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PloS One 2024The COmprehensive Score for Financial Toxicity (COST) has proven to be a reliable tool for quantifying the impact of financial toxicity (FT) in patients with cancer in...
INTRODUCTION
The COmprehensive Score for Financial Toxicity (COST) has proven to be a reliable tool for quantifying the impact of financial toxicity (FT) in patients with cancer in clinical and public health settings. However, the COST has not yet been validated in Vietnam. Therefore, we aimed to evaluate its reliability and validity among Vietnamese patients with cancer.
METHODS
A cross-sectional study was conducted in a sample of 300 patients with cancer aged 27-95 years (mean: 58.5±11.2) in a tertiary hospital. The COST was translated into Vietnamese and English and adjusted to suit the local culture. Reliability was evaluated using Cronbach's alpha and McDonald's omega coefficients. The construct and convergent validities were also assessed.
RESULTS
The COST demonstrated good internal consistency and reliability (Cronbach's alpha = 0.913; McDonald's omega = 0.915). The exploratory factor analysis revealed two factors that explained 64.9% of the variance. The adjusted fit indices indicated a good fit of the model (χ2 (39) = 67.78, p = 0.003; standardized root mean squared residual = 0.042; Tucker-Lewis index = 0.971; comparative fit index = 0.979; root mean square error of approximation = 0.061, 90% confidence interval = 0.035-0084). Higher COST scores were significantly correlated with higher health-related quality of life (EQ-5D-5L utility score: r = 0.21, p = 0.002; EQ VAS: r = 0.28, p < 0.001). Multivariate quantile regression analysis revealed that female sex, rural residence, and unstable job/unemployment were associated with lower COST scores. There was no statistically significant difference in other factors, including clinical factors (types of cancer, staging, and treatment modalities).
CONCLUSIONS
The COST is reliable and valid, making it suitable for assessing FT severity in Vietnamese patients with cancer.
Topics: Humans; Middle Aged; Male; Female; Vietnam; Aged; Adult; Neoplasms; Cross-Sectional Studies; Aged, 80 and over; Reproducibility of Results; Surveys and Questionnaires; Cost of Illness; Southeast Asian People
PubMed: 38941304
DOI: 10.1371/journal.pone.0306339 -
PloS One 2024Application essays are a commonly used admission instrument for students entering higher education. The quality of the essay is usually scored, but this score is often...
Application essays are a commonly used admission instrument for students entering higher education. The quality of the essay is usually scored, but this score is often subjective and has poor interrater reliability due to the unstructured format of the essays. This results in mixed findings on the validity of application essays as an admission instrument. We propose a more objective method of using application essays, using Latent Dirichlet Allocation (LDA), a text mining method, to distinguish seven moves occurring in application essays written by students who apply to a master degree program. We use the probability that these moves occur in the essay to predict study success in the master. Thereby we answer the following research question: What is the effect of discussing different moves in students' application essays on the student grades in a master program? From the seven different moves (functional unit of text) we distinguished, five of which have a significant effect on student grades. The moves we labeled as 'master specific' and 'interest to learn' have a positive effect on student grades, and the moves we labeled as 'research skills', 'societal impact' and 'city and university' have a negative effect. Our interpretation of this finding is that topics related to intrinsic motivation and specific knowledge, as opposed to generic knowledge, are positively related with study success. We thereby demonstrate that application essays can be a valid predictor of study success. This contributes to justifying their use as admission instruments.
Topics: Humans; Students; School Admission Criteria; Universities; Educational Measurement
PubMed: 38941298
DOI: 10.1371/journal.pone.0304394 -
PloS One 2024To investigate associations between a swimmer's career progression and winning a medal at the Olympic Games (OG) or World Championships (WC). A total of 4631 swimming...
