Karin Coyne - Academia.edu (original) (raw)

Papers by Karin Coyne

Monitoring airway disease

European Journal of Hospital Pharmacy, Feb 14, 2016

Background Opioids are often recommended by guidelines for the treatment of various types of chro... more Background Opioids are often recommended by guidelines for the treatment of various types of chronic pain. Opioid treated patients with chronic non-cancer pain report 40–80% prevalence of opioid induced constipation (OIC), and the presence of OIC negatively impacts health related quality of life (HRQL). OIC’s impact on different chronic pain types is unknown. Opioids can intensify constipation, compounding the interdependent relationship between constipation and back pain. Purpose To examine OIC’s impact on patients with chronic back pain versus other chronic pain types. Material and methods Adult chronic non-cancer pain patients receiving daily opioids for ≥4 weeks and reporting OIC participated in a 24 week prospective longitudinal study. Web based surveys at baseline and at weeks 2, 4, 6, 8, 12, 16 and 24 assessed OIC symptoms, laxative use, pain level, HRQL, productivity and perceived satisfaction with laxatives. Patients were asked about constipation symptom frequency and the bother associated with each reported symptom. Results 489 eligible patients reported back pain only (BP: n = 89, 18.2%), back pain+other pain (BPOP: n = 286, 58.5%) or other pain only (OP: n = 114, 23.3%). Abdominal discomfort, abdominal pain, stomach cramps, rectal burning and bowel movements (BMs) too hard were reported to occur with >25% of BMs more frequently among BP than OP. BP reported significantly greater bother with abdominal pain, bloating, stomach cramps and painful BMs than OP. Significantly greater HRQL impact was observed among BP than OP. BP reported the highest rates of laxative non-use (39.3%) and were more likely to report little benefit from laxatives (71%) than the other groups. Conclusion Patients with BP reported significantly greater OIC symptom frequency, bother and HRQL impact than patients with OP. High rates of laxative non-use among patients with BP likely contributed to their higher OIC symptom burden. Whether better information about effective OIC therapies will reduce OIC burden or patients eschew current therapies due to tolerability issues or lack of efficacy requires further exploration. Clinician-patient conversation is warranted, and patients with BP and OIC require additional attention. References and/or Acknowledgements Funding for this research was provided by AstraZeneca Pharmaceuticals LP (Wilmington, DE, USA). Conflict of interest.

Value in Health, Jun 1, 2012

information for patients over age 65 with at least one diagnosis for Crohn's disease. Patients wh... more information for patients over age 65 with at least one diagnosis for Crohn's disease. Patients who initiated therapy with tumor necrosis factor (TNF) and non-TNF agents were identified. We examined the treatment patterns such as switching to another TNF, switching to a non-TNF, and discontinuation for two years after the initiation of TNF biologics. We created a data visualization tool help visualize how patients change their treatment patterns after first and second switches. RESULTS: A total of 3287 Crohn's disease patients initiated therapy with a TNF medication. 4.23% of these patients switched to another TNF, 1.00% switched to a non-TNF, 60.42% discontinued therapy and 34.35% continued their initial therapy. Among patients who switched to another TNF, 48.20% continued the switched therapy, 41.01% discontinued, 10.07% switched to another TNF, and 0.72% switched to a non-TNF. A total of 2,140 Crohn's disease patients initiated their therapy with a non-TNF, of which 0.89% switched to an anti-TNF, 0.37% switched to a TNF, 97.38% discontinued therapy, and 1.36% continued their initial therapy. CONCLUSIONS: When analyzing subsequent years and switches, treatment patterns can be difficult to capture. Data visualization tools can help present these complicated flows effectively for a diverse health outcomes research audience.

Current Medical Research and Opinion, Jan 18, 2021

Abstract Objective The Prescription Opioid Misuse and Abuse Questionnaire was developed to identi... more Abstract Objective The Prescription Opioid Misuse and Abuse Questionnaire was developed to identify prescription opioid abuse and misuse among patients with chronic pain, however, evidence of construct validity and reproducibility is needed. Methods Chronic pain patients were recruited from five Department of Defense Military Health System clinics across the United States. Construct validity was examined using subjective clinician-reported and patient-reported measures as well as objective information (e.g. hair/urine drug screens and electronic medical records). Test-retest reliability was assessed across 2 timepoints among a subgroup of patients with stable chronic pain. Results Of 3,263 screened patients, 938 (28.7%) met eligibility and were enrolled; 809 (86.2%) completed the Prescription Opioid Misuse and Abuse Questionnaire. Construct validity was supported by comparison to other validated questionnaires and hair and urine screens which yielded high agreements with patient reports on the Prescription Opioid Misuse and Abuse Questionnaire. Electronic medical record data supported patients’ Prescription Opioid Misuse and Abuse Questionnaire responses regarding physician and emergency room visits and opioid refills. The Prescription Opioid Misuse and Abuse Questionnaire had excellent test–retest reliability; the percentage agreement between the two Prescription Opioid Misuse and Abuse Questionnaire administrations was high (>90%) for most questions. Discussion Results suggest that the Prescription Opioid Misuse and Abuse Questionnaire is a valid and reproducible tool that can be used to assess the presence of prescription opioid misuse and abuse among patients with chronic pain.

