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Dysuria

Dysuria: A common urinary tract symptom characterized by painful, difficult, or uncomfortable urination.
It can have various underlying causes, such as infection, inflammation, or obstruction of the urinary tract.
PubCompare.ai can optimize Dysuria research by enhancing reproducibility and accuracy, helping researchers easily locate the best protocols from published literature, preprints, and patents using AI-driven comparisons.
Leveraging PubCompare.ai's powerful tools, researchers can identify the most effective products and streamline their research process, experincing enhanced productivity and confidence in their Dysuria findings.

Most cited protocols related to «Dysuria»

1
Respondent-Driven Sampling of HIV/STI Survey
Participants were recruited using respondent-driven sampling (RDS) according to previously described methods [20 (link)–22 (link)]. Briefly, study staff recruited an initial small group of participants (“seeds”) who had a variety of different sociodemographic characteristics and lived in a variety of neighbourhoods across Abuja and Lagos, Nigeria. Each seed was provided three coupons to distribute to other potential participants in the MSM community. Each subsequent participant who was recruited into the study was given another three coupons and recruitment continued in this manner. This form of recruiting may have reached a wider and more diverse population, including a more marginalized group of study participants [21 (link)].
To be enrolled, each participant had to be an adult (age 16 years or older at the Abuja site and 18 years or older at the Lagos site) who was assigned a male gender at birth and reported receptive or insertive anal intercourse at least once in the previous 12 months. The participant must also have presented a valid RDS coupon.
Upon enrolment, each participant underwent screening for HIV and STIs. Demographic and behavioural data were collected using a structured interview and questionnaire administered by study staff. These data included information about occupation, HIV risk factors and sexual behaviours. A complete medical examination with documentation of medical history was performed by a study physician. The physician asked each participant about the presence of specific symptoms of STIs such as fevers/sweats, thrush/mouth sores, rash, genital discharge, genital/rectal pain and painful urination.
Participants who enrolled in the cohort between 20 March 2013 and 18 January 2016 with documented screening results for HIV, chlamydia and gonorrhoea were included in this analysis.
Keshinro B., Crowell T.A., Nowak R.G., Adebajo S., Peel S., Gaydos C.A., Rodriguez-Hart C., Baral S.D., Walsh M.J., Njoku O.S., Odeyemi S., Ngo-Ndomb T., Blattner W.A., Robb M.L., Charurat M.E, & Ake J. (2016). High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. Journal of the International AIDS Society, 19(1), 21270.
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Publication 2016
Adult Anus Chlamydia Coitus Dysuria Exanthema Fever Genes, vif Genitalia Gonorrhea Insertion Mutation Labor Pain Males Oral Candidiasis Oral Ulcer Patient Discharge Physicians Rectum Sexually Transmitted Diseases Sweat Testing, AIDS
2
Antibiotic Dispensing Practices in Riyadh Pharmacies
A cross sectional study of a quasi-random sample of 327 pharmacies was conducted in Riyadh, the capital of Saudi Arabia with about 5 million habitants, in November 2010. The sample was intended to be representative of all Riyadh pharmacies. The sample was stratified by the five regions of Riyadh (Eastern, Western, Northern, Southern, Central) regardless of the pharmacy's size, deprivation level of the area. A convenience sample of streets was chosen from each region and a complete enumeration of all pharmacies in each street was considered. Each pharmacy was visited once by two investigators (total of 6 male physicians and 2 male medical students participated) who simulated having a brother/sister with a predetermined clinical scenario according to simulated-client method pharmacy surveys [19 (link),20 ]. The scenarios included sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection in a pregnant (childbearing age) women. The investigators concealed their identity and the study objective of their visits from the approached pharmacists who were identified by their licenses and pictures on the front wall of the pharmacy. The clinical scenarios were presented as follow; one investigator talked to the pharmacist while the other observed the discussion and memorized the responses. Immediately after leaving the pharmacy, both investigators completed a standardized data form that included information about the location of the pharmacy, antibiotics dispensing practice, pharmacists' inquiries about associated symptoms (e.g. fever/shortness of breath/abdominal pain/loin pain), allergy history, pregnancy status in case of UTI; type of antibiotic, if dispensed; and information about drug interactions if this was provided by the pharmacist.
Two sessions of standardization took place in the presence of all actors. Each group rehearsed simulating all the clinical scenarios to the senior investigator using the same complaints (terminology and statements). Rehearsal was repeated to ensure reliability of the simulated scenario. The actors used lay language and refrained from using any jargon.
Only the following clinical information was presented to the pharmacist. Any additional information was only provided if the pharmacist inquired about it. The sore throat scenario: a healthy young male relative was described as having difficulties in swallowing with slight fever of 24 hours duration. Acute bronchitis scenario: an elderly man relative was described as having sore throat, cough with sputum production. Additional information provided upon request was the patient had multiple comorbid conditions and was using warfarin.
Acute sinusitis scenario: a young male relative was described as having running nose, facial pain, and headache. Otitis media scenario: a 5-year-old relative child was described as having ear pain and discharge. Urinary tract infection scenario: a childbearing female relative was described as having dysuria and urinary frequency. Diarrhea scenario: a young male relative was described with loose bowel motion for one day.
Three levels of demand were used sequentially until an antibiotic was dispensed or denied [4 (link)]: 1) Can I have something to relieve my symptoms?: 2) Can I have something stronger? 3) I would like to have an antibiotic.
Data are presented as percentage of the pharmacists' responses toward the simulated clinical scenarios.
The study was approved by the Institutional Review Board at King Fahd Medical City. Deception and incomplete disclosure to study subjects (pharmacists) were considered ethically acceptable because this was a minimal risk study and it could not have been performed with complete disclosure of investigator entity. Data were kept anonymous.
Bin Abdulhak A.A., Altannir M.A., Almansor M.A., Almohaya M.S., Onazi A.S., Marei M.A., Aldossary O.F., Obeidat S.A., Obeidat M.A., Riaz M.S, & Tleyjeh I.M. (2011). Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study. BMC Public Health, 11, 538.
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Publication 2011
Abdominal Pain Aged Antibiotics Bronchitis Brothers Child Clinical Investigators Cough Diarrhea Drug Interactions Dyspnea Dysuria Earache Ethics Committees, Research Facial Pain Fever Headache Hypersensitivity Males Otitis Media Patient Discharge Patients Physicians Pregnancy Rhinorrhea Sinusitis Sore Throat Sputum Students, Medical Urinary Tract Infection Urine Warfarin Woman
3
Systematic Review of IC/BPS Diagnosis and Treatment

