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Although lung cancer remains the leading cause of cancer deaths in the US, recent advances in early detection and treatment have led to improvements in survival. However, there is a considerable risk of recurrence or second primary lung cancer (SPLC) following curative-intent treatment in patients with early-stage non-small cell lung cancer (NSCLC). Professional societies recommend routine surveillance with CT to optimise the detection of potential recurrence and SPLC at a localised stage. However, no definitive evidence demonstrates the effect of imaging surveillance on survival in patients with NSCLC. To close these research gaps, the Advancing Precision Lung Cancer Surveillance and Outcomes in Diverse Populations (PLuS2) study will leverage real-world electronic health records (EHRs) data to evaluate surveillance outcomes among patients with and without guideline-adherent surveillance. The overarching goal of the PLuS2 study is to assess the long-term effectiveness of surveillance strategies in real-world settings.
PLuS2 is an observational study designed to assemble a cohort of patients with incident pathologically confirmed stage I/II/IIIA NSCLC who have completed curative-intent therapy. Patients undergoing imaging surveillance will be followed from 2012 to 2026 by linking EHRs with tumour registry data in the OneFlorida+ Clinical Research Consortium. Data will be consolidated into a unified repository to achieve three primary aims: (1) Examine the utilisation and determinants of CT imaging surveillance by race/ethnicity and socioeconomic status, (2) Compare clinical endpoints, including recurrence, SPLCs and survival of patients who undergo semiannual versus annual CT imaging and (3) Use the observational data in conjunction with validated microsimulation models to simulate imaging surveillance outcomes within the US population. To our knowledge, this study represents the first attempt to integrate real-world data and microsimulation models to assess the long-term impact and effectiveness of imaging surveillance strategies.
This study involves human participants and was approved by the University of Florida Institutional Review Board (IRB), University of Florida IRB 01, under approval number IRB202300782. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations encompass ensuring the confidentiality of patient information. All disseminated data will be de-identified and summarised.
Exposure to prescription opioids following traumatic injury can increase the risk of developing tolerance, persistent opioid use and opioid use disorder. The mechanisms underlying opioid tolerance or dependence are not well understood, and no biomarkers predict risk. Opioid exposure causes epigenetic modifications, including alterations in microRNA (miRNA) expression. Several miRNAs, which regulate synaptic plasticity, are hypothesised to underlie substance use disorders and influence µ-opioid receptor levels, modulating opioid tolerance. This project aims to develop a bio-behavioural signature to predict persistent opioid use and chronic pain up to 6 months post-discharge.
The study will use a prospective cohort design, enrolling 180 adult patients at a Level I Trauma Center who are prescribed opioids at discharge. Prospective data will be collected in the hospital and at 7 days and 1, 3 and 6 months post-discharge. Biological data (genotyping and miRNA levels) and clinical measures of opioid use, pain, pain sensitivity (EEG) and psychosocial functioning will be collected at each time point. Bayesian regression methods will be used to identify baseline clinical, genetic, epigenetic and psychosocial predictors of opioid use and pain outcomes at 6 months post-discharge. Growth mixture modelling will identify distinct subgroups with varying trajectories, followed by Bayesian hierarchical modelling to predict trajectory classification based on predictor variables.
Ethics approval for this study was obtained from the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects (HSC-MS-24–0314). Findings will be disseminated in peer-reviewed scientific journals and at national and international conferences.
To (1) examine the attitudes of community-dwelling adults towards death and their ability to cope with death, as well as (2) understand the influence of advance care planning on community-dwelling adults' death attitudes and coping with death.
A sequential explanatory mixed-methods study was conducted in Singapore.
In Phase I, a case–control study was conducted to examine the differences in death attitudes and coping with death ability between community-dwelling adults who have completed advance care planning and those who have not. A univariate general linear model was used to compute the mean difference in death attitudes and coping with death scores. In Phase II, a descriptive qualitative study was conducted to provide an in-depth understanding of the influence of advance care planning among community-dwelling adults. Thematic analysis was used for qualitative analysis. Mixed-methods analysis was conducted to integrate the quantitative and qualitative data.