Neurourology and Urodynamics, 2009

Aims: Although overactive bladder (OAB) impacts patient health-related quality of life, the impac... more Aims: Although overactive bladder (OAB) impacts patient health-related quality of life, the impact of OAB on family members is not known. Presently, no validated instruments exist to assess family impact, thus we examined the psychometric properties of a new instrument, the overactive bladder family impact measure (OAB-FIM). Methods: Dyads of OAB patient-family members and control patient-family members were recruited from clinics. Family members (spouses, significant others, or daughters) completed the 32-item draft OAB-FIM. Patients completed the overactive bladder questionnaire (OAB-q) and the patient perception of bladder condition (PPBC). Both patients and family members completed two validated relationship measures. Item and exploratory factor analyses were performed to determine subscale structure; reliability and validity were assessed. Results: One hundred ninety-three patient-family member dyads (163 OAB, 30 control) participated. OAB patients were mostly women (82%); the control group was younger with fewer women (53%). Family members were predominantly men (OAB, 58%; control, 52%), and control family members were younger than OAB family members. Thirteen items were deleted from the draft OAB-FIM based on item performance and factor structure based on exploratory factor analyses, leaving 19-items in the final OAB-FIM. Four subscales (Irritation, Activities, Travel, Concern) were derived for use among all family members; two additional subscales (Sleep, Sex) were derived for use with spouses/ significant others. The OAB-FIM discriminated between OAB and control family members with OAB family members demonstrating significant impact (all P < 0.0001). Internal consistency reliability (Cronbach's alpha >0.70) and 2-week test-retest reliability (intraclass correlation coefficients >0.73) were high for all subscales. Concurrent validity of the OAB-FIM was demonstrated through statistically significant (P < 0.001) Spearman correlations with the OAB-q (0.35-0.58) and the PPBC (0.31-0.56). The OAB-FIM also demonstrated known-groups validity, distinguishing between family members of OAB patients and family members of control patients. Conclusions: This study supports the reliability and validity of a new measure to assess the impact of OAB on family members and demonstrates that family members are affected by another's medical condition.

Clinical Cardiology, Jul 1, 2000

Background: Antithrombotic adjuncts to fibrinolytic drugs for acute myocardial infarction increas... more Background: Antithrombotic adjuncts to fibrinolytic drugs for acute myocardial infarction increase the rate and speed of infarct artery recanalization. Hyporhesis: A low-molecular-weight heparin might be preferable to unfractionated heparin for this indication, as it has been shown to be in several other thrombus-related vascular disorders. Methods: We performed a pilot study in 20 patients, all receiving aspirin and recombinant tissue plasminogen activator. Randomization was to standard dose intravenous unfractionated heparin or enoxaparin (the fmt dose given intravenously and followed by a subcutaneous administration). The endpoint was stability of anticoagulant effect. Results: Enoxaparin produced stable therapeutic anti-Xa levels with minimal effect on activated partial thromboplastin times. Unfractionated heparin produced wide swings of these parameters, often outside desired levels. Conclusions: Enoxaparin may be a better antithrombotic agent than conventional unfractionated heparin when used in conjunction with fibrinolytics.

Reproductive Sciences, Jun 1, 2013

The menstrual pictogram (MP), a semiquantitative, easy-to-use tool to assess blood loss, was vali... more The menstrual pictogram (MP), a semiquantitative, easy-to-use tool to assess blood loss, was validated against the reference standard of alkaline hematin (AH) quantitation using data pooled from 3 clinical trials. Premenopausal women aged ≥18 years with heavy menstrual bleeding (HMB) associated with uterine leiomyomata were randomized to asoprisnil (10 or 25 mg) or placebo. Patients completed the MP and collected feminine hygiene products for assessment of blood loss by the AH method. Agreement between the MP and the AH method was calculated. The positive predictive value of the MP total to distinguish women with HMB against the AH total was 91%. The agreement (κ-statistic) between AH and MP totals for classifying patients with ≥50% or &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50% decreases in HMB was 0.88 (95% confidence interval [CI], 0.78-0.98), and the MP was 96% sensitive and 92% specific. The methods showed good association for percentage change in blood (intraclass correlation coefficient [ICC] of 0.86, 95% CI, 0.80-0.91) but not for actual blood loss per cycle (ICC of 0.64, [95% CI, 0.55-0.71]); the greatest underestimation occurred for severely stained napkins. In this study, the MP distinguished women with HMB and adequately assessed improvements with therapy.

Heart & Lung, Jul 1, 1998

The evaluation of functional status as an outcome for patients with cardiac disease has become co... more The evaluation of functional status as an outcome for patients with cardiac disease has become common practice in both clinical settings and research studies. However, the measurement of functional status lacks conceptual clarity, frequently focuses on only one dimension of functioning, and overlooks the individuality of the patient. Some measures of functional status have questionable sensitivity to capture change over time, or the ability to discriminate between groups, and lack reports of reliability and validity testing. The purpose of this article is to discuss critical issues related to the evaluation of functional status, with a focus on objective and subjective measures of functional status frequently used in cardiac populations.