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Publication 2011
Chronic Pain Cystitis Diagnosis Dietary Supplements Dysuria Hypersensitivity Interstitial Cystitis, Chronic Mastocytosis Pain Patients Pelvic Diaphragm Pelvic Pain Pelvis Syndrome Urinary Bladder
4
Urinary Tract Infection Symptom Diary Study
We excluded those in whom antibiotic treatment is more definitely indicated (children, men, pregnant women, patients with pyelonephritis), those with nausea, vomiting, or other severe systemic symptoms, and women aged over 75 (in this age group there is a different pattern of symptom reporting12 (link)
13 ). We also excluded patients with psychotic illnesses or dementia or who needed terminal care as they might be unable to complete the diary.
General practitioners or practice nurses recruited patients with suspected urinary tract infection. The practitioner recorded baseline symptoms, clinical information, and age, sex, and postcode, and noted whether antibiotics were prescribed. They also asked all patients to provide a fresh sample of midstream urine. Each patient kept a daily diary of symptoms, grading severity for up to 14 days: 0 (no symptoms), 1 (very slight problem), 2 (slight problem), 3 (moderately bad problem), 4 (bad problem), 5 (very bad problem), or 6 (as bad as it could be). The symptoms in the diary (dysuria, haematuria, frequency during day and night, “smelly urine,” “tummy pain,” generally feeling unwell, and restriction of daily activities) were chosen based on the common presenting symptoms of urinary tract infection10
14 (link) and were collected in a diary that has previously been validated and shown to be sensitive to change for other acute infections.15 (link) Patients were also phoned by the research assistant after three days to check there were no problems with completing the questions but were not asked about compliance or to return to the surgery as this could alter their behaviour. A reminder was sent if no diary was returned and, if necessary, a subsequent shorter questionnaire and telephone contact to provide basic information about the duration of symptoms.
When they had completed the diary, patients also completed a validated questionnaire about their perceptions of different aspects of communication in the consultation.2 (link)
7 (link) Their perceptions of the doctor’s communication were all measured on a scale from 0 (very strongly disagree that the doctor did this) to 6 (very strongly agree).2 (link)
7 (link) They also described enablement—the extent to which they felt enabled to manage both this episode and future episodes16 (link)—and completed a somatic symptom inventory (a measure of somatisation)6 (link) when the diary was finished. On completion they returned their diaries to the research centre in a freepost envelope.
Little P., Merriman R., Turner S., Rumsby K., Warner G., Lowes J.A., Smith H., Hawke C., Leydon G., Mullee M, & Moore M.V. (2010). Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. The BMJ, 340, b5633.
Publication 2010
Age Groups Antibiotics Child Dementia Dysuria Feelings General Practitioners Hematuria Infection Medically Unexplained Symptoms Mental Disorders Nausea Nurses Operative Surgical Procedures Pain Patients Physicians Pregnant Women Pyelonephritis Sense of Smell Terminal Care Urinary Tract Urinary Tract Infection Urine Woman
5
Differential Diagnosis of Arboviral Infections
Presence of the following clinical features were assessed: maculopapular rash, itching, edema, macular rash, enanthema, lymphadenopathy, arthralgia, conjunctival hyperemia, oropharyngeal pain, earache, nasal congestion, purpura, fever, vomiting, hepatomegaly, abdominal pain, nausea, anorexia, headache, taste alteration, bleeding, prostration, lightheadedness, chills, myalgia, dyspnea, low back pain, cough, coryza diarrhea, gingivorrhagia, sweating, petechiae, hoarseness, choluria, dysuria, photophobia, retro-orbital pain and epistaxis. These signs and symptoms were evaluated in the first medical visit by history and clinical examination recorded in structured case report forms. Data on signs and symptoms present on the first or second clinic visit within the first week of disease was collected.
Confirmatory diagnosis of infection for ZIKV, DENV and CHIKV was made by real time PCR test of blood or urine specimens obtained during the same time period [10 (link)]. Dual or triple co-infections were excluded from analysis. Other febrile illnesses (OFI) were diagnosed based on negatives PCR results for all circulating arbovirus. Patients included before 2015 and those who tested negative for ZIKV by RT-PCR were classified as Zika-negative.
Braga J.U., Bressan C., Dalvi A.P., Calvet G.A., Daumas R.P., Rodrigues N., Wakimoto M., Nogueira R.M., Nielsen-Saines K., Brito C., Bispo de Filippis A.M, & Brasil P. (2017). Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics. PLoS ONE, 12(6), e0179725.
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Publication 2017
Abdominal Pain Anorexia Arboviruses Arthralgia Chills Clinic Visits Coinfection Common Cold Conjunctiva Cough Diarrhea Dyspnea Dysuria Earache Edema Epistaxis Exanthema Fever Gingival Hemorrhage Headache Hematologic Tests Hoarseness Hyperemia Infection Lightheadedness Low Back Pain Lymphadenopathy Macula Lutea Myalgia Nausea Nose Oropharynxs Pain Patients Petechiae Photophobia Physical Examination Purpura Real-Time Polymerase Chain Reaction Reverse Transcriptase Polymerase Chain Reaction Urine Zika Virus