In Phase I, 80 community-dwelling adults who had completed advance care planning and 81 community-dwelling adults who did not have advance care planning were included. Adults who had completed advance care planning had significantly higher coping with death scores (t = 4.14, p < 0.01). In Phase II, a purposive sample of 24 adults who had completed advance care planning was selected for individual semi-structured interviews. From the thematic analysis, three themes were developed: (1) Advance care planning enables coping with death, (2) overcoming fear of death with advance care planning and (3) confronting death with advance care planning.
Advance care planning may influence death attitudes and coping with death. Further work on longitudinal designs and among individuals from different age groups should be used to gain further in-depth understanding of the impacts of advance care planning.
Strategies to enhance one's coping abilities with death and death attitudes should be developed to stimulate the uptake of advance care planning.
This paper was reported according to the Good Reporting of A Mixed Methods Study framework.
Community-dwelling adults participated in the survey and interviews.
We investigated the epidemiology and impact on mortality of antimicrobial resistance (AMR) in cancer patients with bacteraemia at Oxford University Hospitals (OxUH), UK, and Oslo University Hospital (OsUH), Norway, during 2008–2018.
Historical cohort study.
Regional hospital trusts with multiple sites in OxUH and OsUH.
Patients with cancer and blood cultures positive for one of six pathogen groups during a hospital stay within 3 years following their first cancer diagnosis were followed for 30 days after their first bacteraemia episode. We determined the number of cases and the proportion of infections with an AMR phenotype. Excess mortality and the population-attributable fraction (PAF) due to AMR were estimated by contrasting observed mortality at the end of follow-up with an estimated counterfactual scenario where AMR was absent from all bacteraemias, using inverse probability weighting.
30-day all-cause mortality following the first bacteraemia episode.
A resistant phenotype of the causative pathogen.
The study included 1929 patients at OxUH and 1640 patients at OsUH. The highest resistance proportions were found for vancomycin resistance in enterococci (85/314, 27.1%) and carbapenem-resistance in Pseudomonas aeruginosa (63/260, 24.2%) at OxUH, and third-generation cephalosporin resistance in Escherichia coli (62/743, 8.3%) and Klebsiella pneumoniae (14/223, 6.3%) at OsUH. Observed mortality for all infections was 26.4% at OxUH, with an estimated counterfactual mortality without AMR of 24.7%, yielding an excess mortality of 1.7% (95% CI: 0.8 to 2.5%). The PAF was 6.3% (95% CI: 2.9 to 9.6%), meaning an estimated 32 of 509 deaths could be attributed to AMR. Limited events at OsUH precluded a similar estimate.
Despite estimating modest excess mortality, the mortality attributable to resistance in these two high-income, low-prevalence settings highlights the potential for escalation if global resistance trends continue to worsen.
Youth electronic cigarette (e-cigarette) use is a global health challenge, with multiple jurisdictions wrestling with appropriate responses, in the face of limited evidence available on effective interventions. Identifying and synthesising evidence on the effects of interventions to prevent youth e-cigarette use is required to inform prevention-focussed health policy and practice.
We plan to undertake an individual participant data (IPD) prospective meta-analysis (PMA). We will conduct systematic searches to identify eligible planned or ongoing randomised controlled trials (RCTs) using trial registries via WHO ICTRP and ClinicalTrials.gov and databases Medline, Embase, CENTRAL, PsycINFO, Web of Science, CINAHL and Europe PMC. We will also search grant websites for additional studies. We will include any RCT of e-cigarette and cigarette prevention interventions for youth including non-smoking and non-vaping youth aged 10 to 19 years, with no intervention, waitlist, usual care or active control. Primary outcomes will be measures of current or ever e-cigarette use. Secondary outcomes include measures of current and ever cigarette (conventional cigarette) use.
