INTERMED-Self Assessment(IMSA): validityand preliminaryapplicationsin research

Transcription

1 INTERMED-Self Assessment(IMSA): validityand preliminaryapplicationsin research Silvia Ferrari, Modena (I); Arianne KB Van Reedt Dortland, Amsterdam (NL); Annette Boenink, Amsterdam (NL) & The INTERMED Consortium

2 Disclosure: Silvia Ferrari, MD No conflict of interest to declare

3 1) IM-SA and IM-SA Study: What and Why? 2) IM-SA s measurement properties 3) An example of use in research (Modena METS)

4 1) WHAT and WHY IM-SA Self-Assessment version of the INTERMED method Multiple choice questionnaire, filled in individually by the patient(with help if necessary) 4

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6 1) WHAT and WHY IM-SA Possible applications: Clinical activities first assessment and follow-up(i.e. during hospital stay, or in the out-patient clinic) Research Time-saving, informative Available in different languages: English, Dutch, French, German, Spanish, Italian But Different from IM-CAG (the interview): mirroring different perspectives of health care professionals and patients HOW and HOW MUCH different? Aimof the IM-SA Study 6

7 IM-SA Study(IMSAS): an International multicentric study Site Disease/Clinic In- or Out- Patient N of pts Principal investigator SUVA, Sion(CH) Rehabilitation IP 175 François Lüthi, Cyrille Burrus Lausanne, CHUV (CH) Rheumatology IP 93 Catherine Zdrojewski, Fritz Stiefel Amsterdam 1 VUmc MedPsyUnit,Internal IP/OP 160 Annette Boenink, Arianne KBvan Medicine, Nephrology Reedt Dortland Modena Liver disorders IP/OP 96 Silvia Ferrari Amsterdam 2 AMC Rehabilitation and Cardiology OP 129 Corine Latour Freiburg Oncology IP 86 Andreas Joos, Johannes Eichenlaub San Francisco HIV-clinic IP/OP (ongoing) Steven Frankel Nantes Endocrinology IP 111 Marie Guitteny-Collas TOTAL 850 7

8 Aims Has the IM-SA a predictive validity comparable to the IM-CAG? Definition of a clinical cut-off point for the SA-tool, as it was defined for the IM-CAG 8

9 Baseline (T0) Assessments Administered by researcher: Self-administered: Sociodemographic data Medical history IM-CAG CIRS (Comorbidity Illness Rating Scale) IM-SA Face-validity on IMSA HADS SF-36 EuroQol Follow-up (T1 = 3 months, T2 = 6) SF 36, EuroQol, Healthcare utilization: # Emergency Room visits # Medical outpatient consultation # Diagnostics # Days of hospitalization 9

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11 General features of the sample (N = 850) Variable % or Median (Total range) Sex (% female) 39.1 Age 54 (17 to90) CIRS total score 6.6 (0-34) Number of diseases (%) IM-SA score Total 15.3 (0-45) Biological 6(0-15) Psychological 3(0-15) Social 3 (0-13) Health care 3 (0-12) % complex (IM 21) 36.7 Emotional well-being (SF-36) 64 (0-100) Depression and anxiety HADS 22 (13-39)

12 1) IM-SA and IM-SA Study: What and Why? 2) IM-SA s measurement properties 3) An example of use in research (Modena METS)

13 Feasibility Validity Reliability Measurement properties Internal consistency Interrater agreement Validity according to subjects Construct validity Known-group validity Convergent validity

14 Feasibility Is it realizable to assess the IM-SA? Yes: no subjects had more than 15% missing IM-SA items

15 Validity according to subjects 95.2% found the questions of the IM-SA appropriate to ask 92.4% believed that the IM-SA did not miss issues pertinent to their care

16 Reliability: internal consistency Do all IM-SA items (all measuring complexity) yield similar scores? Yes: Cronbach s α =.80 = satisfactory

17 Reliability: interrater agreement Do patients (IM-SA) and professionals (IM-CAG) agree? Yes, moderately to substantially (IM-SA and IM-CAG SHOULD differ!) CONCORDANCE IM-SA Domains Total score Biological Psychological Social Health care Intraclass correlation coefficients Total IM-CAG score.72( ) IM-CAG biological domain.59( ) IM-CAG psychological domain.70( ) IM-CAG social domain.64( ) IM-CAG health care domain.49( ) Intraclass correlation coefficients (95% CI)