Most recents protocols related to «Dysuria»

1
Chlamydia: Diagnosis, Transmission, and Impacts
Not available on PMC !

Example 2

Chlamydia is a common STI that is caused by the bacterium Chlamydia trachomatis. Transmission occurs during vaginal, anal, or oral sex, but the bacterium can also be passed from an infected mother to her baby during vaginal childbirth. It is estimated that about 1 million individuals in the United States are infected with this bacterium, making chlamydia one of the most common STIs worldwide. Like gonorrhea, chlamydial infection is asymptomatic for a majority of women. If symptoms are present, they include unusual vaginal bleeding or discharge, pain in the abdomen, painful sexual intercourse, fever, painful urination or the urge to urinate more frequently than usual. Of those who develop asymptomatic infection, approximately half may develop PID. Infants born to mothers with chlamydia may suffer from pneumonia and conjunctivitis, which may lead to blindness. They may also be subject to spontaneous abortion or premature birth.

Diagnosis of chlamydial infection is usually done by nucleic acid amplification techniques, such as PCR, using samples collected from cervical swabs or urine specimens (Gaydos et al., J. Clin. Microbio., 42:3041-3045; 2004). Treatment involves various antibiotic regimens.

In some embodiments, the disclosed device can be used to detect chlamydial infections from menstrual blood or cervicovaginal fluids.

