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The Cystic Fibrosis (CF) Impact Questionnaire (CF-IQ) was qualitatively developed to assess the impact of CF in the context of treatment advancements and increased longevity. This study reports the CF-IQ validation. In this noninterventional validation study, people with CF completed the 40-item CF-IQ and validating patient-reported outcome measures (PROMs) via electronic diaries at enrollment (baseline) and at the 4-week follow-up. Validation consisted of modern methods and focus groups to finalize structural validity, and classical methods to assess internal consistency [1–3], test-retest reliability [4,5], concurrent validity [5], and known-groups validity [5] of the CF-IQ. At baseline, 214 adults completed the survey; 193 completed the follow-up survey. Unidimensional item response theory (IRT) models were separately fit to 5 prespecified domains (Control and Burden of CF Treatment Impacts, Physical Activity Impacts, Social Activity Impacts, Emotional Impacts, and Work/School Limitation Impacts). IRT local dependence (LD) statistics identified 17 redundant items. Two independent CF-patient focus groups (14 total patients) confirmed these findings, and the 17 items were dropped. Each domain defined on the final 23 items achieved the criterion of exact model fit as measured by the root mean squared error of approximation (RMSEA, values = 0), Internal consistency (Cronbach's α) values ranged from 0.81 to 0.89, 4 of 5 domains achieved acceptable test-retest reliability, with intraclass correlation coefficient (ICC) values ≥ 0.7, acceptable concurrent validity was achieved for all domains, and known-groups validity was established. The novel CF-IQ is a psychometrically robust PROM capturing patient-centric impacts of CF in the context of the current standard of care. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of the administration of the Pfizer–BioNTech COVID-19 vaccinations between adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD subjects. Method: A retrospective chart review was performed on all adolescents aged 12–17 years registered at a central district in Israel from January 1st 2021 to October 31st 2021. Results: Of the 46,544 subjects included in the study, 8241 (17.7%) were diagnosed with ADHD. Of them, 3% were PCR-COVID-19 positive. Among the patients with ADHD, the older adolescents were more likely to be vaccinated: 48.8% of those aged 12-15 years were vaccinated versus 59.6% of patients aged 16-17 years. The ultra-orthodox Jewish and Arab adolescents in the ADHD group were far less likely to be vaccinated (22.9% and 34.6%, respectively), compared to the adolescents with ADHD in the general population (60.5%). Girls were also somewhat more likely to be vaccinated. Conclusions: Adolescents diagnosed with ADHD had a higher COVID-19 vaccination rate compared to their non-ADHD counterparts. The vaccine uptake was lower amongst Arab and ultra-orthodox Jewish populations. [ABSTRACT FROM AUTHOR]

Objective: To postulate that ADHD is a potential risk factor for COVID-19 infection; to evaluate the COVID-19 risk factor on drug-treated ADHD subjects. Methods: A retrospective chart review was performed on ADHD subjects aged 6 to 18 years in Israel, who had undergone at least one COVID-19 test during the study period. Results: Of the 64,409 subjects included in the study, 6,207 (9.64%) had at least one positive COVID-19 test result, 13,300 (20.65%) were diagnosed with ADHD, and of whom 1,751 (13%) had purchased at least two ADHD medications 3 months prior to COVID-19 testing and were defined as being medically treated. Medically-treated ADHD subjects had a significantly lower likelihood to be infected with COVID-19 than untreated subjects. Conclusion: Untreated ADHD patients seem to constitute a risk group for COVID-19 infection. Drug treatment ameliorates risk of spreading COVID-19 infection within the pediatric population and secondary spread in the general population. [ABSTRACT FROM AUTHOR]

Since there is existing well-established conceptual work on the diagnostic process suggested in the 2015 National Academy of Medicine's publication I Improving Diagnosis in Healthcare i [[1]], which was recently further refined for use in the acute care setting by ED providers [[12]], we did not seek to develop a new theory of ED diagnosis but rather to understand concepts relevant to neurological diagnosis from EM physicians' perspective. While others have described discrepancies between internists and neurologists regarding cerebrovascular diagnoses in patients with transient neurological complaints [[22]], we identified an attitude of epistemological skepticism among EM physicians regarding transient and non-specific neurologic complaints. The field concerned with the initial assessment, diagnosis, and management of these challenging patients has been dubbed acute diagnostic neurology and is best conceptualized as a subfield of emergency medicine (EM). Keywords: clinical reasoning; diagnostic error; emergency medicine; semi-structured interviews; stroke; transient ischemic attack EN clinical reasoning diagnostic error emergency medicine semi-structured interviews stroke transient ischemic attack 225 235 11 05/12/22 20220501 NES 220501 Introduction Failure to establish an accurate and timely explanation of a patient's health problem, a diagnostic error, is a well-recognized healthcare challenge [[1]]. [Extracted from the article]