To investigate associations between a swimmer's career progression and winning a medal at the Olympic Games (OG) or World Championships (WC). A total of 4631 swimming performances of 1535 top swimmers (653 women, 882 men) from 105 nationalities since1973 were extracted from FINA rankings. A panel of 12 predictor variables including nationality, gender, competition, age, number and timing of competitions, pattern of progressions and regressions in performance, and medal outcomes was established. Linear logistic regression was used to study the association between winning a medal and predictor variables. Logistic regression coefficients were obtained by training on 80% of the database, and prediction accuracy evaluated on the remaining 20%. Using the training set, a selection of 9 most relevant features for prediction of winning a medal (target variable) was obtained through exhaustive feature selection and cross-validation: nationality, competition, number of competitions, number of annual career progressions (nb_prog), maximum annual career progression (max-progr), number of annual career regressions (nb_reg), age at maximum annual progression, P6 (the level of performance six months before the World Championships or Olympic Games), and P2 (the level of performance two months before the World Championships or Olympic Games). A logistic regression model was built and retrained on the entire training set achieved an area under the ROC curve of ~90% on the test set. The odds of winning a medal increased by 1.64 (95% CI, 1.39-1.91) and 1.44 (1.22-1.72) for each unit of increase in max-progr and n-prog, respectively. Odds of winning a medal decreased by 0.60 (0.49-0.72) for a unit increase in n-reg. In contrast, the odds increased by 1.70 (1.39-2.07) and 4.35 (3.48-5.42) for improvements in the 6 and 2 months before competition (P<0.001, for all variables). The likelihood of a swimmer winning an international medal is improved by ~40-90% with progressions from season-to-season, and reducing the number of regressions in performance. The chances of success are also improved 2- to 4-fold by substantial improvements in performance in the months before competition.
Topics: Humans; Swimming; Male; Female; Athletic Performance; Awards and Prizes; Adult; Logistic Models; Competitive Behavior; Athletes
PubMed: 38941281
DOI: 10.1371/journal.pone.0304444 -
JMIR Research Protocols Jun 2024Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases....
Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study.
BACKGROUND
Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a "stepper" for 6 minutes.
OBJECTIVE
This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings.
METHODS
Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec in Québec, Groupement des Hôpitaux de l'Institut Catholique de Lille in France, and FormAction Santé in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Québec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Québec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives.
RESULTS
Ethical approval was received for this project (October 12, 2023, in Québec and September 25, 2023, in France) and the first participant was recruited in February 2024.
CONCLUSIONS
This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11).
TRIAL REGISTRATION
ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/57404.
Topics: Humans; Chronic Disease; Exercise Test; Reproducibility of Results; COVID-19; Male; Female; Adult; Middle Aged; Telerehabilitation; Walk Test; Telemedicine
PubMed: 38941132
DOI: 10.2196/57404 -
JAMA Network Open Jun 2024Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.
IMPORTANCE
Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.
OBJECTIVE
To measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network. Participants were individuals aged 15 to 21 years presenting to the ED who completed the confidential sexual health survey and indicated female sex assigned at birth and prior penile-vaginal sexual intercourse. Data analysis was performed from January 2023 to February 2024.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the type and proportion of contraception use, the PRI, and provision of EC. Separate multivariable logistic regression models were performed to identify sociodemographic factors associated with these outcomes.
RESULTS
A total of 1063 participants (median [IQR] age, 17.5 [16.5-18.3] years) were included in this analysis; 219 (20.8%) identified as Hispanic, 464 (44.1%) identified as non-Hispanic Black, 308 (29.3%) identified as non-Hispanic White, and 61 (5.8%) identified as other races and ethnicities. In total, 756 participants (71.1%) reported contraception use during their last sexual encounter. Long-acting reversible contraception use (LARC) was the least used (164 participants [15.4%]), and 307 (28.9%) reported no contraception use. Sociodemographic factors associated with overall contraception use, and LARC use specifically, included insurance and race and ethnicity. The overall PRI was 7.89, or an expected 8 pregnancies per 100 female individuals per year. Although 108 participants (10.2%) were eligible for EC, EC was ordered for only 6 (5.6%) of those eligible.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in the ED setting.
Topics: Humans; Adolescent; Female; Pregnancy; Emergency Service, Hospital; Cross-Sectional Studies; Young Adult; Pregnancy in Adolescence; Contraception Behavior; Contraception, Postcoital; United States; Pregnancy, Unplanned; Contraception
PubMed: 38941097
DOI: 10.1001/jamanetworkopen.2024.18213 -
JAMA Network Open Jun 2024While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper...
IMPORTANCE
While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper limit of normal (reference range) at presentation, early imaging is often used for confirmation. A prior prediction model and corresponding point-based score were developed using nonimaging parameters to diagnose AP in patients presenting to the emergency department (ED).