US11864740B2. Sample collection and preservation devices, systems and methods (2024-01-09). NextGen Jane, Inc. [US]. Inventors: Ridhi Tariyal [US], Stephen K. Gire [US].
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Patent 2024
Abdominal Pain Antibiotics Anus Asymptomatic Infections Bacteria Blindness Blood Childbirth Chlamydia Chlamydia Infections Chlamydia trachomatis Coitus Conjunctivitis Diagnosis Dysuria Fever Gonorrhea Infant Medical Devices Menstruation Mothers Neck Nucleic Acid Amplification Techniques Pain Patient Discharge Pneumonia Premature Birth Sexually Transmitted Diseases Spontaneous Abortion Transmission, Communicable Disease Treatment Protocols Urine Vagina Woman
2
Qualitative Insights into Self-Collected STI Sampling
Implemented by the Rakai Health Sciences Program (RHSP), the Rakai Community Cohort Study (RCCS) is an ongoing, open community-based cohort of residents aged 15–49 years in agrarian communities, semi-urban trading centers and Lake Victoria fishing communities in south-central Uganda. 25 (link) The RCCS includes the administration of a demographic and health questionnaire, as well as HIV testing for all consenting participants. Nested within the RCCS, the STI Prevalence Study (STIPS) aimed to estimate STI prevalence among 1,825 sexually active HIV+ and HIV- men and women aged 18–49 years in two communities (one inland and one fishing), from May to October 2019. 26 (link) STIPS participants were tested for Trichomonas vaginalis (TV) (in the field), syphilis (screening in the field; samples tested in the lab), N. gonorrhoeae (NG), C. trachomatis (CT), and herpes simplex virus type 2 (HSV-2) (samples tested in the lab). To this end, three provider-collected penile-meatal swabs were obtained for all male STIPS participants who consented to STI testing. Because we were interested in men’s experience with SCS, a fourth, self-collected swab was obtained from a sub-sample of men (n=40); it is from this sub-sample that we recruited the male study participants for our qualitative interviews (n=15). Three self-collected vaginal swabs were obtained for all female STIPS participants who consented to STI testing (provider-collected samples were not obtained for females); it is from this sample that we recruited the female study participants for our qualitative interviews (n=21). All participants who self-collected samples received instructions from a same-gender provider before sample collection and were then given privacy to self-collect. Interviews were conducted after participants received their HIV, TV and syphilis screening results but before their NG, CT and HSV-2 results. Individuals who tested positive for STIs were provided treatment by RHSP according to the Ugandan National Clinical Treatment Guidelines for Sexually Transmitted Infections.
This qualitative study was conducted among 36 adults—15 men and 21 women—from the STIPS rural, inland community who self-collected a sample in STIPS. We selected participants based on gender and self-reported symptom status, with 9/15 (60%) men and 15/21 (71%) women reporting at least one STI-related symptom in the last six months. Symptoms included: genital ulcer, genital discharge, frequent urination, painful urination, pain during intercourse, bleeding during intercourse, lower abdominal pain, genital warts, and for females: thick and/or colored vaginal discharge, vaginal itching and unpleasant vaginal odor. We conducted semi-structured interviews that explored participants’ experiences and preferences related to SCS/STI testing. Interviews were conducted in a private location of the participant’s choosing. RHSP social and behavioral scientists conducted all interviews in Luganda. The interviewers and study lead debriefed after each interview.
Interviewers transcribed and translated interviews into English. We then imported the data into MAXQDA 201827 for review and initial analysis. Our analysis methods were adapted from the Framework Method. 28 (link) First, we reviewed the interviews in MAXQDA to familiarize ourselves with the data. Second, we developed an analytic framework comprised of categories that were informed by our interview guide and research questions. We used this framework to index the interviews. Third, after all interviews were indexed, we charted the data into a framework matrix in Excel. Fourth, we conducted open-ended coding, followed by focused coding, 29 to identify prominent themes within each category. Prominent themes were defined by the depth of discussion any one participant provided on the topic, prevalence across participants and ‘keyness’ in relation to our research questions. 30 (link) Fifth, we compared the themes by gender and symptom status to assess for any meaningful differences. Finally, we discussed our findings among the research team, including interviewers and co-investigators, to ensure clarity and cohesion.
Ogale Y.P., Grabowski M.K., Nabakka P., Ddaaki W., Nakubulwa R., Nakyanjo N., Nalugoda F., Kagaayi J., Kigozi G., Denison J.A., Gaydos C, & Kennedy C.E. (2023). The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda. medRxiv.
Publication Preprint 2023
Abdominal Pain Adult Chlamydia trachomatis Coitus Condylomata Acuminata Dysuria Females Gender Genitalia Gonorrhea HIV-1 Human Herpesvirus 2 Interviewers Males Neisseria gonorrhoeae Odors Pain Patient Discharge Penis Rural Communities Specimen Collection Syphilis Trichomonas vaginalis Ulcer Urination Vagina Wellness Programs Woman
3
Defining Catheter-Associated Urinary Tract Infections