Objective Background Methods Results Conclusions To better understand the breadth and frequency of symptoms across the phases of the migraine cycle using data captured from qualitative patient interviews conducted through the Migraine Clinical Outcome Assessment System (MiCOAS) project.People living with migraine experience a range of symptoms across the pre‐headache, headache, post‐headache, and interictal phases of the migraine cycle. Although clinical diagnostic criteria and clinical trial endpoints focus largely on cardinal symptoms or monthly migraine days, migraine symptom profiles are far more complex. As a part of the MiCOAS project, semi‐structured qualitative interviews were undertaken to better understand the migraine‐related symptomology from the patient's viewpoint.This concept elicitation study used iterative purposeful sampling to select 40 people with self‐reported medical diagnosis of migraine for interviews that were conducted via audio‐only web conferencing. Key topics related to migraine symptoms, including mood/emotion symptoms, were identified using content analysis. Interview transcripts were also coded to reflect the phase of migraine under discussion, so that patient experiences could be compared by phase.Forty participants (50%, n = 20 episodic migraine; 50%, n = 20 chronic migraine), aged from 21 to 70 years old reported a total of 60 unique symptoms, which were categorized into 30 broader symptom categories. Participants reported between 7 and 22 unique symptom categories across all phases. During pre‐headache and headache, participants reported a median of 7.5 (interquartile range [IQR] = 5.5) and 8 (IQR = 4.0) different symptom categories compared to 4 (IQR = 3.0) and 1.5 (IQR = 2.5) for the post‐headache and interictal periods, respectively. Head pain during the headache phase was the only universally reported symptom (100%, n = 40). Pooling across all phases, the next most reported symptoms were light sensitivity (93%, n = 37), nausea (88%, n = 35), irritability/impatience (83%, n = 24), sound sensitivity (80%, n = 32), and fatigue/exhaustion (80%, n = 32). One or more interictal symptoms were reported by 73% (n = 29) of participants and included mood/emotion symptoms, such as anxiety (30%, n = 12), depression (18%, n = 7), and anger (15%, n = 6), as well as cardinal symptoms, such as light sensitivity (13%, n = 5) and nausea (13%, n = 5).Patients experience a range of symptoms across the phases of the migraine cycle. Results often aligned with clinical expectations, but non‐cardinal migraine‐related symptoms were reported both inside and outside the headache phase, including between attacks. These discoveries highlight the importance of assessing a range of symptoms and timing when developing patient‐reported outcome measures for migraine clinical trials. [ABSTRACT FROM AUTHOR]

Reducing the number of preterm births is a high public health priority in the U.S. Preterm birth, affecting an estimated 380,000 infants annually, is a leading cause of infant mortality and morbidity and is associated with individual and systemic characteristics. Preterm birth is estimated to cost society $26 billion annually. Despite an elevated financial burden caused by preterm birth, very little is known about who bears these costs. This study seeks to understand the relationship between Medicaid and private insurance payment for preterm birth, using multiple years of vital statistics data, which for the first time since 2010 include information on payment source. The nationwide data cover births that occur in all settings, including non-hospital settings, and many maternal characteristics not available in other datasets, improving upon previous analyses. These data can be used to promote better Medicaid coverage of interventions known to be effective in reducing preterm births. [ABSTRACT FROM PUBLISHER]

We evaluated the effect of infrared thermography (IRT) on the clinical assessment of bacterial and viral pharyngitis and its impact on the predictive value of the McIsaac score algorithm for streptococcal pharyngitis in children. We also investigated if IRT could distinguish between bacterial and viral pharyngitis. The study included children aged 2-17 years presenting with sore throat and fever over 38°C from November 1, 2021, to April 30, 2022. Of the 76 assessed children, 16 were excluded due to missing data or technical issues, leaving 60 children (32 males, 28 females) divided into three groups: Group A with streptococcal pharyngitis (N = 30), viral pharyngitis (N = 16), and healthy controls (N = 14). McIsaac score and IRT imaging showed a 90% positive predictive value for streptococcal pharyngitis. While IRT alone could not distinguish between bacterial and viral infections, it significantly increased the predictive value when combined with the McIsaac score., (© 2024 Wiley‐VCH GmbH.)

Objectives: Children often present during winter with painful, red-purple swollen fingers and/or toes, usually misdiagnosed as Raynaud's phenomenon. Pernio, or chronic chilblains, is a localised inflammatory lesion of the skin resulting from an abnormal response to cold. The aim of this study was to better characterise the clinical presentation of chronic chilblains in children., Methods: This is a single-centre retrospective study of patients referred to our paediatric rheumatology clinic with cold, purple, and painful hands. Patients were identified from the paediatric rheumatology clinic database, at the Safra Children Hospital, Israel. Data of the clinical presentation, physical findings, laboratory investigations and the course of the disease were extracted from the patients' charts and analysed., Results: A total of 33 patients (27 females, sex ratio 4.5:1) were identified. Patients age at presentation was 13.5±2.1, and disease duration was 2.0±1.0 winters. Patients presented with prolonged capillary refill time (100%) and abnormal modified Allen test (75.6%). Fingers swelling was the most common finding (81.8%), followed by proximal interphalangeal joint (PIPs) swelling (63.6%), skin ulceration (54.5%), and dry, irritated skin (45.5%). Nailfold capillary microscopy was normal in all patients. The only abnormal laboratory test was the test for anti-nuclear factor (ANA) in 25%., Conclusions: We report a large series of children with a unique symptomatology consisting in chronic chilblains.