Investigators from relevant trials will be invited to join the Synthesis using Prospective meta-Analysis to Reduce youths’ E-cigarette use (SPARKE) consortium prior to trial outcomes being known using harmonised methods. They are then asked to share their data within 12 months of trial completion.
The primary outcomes will be analysed in a two-stage IPD meta-analysis model under an intention-to-treat framework. First, effect estimates and variances will be calculated for each trial with log-binomial regression models adjusting for key prognostic factors. For cluster RCTs, a nested random effect will be specified within trials to account for correlations within clusters. Second, effect estimates will be combined across trials in a random treatment effect, inverse variance meta-analysis model. Effect estimates will be reported as relative risk ratios with 95% CIs.
This study aims to generate and expedite the synthesis of data regarding prevention interventions for adolescent e-cigarette use to inform real-world decision making. Findings will be of interest to key stakeholders, including policy makers and research funders.
Each trial will be responsible for obtaining their own ethics approval. While secondary analysis of data does not usually require ethics approval, we have received cross-institutional ethics approval from the University of Sydney (2023/714) and the University of Newcastle (H-2023–0389).
With a growing need for ultra-widefield fundus (UWF) fundus photographs in clinics and AI development, image quality assessment (IQA) of UWF fundus photographs is an important preceding step for accurate diagnosis and clinical interpretation. This study developed deep learning (DL) models for automated IQA of UWF fundus photographs (UWF-IQA model) and investigated intergrader agreements in the IQA of UWF fundus photographs.
We included 4749 UWF images of 2124 patients to set the UWF-IQA dataset. Three independent board-certified ophthalmologists manually assessed each UWF image on four grading criteria (field of view, peripheral visualisation, details of posterior pole and centring of the image) and a final IQA grading using a five-point scale. The UWF-IQA model was developed to predict IQA scores with EfficientNet-B3 as the backbone model. For the test dataset, Cohen’s quadratic weighted kappa score was calculated to evaluate intergrader agreements and agreements between predicted IQA scores and manual gradings.
Development and test dataset consisted of 3790 images from 1699 patients and 959 images of 425 patients, respectively, without statistical differences in IQA gradings. The average agreement between the UWF-IQA model and manual graders was 0.731, while the average of intergrader agreements among manual graders was 0.603 (Cohen’s weighted kappa score). Posterior pole grading showed the highest average agreements (0.838) between the UWF-IQA model and manual graders, followed by final grading (0.788), centring of the image (0.754), peripheral visualisation (0.754) and field of view (0.535).
Predicted IQA scores using the UWF-IQA model showed better agreements with manual graders compared with intergrader agreements. The automated UWF-IQA model offers robust and efficient IQA predictions with the final and subcategory gradings.
To synthesise the effectiveness of massage therapy for cancer pain, quality of life and anxiety among patients with cancer.
Systematic review and meta-analysis.
This review was reported according to the PRISMA guidelines. Studies evaluating the effects of massage therapy on cancer pain, quality of life or anxiety in patients with cancer pain were eligible. The Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality of studies. Outcomes were pooled using standardised mean differences and narratively synthesised when meta-analysis was not possible.
Pubmed, EMBASE, Web of Science, CINAHL, CENTRAL, Google Scholar, ProQuest Theses and Dissertations were searched for English peer-reviewed studies and grey literature published from inception to 8 January 2024.
Thirty-six RCTs involving 3671 participants were included. Massage therapy significantly improved pain (pooled SMD = −0.51, 95% CI −0.68 to −0.33), quality of life (pooled SMD = 0.48, 95% CI 0.19–0.78 when higher scores indicate better quality of life; pooled SMD = −0.52, 95% CI −0.88 to −0.16 when higher scores indicate poorer quality of life) and anxiety (pooled SMD = −0.38, 95% CI: −0.57 to −0.18) post-intervention. All outcomes had very low certainty of evidence. Most studies had unclear or high risk of bias.