Urinary catheter-associated E. coli isolates were identified from a previously described study of bacteriuric (> 5 × 104 CFU/mL) inpatients (5 (link), 6 (link)). CAUTI was defined as fever (T > 38°C) with contemporaneous bacteriuria and urinary catheter placement (69 (link)). Documented urinary symptoms (dysuria, lower abdominal pain, flank pain) in the absence of fever were regarded as insufficient for CAUTI diagnosis due to their poor reliability in inpatients, particularly those with urinary catheters (1 (link), 4 (link), 7 (link)). CAASB was defined as bacteriuria in the absence of fever and documented urinary symptoms.
Zou Z., Potter R.F., McCoy WH 4.t.h., Wildenthal J.A., Katumba G.L., Mucha P.J., Dantas G, & Henderson J.P. (2023). E. coli catheter-associated urinary tract infections are associated with distinctive virulence and biofilm gene determinants. JCI Insight, 8(2), e161461.
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Publication 2023
Abdominal Pain Diagnosis Dysuria Escherichia coli Fever Flank Pain Inpatient Urinary Catheter Urinary Catheterization Urine
4
Schistosomiasis and FGS Knowledge, Awareness, and Care
Data collected (See S1 File) were imported from password protected online repository into R studio for analysis. Descriptive statistics such as frequencies and percentages were used to summarize; (1) knowledge and awareness of schistosomiasis and FGS among students and HCPs, (2) prevalence of schistosomiasis suspicion among practitioners who give FGS care, (3) availability of FGS care commodities at health care centers, and (4) students’ experience when they sought care on FGS-related symptoms. Chi-square tests was used to examine differences between proportion, and a univariate logistic regression model was performed to estimate if the year of study for the medical and paramedical students influences their knowledge about schistosomiasis and FGS. Additionally, we extracted the anonymized dataset of students who had experienced some of the probable symptoms of FGS and had visited the hospital for medical care. We performed a cross-tabulation analysis on two variables; (i) the symptoms experienced, and (ii) if the practitioner who provided care asked about a major risk factor for FGS (i.e., freshwater contact practice). Chi-square test was also used to test for associations. Similarly for the HCPs, we modelled knowledge about schistosomiasis and FGS against year of practice (less or greater than 10 years) and expertise in performing pelvic examinations; treating venereal diseases; hematuria, lower abdominal pain, dysuria, or and previous suspicion of schistosomiasis during such examinations/treatment. Odd ratios (OR) and 95% Confidence Intervals (CI) were reported accordingly, with significant level established at p < 0.05. All statistical procedures were performed in R studio.
Aribodor O.B., Mogaji H.O., Surakat O.A., Azugo N.O., Jacob E.C., Obikwelu E.M., Nebe O.J, & Jacobson J. (2023). Profiling the knowledge of female medical/para-medical students, and expertise of health care professionals on female genital schistosomiasis in Anambra, South Eastern Nigeria. PLOS Neglected Tropical Diseases, 17(2), e0011132.
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Publication 2023
Abdominal Pain Awareness Dysuria Hematuria Pelvic Examination Physical Examination Schistosomiasis Sexually Transmitted Diseases Student
5
Assessing FGS Awareness among MPMS and HCPs
We used two separate tools (See https://tinyurl.com/mkudxmsw) and (See https://tinyurl.com/mudvvh7t) to document responses from female MPMS and HCPs, respectively. For HCPs, demographic information including age, gender, profession, year of practice and place of work were documented. In addition, we collected information on HCPs expertise on a range of symptoms/condition that overlaps with FGS pathology. These included; (i) if the practitioner performs pelvic examination, (ii) treat venereal diseases, (ii) lower abdominal pain, (iv) dysuria or (v) hematuria. Knowledge of HCPs about schistosomiasis and FGS were also documented, with emphasis on (i) awareness, (ii) source of information, (iii) transmission routes, (iv) preventive practices, (v) treatment choices with emphasis on pregnant women, and (vi) dosage requirements for children and adult. HCPs were also asked if FGS patients should be quarantined and if care commodities for FGS patients are available in their place of work (See S1 File)
Similarly for female MPMS, we collected information on age, religion, parents’ occupation and income. In addition, knowledge about schistosomiasis and FGS were documented, with emphasis on awareness and source of information. We also documented if MPMS (i) have ever been treated with praziquantel, (ii) had contact with freshwater, or (iii) had experienced any of the following symptoms that overlaps with FGS pathology; hematuria, painful urination, lower abdominal pain and venereal diseases (See S1 File).
Aribodor O.B., Mogaji H.O., Surakat O.A., Azugo N.O., Jacob E.C., Obikwelu E.M., Nebe O.J, & Jacobson J. (2023). Profiling the knowledge of female medical/para-medical students, and expertise of health care professionals on female genital schistosomiasis in Anambra, South Eastern Nigeria. PLOS Neglected Tropical Diseases, 17(2), e0011132.
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Publication 2023
1-methyl-1-piperidinomethane sulfonate Abdominal Pain Adult Awareness Child Dysuria Gender Hematuria Parent Patients Pelvic Examination Praziquantel Pregnant Women Schistosomiasis Selection for Treatment Sexually Transmitted Diseases Transmission, Communicable Disease Woman