18 Construct validity: known-group validity Do IM-SA scores differ among known subgroups? IM-SA distinguished between those with 0-1, 2 and 3 diseases (the higher the comorbidity, the higher the IM-SA score) (p<.001) Assessed by Kruskal Wallis test

19 Construct validity: convergent validity Is the IM-SA related to comparable constructs? IM-SA Domains Total score Biological Psychological Social Health care Total IM-CAG score.64 IM-CAG biological domain.50 IM-CAG psychological domain.57 IM-CAG social domain.50 IM-CAG health care domain.31 Mental health (SF-36).65 moderate (Spearman s) correlelation weak correlation

20 Predictive validity Does the IM-SA predict health care use after 3 months? The IM-SA significantly predicts HCU and QoL after 3- and 6- month follow-up

21 Conclusion IM-SA cut-off score for complexity = 19

22 1) IM-SA and IM-SA Study: What and Why? 2) IM-SA s measurement properties 3) An example of use in research (Modena METS)

23 INFLAMMATORY PATHWAYS IN COLORECTAL MUCOSA INTEGRATE SIGNALS FROM DIFFERENT SYSTEMS: A PSYCHO-NEURO-ENDOCRINE-IMMUNOLOGICAL (PNEI) APPROACH TO LARGE BOWEL CANCER PhD Candidate Tutor Dr. Stefano Mancini & Prof. Luca Roncucci

24 Aims of the Project 1) To investigate the relationship between the expression of local inflammatory factors in the colonic mucosa in relation to systemic alterations 2) To deepen our knowledge on emerging molecular pathways possibly implicated in the adenomacarcinoma sequence 3) To implement the study of the early steps of colorectal carcinogenesis through a multidisciplinary approach

25 Materials and methods 1) Exploring humoral immune responses in CRC and other cancers 128 patients (63 CRC/65 OC), mortality after 5 yrs Non organ-specific Abs (NOSA), Colon-related Abs (CAA), HEp-2 Abs Indirect immunofluorescence on rat tissues and HEp-2 cell line 2) Autophagy expression along the adenoma-carcinoma sequence 40/30/30 samples from normal colorectal mucosa/microadenoma/crc LC3B-II and MPO expression by direct immunofluorescence and western blotting Microsatellite status of CRC by nucleotide markers (BAT25, BAT26, NR24, CAT25) 3) Systemic redox balance and subclinical colorectal inflammation 28 patients (14/14 M/F) undergoing to colonoscopy MPO expression on normal colorectal mucosa by immunohistochemistry Oxidative stress (droms, BAP, LP-CHOLOX) in the serum 4) Multidisciplinary approach to colorectal carcinogenesis 64 patients (33/31 M/F) undergoing colonoscopy case-control study adenomas/no adenomas (29/35) Anthropometric and clinical characteristics, atherogenicity (carotid ultrasound, serum) LC3B-II and MPO expression by immunofluorescence on colorectal biopsies Psychometric tests

26 Psychometric tests Hospital Anxiety and Depression Scale (HADS) Temperament and Character Inventory (TCI) Medical Outcome Study Short-Form 36 (SF-36) InterMed Self-Assessment (IMSA)

27 Results at a glance

28 Psychosocial features

29 Temperament matters? TCI-Self Trascendencehigheramongpatientwith adenoma (21.5±3.2 vs. 19.3±3.1, p = 0.03) Relevant at the univariate statistical analysis(a 1-unit increment in TCI- Self Trascendencecorrespondsto an OR of 1.31, CI 5-95% , p = 0.047) TCI-Self Directednessand Cooperativenesshigheramongpatienswith metabolic syndrome

30 Multivariate analysis- Results Only q-imt (left carotid) as sufficient predictor of the presence of adenomas in our population

31 Thanks to the IMSA people for the joint forces and collaboration!

32 THANKS FOR YOUR ATTENTION! INTERMED-Self Assessment(IMSA): validity and preliminary applications in research