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The article discusses a study conducted to assess whether the length of the transfusion cycle affects the level of pain and whether pain varies by pretransfusion haemoglobin (Hb) level and reticulocyte count. Topics discussed include non-significant trend towards lower prevalence of pain midway through the transfusion cycle, prevalence of pain correlated with higher, pre-transfusion Hb and length of transfusion cycle, pre-transfusion Hb level and reticulocyte counts.

Objective To identify styles of physician decision making (as opposed to singular clinical actions) and to analyze their association with variations in the management of a vignette presentation of coronary heart disease ( CHD). Data Source Primary data were collected from primary care physicians in North and South Carolina. Study Design In a balanced factorial experimental design, primary care physicians viewed one of 16 (24) video vignette presentations of CHD and provided detailed information about how they would manage the case. Data Collection Method 256 MD primary care physicians were interviewed face-to-face in North and South Carolina. Principal Findings We identify three clusters depicting unique styles of CHD management that are robust to controls for physician (gender and level of experience) and patient characteristics (age, gender, socioeconomic status, and race) as well as key organizational features of physicians' work settings. Physicians in Cluster 1 'Cardiac' ( N = 92) were more likely to focus on cardiac issues compared with their counterparts; physicians in Cluster 2 'Talkers' ( N = 93) were more likely to give advice and take additional medical history; whereas physicians in Cluster 3 'Minimalists' ( N = 71) were less likely than their counterparts to take action on any of the types of management behavior. Conclusions Variations in styles of decision making, which encompass multiple outcome variables and extend beyond individual-level demographic predictors, may add to our understanding of disparities in health quality and outcomes. [ABSTRACT FROM AUTHOR]

Pain is not a symptom generally associated with thalassaemia. However, providers have noted increasing patient reports of pain, creating an impetus for this prospective, observational assessment of pain in thalassaemia patients. The primary study goals were to assess pain prevalence, severity, location, and potential risk factors. This was a multicentre, prospective study of thalassaemia patients receiving care at 12 Thalassaemia Clinical Research Network sites. Pain was assessed using the Brief Pain Inventory. Two hundred and fifty-two thalassaemia patients ranging in age from 12 to 71 years (mean 28·8) were enrolled. Sixty-four per cent reported experiencing pain during the last 4 weeks, 22% of whom reported pain on a daily basis. Ordinal regression analysis of pain ratings demonstrated significant ( P < 0·001) correlation of increased age with increased pain, irrespective of diagnosis, transfusion status, gender, bone density, chelator type or iron overload. Eighty-one per cent reported having pain for 1 year or longer and 31% reported pain for five or more years. Pain is a major cause of morbidity and an unrecognized problem for patients with thalassaemia. Age is the strongest predictor of frequency and severity. Little else is known about the aetiology and predictors of this pain syndrome. [ABSTRACT FROM AUTHOR]

Hypogonadism (HG) is a clinical disorder consisting of reduced testosterone (T) levels and characteristic signs and symptoms of low T. Current instruments used to assess hypogonadal symptoms in men lack adequate measurement properties. To present data on the quantitative validation of a new self-report instrument (HG Screener) developed to identify men with symptoms of HG. This is a psychometric validation study conducted at 16 clinical sites across the Unites States. Subjects completed two visits separated by 2-4 weeks. One hundred and thirty-one men (82 hypogonadal patients with total T ≤ 10·4 nmol/l and 49 controls with total T > 10·4 nmol/l) aged 21-75 years were enrolled. Self-reported assessments including the HG Screener (at both visits) along with seven validated questionnaires. The results of a factor analysis identified five functional factors or domains. The resulting instrument contains 25 items consisting of 18 functional items in five core domains (sexual function, mood, memory, sleep function and fatigue) and seven physical symptom items. Overall, the new instrument was found to have strong psychometric properties, including acceptable discriminant, construct and content validity, as well as good internal consistency and test-retest reliability. A new screening tool (HG Screener) for identifying men with HG has been developed and validated according to FDA standards. This new instrument possesses acceptable psychometrics and is available for clinical or research use. [ABSTRACT FROM AUTHOR]