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More about "Dysuria"

Dysuria, also known as painful urination or difficult urination, is a common urinary tract symptom that affects many individuals.
This condition is characterized by discomfort, pain, or a burning sensation during the process of urinating.
Dysuria can have various underlying causes, including urinary tract infections (UTIs), inflammation of the bladder or urethra, obstruction of the urinary tract, or even certain medical conditions like sexually transmitted infections (STIs).
Researchers and medical professionals can utilize tools like PubCompare.ai to optimize their Dysuria research.
This AI-driven platform can enhance the reproducibility and accuracy of studies by helping researchers easily locate the best protocols and methodologies from published literature, preprints, and even patents.
By leveraging the powerful comparison features of PubCompare.ai, researchers can identify the most effective products and streamline their research process, leading to enhanced productivity and confidence in their Dysuria findings.
It's important to note that Dysuria can be caused by a variety of factors, and proper diagnosis and treatment are crucial.
Healthcare providers may employ a range of diagnostic tools, such as IsoVitaleX, Combur 9 Test strips, API Candida, and Cobas urine specimen collection kits, to help identify the underlying cause.
Statistical analysis software like Stata 12.0, SPSS Statistics for Windows (Version 25.0), and SAS software 9.4 can also be utilized to analyze research data and draw meaningful conclusions.
In some cases, patients may be treated with antibiotics or other medications, depending on the cause of their Dysuria.
However, it's important to follow the guidance of healthcare professionals and to avoid self-medicating, as this could lead to further complications.
By understanding the various aspects of Dysuria and the tools available to optimize research, researchers and healthcare providers can work together to improve the diagnosis, treatment, and management of this common urinary tract symptom, ultimately leading to better patient outcomes.