OBJECTIVE
To evaluate the performance of the prediction model to diagnose AP in a prospective patient cohort.
DESIGN, SETTING, AND PARTICIPANTS
This prospective diagnostic study included consecutive adult patients presenting to the ED between January 1, 2020, and March 9, 2021, at 2 large academic medical centers in the northeastern US with serum lipase levels at least 3 times the upper limit of normal. Patients transferred from outside institutions or with malignant disease and established intra-abdominal metastases, acute trauma, or altered mentation were excluded. Data were analyzed from October 15 to October 23, 2023.
EXPOSURES
Participants were assigned scores for initial serum lipase level, number of prior AP episodes, prior cholelithiasis, abdominal surgery within 2 months, presence of epigastric pain, pain of worsening severity, duration from pain onset to presentation, and pain level at ED presentation.
MAIN OUTCOME AND MEASURES
A final diagnosis of AP, established by expert review of hospitalization records.
RESULTS
Prospective scores in 349 participants (mean [SD] age, 53.0 [18.8] years; 184 women [52.7%]; 66 Black [18.9%]; 199 White [57.0%]) demonstrated an area under the receiver operating characteristics curve of 0.91. A score of at least 6 points achieved highest accuracy (F score, 82.0), corresponding to a sensitivity of 81.5%, specificity of 85.9%, positive predictive value of 82.6%, and negative predictive value of 85.1% for AP diagnosis. Early computed tomography or magnetic resonance imaging was performed more often in participants predicted to have AP (116 of 155 [74.8%] with a score ≥6 vs 111 of 194 [57.2%] with a score <6; P < .001). Early imaging revealed an alternative diagnosis in 8 of 116 participants (6.9%) with scores of at least 6 points, 1 of 93 (1.1%) with scores of at least 7 points, and 1 of 73 (1.4%) with scores of at least 8 points.
CONCLUSIONS AND RELEVANCE
In this multicenter diagnostic study, the prediction model demonstrated excellent AP diagnostic accuracy. Its application may be used to avoid unnecessary confirmatory imaging.
Topics: Humans; Pancreatitis; Female; Male; Prospective Studies; Middle Aged; Adult; Lipase; Emergency Service, Hospital; Aged; Predictive Value of Tests; Acute Disease; Abdominal Pain
PubMed: 38941094
DOI: 10.1001/jamanetworkopen.2024.19014 -
JAMA Health Forum Jun 2024Sponsorship of promotional events for health professionals is a key facet of marketing campaigns for pharmaceuticals and medical devices; however, there appears to be...
IMPORTANCE
Sponsorship of promotional events for health professionals is a key facet of marketing campaigns for pharmaceuticals and medical devices; however, there appears to be limited transparency regarding the scope and scale of this spending.
OBJECTIVE
To develop a novel method for describing the scope and quantifying the spending by US pharmaceutical and medical companies on industry-sponsored promotional events for particular products.
DESIGN AND SETTING
This was a cross-sectional study using records from the Centers for Medicare & Medicaid's Open Payments database on payments made to prescribing clinicians from January 1 to December 21, 2022.
MAIN OUTCOMES AND MEASURES
An event-centric approach was used to define sponsored events as groupings of payment records with matching variables. Events were characterized by value (coffee, lunch, dinner, or banquet) and number of attendees (small vs large). To test the method, the number of and total spending for each type of event across professional groups were calculated and used to identify the top 10 products related to dinner events. To validate the method, we extracted all event details advertised on the websites of 4 state-level nurse practitioner associations that regularly hosted industry-sponsored dinner events during 2022 and compared these with events identified in the Open Payments database.
RESULTS
A total of 1 154 806 events sponsored by pharmaceutical and medical device companies were identified for 2022. Of these, 1 151 351 (99.7%) had fewer than 20 attendees, and 922 214 (80.0%) were considered to be a lunch ($10-$30 per person). Seven companies sponsored 16 031 dinners for the top 10 products. Of the 227 sponsored in-person dinner events hosted by the 4 state-level nurse practitioner associations, 168 (74.0%) matched events constructed from the Open Payments dataset.