Family Practice, Aug 1, 2004

Background. Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in vi... more Background. Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in visual impairment or blindness. Objective. This exploratory qualitative research was conducted to evaluate the symptom experience of DR, its impact on daily activities and health-related quality of life (HRQL), and the applicability of two vision-specific questionnaires. Methods. Four focus groups (n = 15) were conducted with people with DR to explore their symptom experience and the impact on functioning and HRQL. Adults with type I or II diabetes and mild, moderate or severe non-proliferative DR (NPDR) or proliferative DR (PDR) were recruited. Content analysis and descriptive statistics were used to analyse the data. Results. Participants described a range of symptoms and impact. Difficulty driving, especially at night, and trouble reading were noted with all levels of severity. Participants with PDR and decreased visual acuity have foregone many other important life aspects such as work, reading and sports. For the severely affected, diabetic care activities (e.g. exercising, reading nutritional labels, preparing insulin injections and glucose testing) were difficult to accomplish. Loss of independence, especially mobility and increased fear of accidents, had a profound impact on social activities. For those patients who had not experienced other complications of diabetes, the threat of vision loss was the most devastating. Conclusion. The loss of independence and mobility associated with decreased visual functioning and visual loss were major concerns. Moderate, severe NPDR and PDR associated with visual impairment have a significant impact on HRQL, particularly in the areas of independence, mobility, leisure and self-care activities.

The Journal of Allergy and Clinical Immunology: In Practice

Journal of Allergy and Clinical Immunology, 2022

European Urology Focus, 2022

BACKGROUND The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine dur... more BACKGROUND The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine during the main sleep period, has been investigated primarily in middle-aged to older men. There is thus a gap in the NP evidence base for women and for younger individuals. OBJECTIVE To estimate the prevalence of nocturia due to NP in the USA. DESIGN, SETTING, AND PARTICIPANTS This large epidemiologic study used a US population-representative sample of men and women aged ≥30 yr to assess the prevalence of NP (NCT04125186). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Consenting participants completed an online survey (Lower Urinary Tract Symptoms Tool and comorbidities). All who reported two or more voids per night and 100 random respondents each reporting no or one void per night were asked to complete a 3-d bladder diary. Two NP definitions were used: nocturnal urine production >90 ml/h (NUP90) and Nocturnal Polyuria Index >0.33 (NPI33). Crude and population-adjusted prevalence results were calculated from completed diaries for the following subgroups by sex and age: idiopathic NP; NP with overactive bladder (NP-OAB) or bladder outlet obstruction (NP-BOO; men only); NP associated with other comorbidities; and no NP (did not meet the NPI33 or NUP90 definition). RESULTS AND LIMITATIONS Among the 10,190 respondents who completed the survey, the mean age was 54.4 yr (range 30-95); 3,339 reported two or more nocturnal voids and 1,763 completed the 3-d diary (response rate 49.3%). The adjusted overall NP prevalence was 31.5% among men and 38.5% among women using the NPI33 definition, and 23.8% among men and 18.1% among women using NUP90. The adjusted idiopathic NP prevalence was lower among men (NPI33: 5.2%; NUP90: 1.4%) than among women (NPI33: 9.8%; NUP90: 4.0%). The prevalence of idiopathic NP decreased with age as NP associated with other possible causes increased with age in men (most common, BOO) and women (most common, OAB). CONCLUSIONS This is the first population-based study of NP prevalence to include men, women, and young adults. NP is common; a multifactorial etiology should be considered, particularly as age increases. PATIENT SUMMARY In this population-based US study, we examined the frequency of nighttime urination among men and women aged ≥30 y and older. We found that nighttime urination is common among men and women. Many conditions can lead to increased nighttime urination as people age.

Monitoring airway disease, 2020

Monitoring airway disease, 2021

TP10. TP010 CLINICAL AND POPULATION-LEVEL STUDIES OF ASTHMA, 2021

Chest, 2018

Severe uncontrolled asthma (SUA) is under-identified and sub-optimally treated. The clinical and ... more Severe uncontrolled asthma (SUA) is under-identified and sub-optimally treated. The clinical and economic burden is disproportionately high, accounting for nearly 40% of asthma-related costs. With advances in asthma therapies, an urgent need exists to optimize SUA recognition, management, and referrals by primary care to qualified specialists. The AstraZeneca US PRECISION initiative included formation of an advisor network of scientific and clinical experts and health care practitioners (HCPs) to develop best-practice tools for SUA. Here we describe the development of the tool. METHODS: Collaborative focus groups of national experts and local pulmonologists, allergists, primary care providers, and practice team members were conducted to: 1) understand criteria used in clinical practice to detect, treat, and track SUA; 2) identify/create materials to address education gaps and practice barriers; 3) determine efficient ways to implement developed resources. Focus groups were in geographic regions of SUA unmet need, based on public morbidity/mortality indices and patterns of asthma medication use in collaboration with a contract research organization.