban‐Rural designation (interaction P =.018), with its likelihood increasing by 2%–3% with each 10‐mile increment among persons residing in medium‐, small‐, and non‐metropolitan counties compared to those residing in the most rural counties. Conclusions: Telemedicine visits were less often completed by patients of older age, non‐white race, male sex, and those residing in counties having higher NDI scores. While telemedicine has the potential to improve healthcare access and decrease costs, proactive efforts need to be taken to mitigate disparities in vulnerable populations. [ABSTRACT FROM AUTHOR]

Social validation is the value judgment from society on the importance of a study. The social validity of behavior goals used in the social competence intervention literature was assessed using the Q-sort technique. The stimulus items were 80 different social competence behavior goals taken from 78 classroom-based social competence intervention studies published between 1970 and 2000 for preschool children. Participants (N = 36) were early childhood special educators, early childhood educators, and administrators. Participants generated three distinct viewpoints concerning valued social competence behavior goals: Factor 1, reduction in negative behaviors; Factor 2, pro-social; and Factor 3, communication and good manners. Recommendations for research in the area of social competence interventions are discussed in light of these findings. (Contains 4 tables.)

Background: Societal factors that influence wait‐listing for transplantation are complex and poorly understood. Social determinants of health (SDOH) affect rates of and outcomes after transplantation. Methods: This cross‐sectional study investigated the impact of SDOH on additions to state‐level, 2017–2018 kidney and liver wait‐lists. Principal components analysis, starting with 127 variables among 3142 counties, was used to derive novel, comprehensive state‐level composites, designated (1) health/economics and (2) community capital/urbanicity. Stepwise multivariate linear regression with backwards elimination (n = 51; 50 states and DC) tested the effects of these composites, Medicaid expansion, and center density on adult disease burden‐adjusted wait‐list additions. Results: SDOH related to increased community capital/urbanicity were independently associated with wait‐listing (starting models: B =.40, P =.010 Kidney; B =.36, P =.038 Liver) (final models: B =.31, P =.027 Kidney, B =.34, P =.015 Liver). In contrast and surprisingly, no other covariates were associated with wait‐listing (P ≥.122). Conclusions: These results suggest that deficits in community resources are important contributors to disparities in wait‐list access. Our composite SDOH metrics may help identify at‐risk communities, which can be the focus of local and national policy initiatives to improve access to organ transplantation. [ABSTRACT FROM AUTHOR]