This review found that massage therapy is beneficial to patients with cancer in improving pain, quality of life and anxiety. Healthcare institutions and healthcare professionals should recognise the value of massage therapy to enhance the care of patients with cancer pain.
PRISMA guidelines.
No Patient or Public Contribution.
PROSPERO CRD42023407311.
To develop a family-centred end-of-life care protocol and evaluate its feasibility.
The draft protocol was created by integrating literature review results and existing protocols and interviewing bereaved parents. A Delphi study and an experts' review were conducted to refine the draft, followed by feasibility testing with neonatal intensive care unit nurses.
A 71-item protocol based on an integrated end-of-life care model and the family-centred care concept was developed, comprising three sections: principal guidelines, communication during end-of-life care and five substeps (4, 17 and 71 items, respectively) according to changes in an infant's condition. The feasibility was confirmed by an increase in competency and a positive attitude towards infant end-of-life care participants who completed the protocol education.
The protocol was feasible and improved nurses' competency and attitude in providing end-of-life care for infants and parents requiring support due to the loss of their infants. It can positively impact the well-being of parents who have experienced the loss of their infants in neonatal intensive care units and enhance family-centred care within the units.
Application of the family-cantered end-of-life care could support infants' dying process and improve bereaved parents' quality of life in neonatal intensive care units.
This study increased neonatal end-of-life nursing needs' awareness among nurses and parents during bereavement. It offered preliminary evidence regarding the feasibility of a neonatal end-of-life care protocol developed in this study.
AGREE Reporting Checklist 2016.
We interviewed bereaved parents to develop the draft protocol and involved neonatal care experts for the Delphi study and neonatal nurses (who would use the protocol) as feasibility test subjects.
This was a doctoral dissertation and did not require protocol registration as the feasibility test involved a single neonatal intensive care unit.
With the prolongation of the COVID-19 pandemic, more individuals are experiencing sequelae after COVID-19 infection, also known as post-acute COVID-19 syndrome (PCS). The aims of this study were to describe the prevalence and characteristics of PCS symptoms such as fatigue, anxiety, and depression and to compare these symptoms according to participant characteristics in patients who had been previously hospitalized due to COVID-19.
A descriptive cross-sectional study design was used.
We included 114 individuals who had been hospitalized for COVID-19 and were discharged from the hospital at least 4 weeks before. Symptoms were assessed using the Fatigue Severity Scale, the Hospital Anxiety-Depression Scale, and the PCS symptom questionnaire developed by the authors. We used descriptive statistics, the Student's t-test, the Wilcoxon rank-sum test, and the Kruskal–Wallis test for statistical analyses.
The most prevalent symptoms were anxiety (66.7%), fatigue (64.0%), headache (57.9%), and concentration or memory difficulties (57.9%). Concentration or memory difficulties and sleep disturbances had the highest mean frequency. Concentration or memory difficulties were rated with the highest mean severity, and cough, loss of taste, and muscle and joint pain had the highest mean distress scores. Female participants, individuals hospitalized for more than 2 weeks, individuals discharged more than 9 months ago, unvaccinated patients, and those who tried at least one symptom relief method reported higher symptom distress.
The findings of this investigation into the frequency, severity, and distress of symptoms shed light on the identification of post-COVID symptoms in detail. To objectively evaluate and comprehend the symptom trajectories of PCS, prospective studies about the development of symptom assessment tools and studies with a longitudinal design should be conducted.
A substantial number of respondents reported numerous symptoms and expressed symptom distress; therefore, the development of nursing interventions and treatments to alleviate PCS symptoms is crucial.
To examine the effects of spousal support and parent–nurse partnership on caregiver burden of parents of children with chronic disease.
With the trend of increasing the global number of children with chronic diseases, the parental caregiver burden has become increasingly prevalent.
Cross-sectional study.