CONCLUSIONS AND RELEVANCE
These findings indicate that an event-centric analysis of Open Payments data is a valid method to understand the scope and quantify spending by pharmaceutical and medical device companies on industry-sponsored promotional events attended by prescribers. Expanding and enforcing the reporting requirements to cover all payments to all registered health professionals would improve the accuracy of estimates of the true extent of all sponsored events and their impact on clinical practice.
Topics: Humans; Cross-Sectional Studies; United States; Drug Industry; Marketing; Conflict of Interest; Centers for Medicare and Medicaid Services, U.S.
PubMed: 38941087
DOI: 10.1001/jamahealthforum.2024.1581 -
Alternative Therapies in Health and... Jun 2024The objective of this study was to evaluate the efficacy of the combined treatment of Ying-Huang Decoction and San-ao Decoction compared to conventional treatment alone...
OBJECTIVE
The objective of this study was to evaluate the efficacy of the combined treatment of Ying-Huang Decoction and San-ao Decoction compared to conventional treatment alone in patients with sepsis-associated acute lung injury (S-ALI) and to assess its potential mechanisms for improving clinical symptoms, reducing inflammatory response, and promoting respiratory function recovery.
METHODS
We included 84 S-ALI patients admitted to our hospital between January 2021 and January 2023. The patients were divided into a control group and an observation group, with 42 patients in each group. The control group received conventional treatment, while the observation group received the combined treatment of Ying-Huang Decoction and San-ao Decoction in addition to conventional treatment. The study was conducted in accordance with the principles of the Helsinki Declaration and received ethical approval. The main outcome measures assessed included symptom scores, levels of inflammatory factors, lung injury scores (such as LIS scores), respiratory function parameters (such as PVPI and EVLWL levels), and the incidence of adverse reactions.
RESULTS
The observation group receiving the combined treatment of Ying-Huang Decoction and San-ao Decoction demonstrated favorable outcomes compared to the control group. Significant improvements were observed in the observation group's symptom scores compared to the control group (P < .05). Patients in the observation group experienced a notable alleviation of clinical symptoms associated with S-ALI. In terms of inflammatory response, the observation group showed significantly lower levels of inflammatory factors, including IL-6, CRP, and IL-17, compared to the control group (P < .01). This suggests that the combined decoction treatment effectively reduced the systemic inflammatory response in S-ALI patients. Lung injury scores, as assessed by the LIS, were significantly reduced in the observation group compared to the control group (P < .05). This indicates that the combined treatment contributed to the mitigation of lung tissue damage in S-ALI patients. Respiratory function parameters, such as PVPI and EVLWL levels, showed significant improvement in the observation group compared to the control group (P < .01), indicating enhanced respiratory function.
CONCLUSION
The combined treatment of Ying-Huang Decoction and San-ao Decoction, in addition to conventional treatment, demonstrated beneficial effects in the management of S-ALI, leading to improved clinical symptoms, reduced inflammatory response, and enhanced respiratory function. These findings suggest the potential integration of traditional Chinese medicine approaches, such as Ying-Huang Decoction and San-ao Decoction, in the treatment of S-ALI, providing additional options for clinicians and potentially improving patient outcomes. It is important to acknowledge the limitations of this study, such as its retrospective design and the need for further research with larger sample sizes to validate the results and minimize potential biases.
PubMed: 38940807
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Stroke is a major cause of long-term disability in adults. Routine nursing mainly meets the life needs of patients through the intervention of patients' general life but...
BACKGROUND
Stroke is a major cause of long-term disability in adults. Routine nursing mainly meets the life needs of patients through the intervention of patients' general life but only provides the most basic services for patients, which makes it difficult to meet the requirements of patients' physical exercise and other aspects, affecting the prognosis. Early rehabilitation after a stroke is important for the recovery of bodily functions in stroke patients. However, the impacts of early rehabilitation nursing on motor function, swallowing function as well as quality of life in stroke patients remain to be further explored.
OBJECTIVE
To investigate the effects of early rehabilitation nursing on motor function, swallowing function as well as quality of life in stroke patients.
DESIGN
This was a randomized, single-blind, controlled experiment.
SETTING
This study was carried out in the neurology department at Xuzhou Central Hospital.
