70 Chapter 5 2023. No reminders were sent. Two months after the invitation, we determined the response on the questionnaire and assessed the answers of the returned anonymous questionnaires. Participants were excluded from analysis if they had not fully completed the questionnaire. All self-BAT questionnaires were reviewed, and total and domain-specific scores determined by a gynecologist specializing in bleeding disorders in women (H.P.E) and double-checked by a second clinician, also familiar with bleeding disorders in women (M.C.P). Measurements The survey consisted of two sections. Section one collected the patients’ self-reported demographic characteristics and clinical data which included: age (yrs), weight (kg), length (cm), smoking (no/yes), alcohol use (no/yes), sporting >2 hours a week (no/yes), anticoagulant use (no/yes), and positive family history for bleeding disorders (no/yes, if yes which) [14], [15]. Section two included the self-BAT tool. The self-BAT questionnaire consists of 14 domains covering epistaxis, cutaneous bleeding, minor cutaneous wounds, hematuria, gastrointestinal bleeding, oral cavity bleeding, tooth extraction, surgical bleeding/major trauma, menorrhagia, postpartum bleeding, muscle hematomas, hemarthrosis, central nervous system bleeding, and one final domain on other bleeding symptoms like bleeding during intercourse [13]. Each domain scores from 0 (absence of bleeding symptoms) to 4 (symptoms requiring extensive medical intervention), and the overall bleeding score is determined by summing the scores for all domains with a range of 0 till 56 [8]. This validated self-BAT has cut-off values to define bleeding tendency per age group, defined as, ≥5 points in the 18-30 years group, ≥6 points in 31-52 years group. [16]. To assess whether an abnormal self-BAT score is associated to treatments, we used a score of 6 as the cut-off level, because a self-BAT score of 6 or greater in females is considered as abnormal [10]. A free-text section (‘We may not have asked everything you’d like to talk about. You may write down any other problems with bleeding or other things, such as comments on this questionnaire, below’) was added to the self-BAT questionnaire to capture a broader perspective and deeper understanding of study participants’ experiences and to elicit their views regarding management for HMB that are important to them. Statistical Analysis Data were collected anonymized and entered into an IBM SPSS statistics version 29 (IBM Corp., Armonk, New York, United States) dataset for statistical analysis. For the self-BAT scores: median scores, interquartile range (IQR, 25–75%) and frequencies for distribution were calculated. Due to unequally distributed data and some small sample sizes per group, presented P values were derived from χ2 test or Fisher exact test with 95% confidence intervals (CI). Continuous variables are reported with numbers (%) or depending on the distribution as a mean ± standard deviation (± SD) or median with IQR. Outcomes of logistic regression analysis are used to estimate the linear combination of self-BAT outcome and medical or surgical treatment outcome for HMB, reported as odds ratio (OR) and 95% confidence interval (CI). A p-value of less than 0.05 was considered statistically significant. Open answers were independently categorized by two authors (H.P.E. and M.C.P), and subsequently analyzed by an independent assessor (E.G.). Any disagreement was discussed until consensus was achieved.
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