The study participants included 115 parents of children diagnosed with chronic disease at a general hospital in South Korea. The study duration was 4 June 2021–30 April 2022. Self-reported measures included the parent–nurse partnership scale, the Korean version of the Parenting Alliance Inventory and the family caregiver burden scale. T-tests, ANOVA, Pearson's correlation coefficients and hierarchical linear multiple regression were conducted using IBM SPSS version 26.0. This study followed STROBE guideline.
Parental caregiver burden was significantly negatively associated with spousal support and parent–nurse partnership. Factors significantly influencing caregiver burden were parental alcohol consumption; child's inherited metabolic disease, cardiovascular disease, disease relating to haematological tumours or kidney disease diagnosis; child's health perceived as poor by parents; child's dependency perceived as high by parents; hospitalization recency; and low spousal support. These factors accounted for 65% of caregiver burden.
Parental caregiver burden was related to spousal support and parent–nurse partnership, but the primary factor affecting caregiver burden was spousal support.
The results highlighted the role of healthcare professionals in educating parents of children with chronic diseases to facilitate spousal support and have implications for nursing and community-based interventions to reduce parental caregiver burden. Furthermore, they underlined that policymakers and other stakeholders should pay attention to the parental caregiver burden through government-based, family-centered strategies.
Parents of children with chronic disease were recruited to perform the self-administered survey in the phase of data collection.
This study aims to identify longitudinal patterns and predictors of cognitive function trajectories among Korean older adults with cardiovascular diseases.
This study is a longitudinal panel analysis based on secondary data. Data from the the Korean Longitudinal Study of Ageing (KLoSA) were used for analysis.
The KLoSA is a representative panel survey of older Koreans. We analyzed responses from 301 participants aged ≥65 years who completed the same survey more than three times out of five waves between 2012 and 2020.
Latent class growth modeling identified two trajectories of cognitive function in older people with cardiovascular diseases: “low and declining” (n = 81, 26.9%) and “high and declining” (n = 220, 73.1%). Participants in “the low and declining trajectory group” were more likely to have a low educational level, weak handgrip strength, depression, and low social participation at baseline than those in “the high and declining trajectory group.”
Our results indicate a need to develop community-based tailored interventions for improving handgrip strength, mental health, and social participation in delaying cognitive decline in older people with cardiovascular diseases considering their educational level.
Healthcare providers should be more concerned about older people with a weaker handgrip, depression, and low social activities as a high-risk group for cognitive decline over time in cardiovascular care. Therefore, it is necessary to evaluate them early with standardized tools and make subsequent strategies for the older population with cardiovascular diseases.
The unprecedented exodus of workers from the healthcare system is a patient safety crisis. Organizational compassion in health care is the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of suffering.
This scoping review aimed to describe the evidence regarding the impact of organizational compassion on clinicians, identify gaps, and provide recommendations for future research.
A comprehensive librarian-assisted database search was conducted. Databases searched were PubMed, SCOPUS, EMBASE, Web of Science, PsychInfo, and Business Source Complete. Combinations of search terms regarding health care, compassion, organizational compassion, and workplace suffering were used. The search strategy was limited to English language articles and those published between 2000 and 2021.
Database search yielded 781 articles. After removing duplicates, 468 were screened by title and abstract, and 313 were excluded. One-hundred and fifty-five underwent full-text screening, and 137 were removed, leaving 18 eligible articles, two of which were set in the United States. Ten articles evaluated barriers or facilitators to organizational compassion, four evaluated elements of compassionate leadership, and four evaluated the Schwartz Center Rounds intervention. Several described the need to create systems that are compassionate to clinicians. Lack of time, support staff, and resources impeded the delivery of such interventions.
Little research has been done to understand and evaluate the impact of compassion on US clinicians. Given the workforce crisis in American health care and the potential positive impact of increasing compassion for clinicians, there is an urgent need for researchers and healthcare administrators to fill this gap.
FreshRSS 