PARTICIPANTS
A total of 116 acute stroke patients validated by craniocerebral computed tomography (CT) and magnetic resonance imaging (MRI) from January 2021 to December 2022 were chosen and separated into the control group (n=58) and research group (n=58) following the random number method.
INTERVENTIONS
The control group was given routine nursing. The research group implemented early rehabilitation nursing 24 hours after admission on the basis of the control group.
PRIMARY OUTCOME MEASURES
(1) recovery of swallowing dysfunction (2) recovery of limb function (3) self-care ability (4) sleep quality (5) quality of life and (6) total satisfaction of patients.
RESULTS
The research group had an elevated total effective rate of swallowing dysfunction recovery in contrast to the control group after nursing (P < .05). The recovery of limb function, self-care ability, sleep quality, and quality of life were promoted in both groups, followed by nursing (P < .05), and those in the research group were higher relative to the control group (P < .05). The total satisfaction of patients in the research group presented higher relative to the control group (P < .05).
CONCLUSION
The application effect of early rehabilitation nursing in acute stroke patients is outstanding, and the swallowing dysfunction and limb dysfunction of patients can be effectively improved, which has a high nursing value and is worth promoting and applying. Therefore, an early physical rehabilitation program for acute stroke inpatients should be considered for implementation in clinical settings.
PubMed: 38940785
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Traumatic brain injury (TBI) can result in lifelong cognitive, emotional, and motor impairments. The emergency department is the first stop for diagnosing and treating...
CONTEXT
Traumatic brain injury (TBI) can result in lifelong cognitive, emotional, and motor impairments. The emergency department is the first stop for diagnosing and treating patients with acute TBI, and the quality of nursing care can greatly influence the prognosis and progression of a patient's condition. Currently, standardized evaluation tools are lacking in the world for assessment of the quality of nursing care.
OBJECTIVE
The study intended to construct a nursing-sensitive indicator system for TBI patients, based on the scientific method of evidence-based nursing and the Delphi method, to provide a quantitative tool for emergency-nursing personnel to manage the quality of care for those patients.
DESIGN
Based on the Joanna Briggs Institute's evidence-based healthcare model, the research team performed a literature search and consulted reference guidelines, conducted two rounds of consultations with experts. sensitive indicators for quality of care, and constructed the sensitive indicator system. The team then conducted a retrospective study.
SETTING
The study took place in the department of emergency surgery at Shanxi Norman Bethune Hospital in Taiyuan, Shanxi, China.
PARTICIPANTS
Participants were 56 patients with TBI who had been admitted to the emergency department between January 2022 and December 2022 and 44 patients with TBI who had been admitted to the emergency department between January 2023 and December 2023.
INTERVENTIONS
The research team assigned: (1) the 56 patients in the first group to the control group, who received routine nursing care and (2) the 44 patients in the second group to the intervention group, who received treatment using the sensitive indicator system for the quality of emergency care for TBI patients as well as routine care.
OUTCOME MEASURES
In the verification study, the research team compared the group's rescue effects and satisfaction with emergency care.
RESULTS
In the first and second rounds of inquiries to experts, the research team distributed 25 questionnaires each time, with 25 valid questionnaires collected both times. The response rate for both rounds of inquiries was 100%. The expert authority coefficients for the first and second rounds of inquiries are 0.844 and 0.878, respectively. The sensitive indicator system's final construction included three primary indicators, seven secondary indicators, and 17 tertiary indicators. The AUC for the sensitive indicators was 0.8355882. The indicator system's use found that the intervention group had a shorter time to diagnosis (P < .001), emergency-department stay (P < .001), and emergency-department-to-surgery time (P < .001) compared to the control group. The intervention group also has a higher success rate for the emergency treatment (P = .014) and a higher nursing satisfaction with nurse-patient communications (P = .003), first-aid operations (P < .001), nursing attitudes (P < .001), and emergency environment (P < .001) compared to the control group.
CONCLUSIONS
The process of constructing quality-sensitive indicators for the nursing care of TBI patients was scientific. The constructed quality-sensitive indicator system for the care of patients with TBI covers key factors that influence the quality of care. It's highly practical and has the ability to transform certain indicators, which can better guide the management of quality of care for TBI.
PubMed: 38940780
DOI: No ID Found