Average Index Score Research Articles

Ten-Year Outcome of a Randomized Trial: Cytoreduction and HIPEC with Mitomycin C Versus Oxaliplatin for Appendiceal Neoplasm with Peritoneal Dissemination.

Appendiceal cancer is a rare disease that has proven difficult to study in prospectively. Our initial reportof this trial showed minor hematologic toxicity with both mitomycin C and oxaliplatin and similar 3-year survival. We now report an update of the first prospective randomized trial for appendiceal cancer with 10-year follow up. Patients with mucinous appendiceal neoplasms and evidence of peritoneal dissemination were enrolled in the Multicenter Randomized Trial to evaluating HIPEC for 120min with oxaliplatin (200mg/M2) or mitomycin C (40mg). Overall survival and disease-free survival were calculated at 10 years and compared between the groups. A total of 121 patients were included in the study. The patients were 57% female, with a mean age of 55.3 years (range 22-82 years). The disease was low grade in 71% and high grade in 29%. The average peritoneal cancer index (PCI) score was 18 (SD 10) in the mitomycin C group and 17.9 (SD 9.4) in the oxaliplatin group (p = 0.94). The 10-year survival rate was 56.2% (SE 7.2) with mitomycin C and 47.5% (SE 8.4) with oxaliplatin, p = 0.83. The 10-year progression-free survival rate in the mitomycin C group was 45.2% (SE 8.4) compared with 50.4% (SE 6.7) in the oxaliplatin group, p = 0.95. Median survival was 9.1 years after HIPEC with oxaliplatin, and median not reached for the mitomycin C group (> 5.6years). Oxaliplatin and mitomycin C have similar long-term efficacy for hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with appendiceal neoplasms and peritoneal dissemination. Long-term survival is experienced by most patients after cytoreduction surgery (CRS) and HIPEC for appendiceal neoplasms.

Debris Index before and after gargling with moringa leaves

Background: Dental and oral hygiene is one of the factors that trigger dental caries. Preventive efforts can be made to anticipate oral health problems, one of which is gargling. The chemical mouthwash ingredient that is often used is chlorhexidin, while if used for a long time it can cause side effects in the form of bacterial resistance and discomfort. Therefore, the need for natural ingredients to minimize side effects that can arise cheap, safe and effective natural ingredients for gargling, one of which is moringa leaves. Objective: The purpose of this study was to determine the debris index before and after gargling with moringa reduce water in TPQ Al-Barokah Bojonggede students in 2024. Methods: This research method is quasi experiment research. This study was conducted with a sample of 30 students obtained using purposive sampling technique. The instrument used was the debris index examination sheet. Results: The difference of the debris index score before and after gargling with moringa reduce water is 0.43. With an average debris index score before gargling is 1,56 and the average debris index score after gargling is 1,13. Conclusion: It can be concluded that after gargling with moringa reduce water can reduce the debris index score.

Special needs school community preparedness facing earthquake (Case study: Special needs school in a very high earthquake’s seismicity region in DIY)

Background: DIY is a province in Indonesia that is very susceptible to earthquakes. In 2006, a seismic event measuring 6.2 on the moment magnitude scale struck DIY, causing injuries and extensive damage to both the structural and non-structural elements of several buildings, including one in the education sector. The problem of structural damage to educational facilities is a significant worry, especially in school communities that cater to vulnerable children, such as those in special needs schools (SLB), who are more susceptible to harm during disasters. This study aims to assess the level of preparedness and accessibility of the special needs school community located in a very high seismic region of earthquakes in the DIY, in the event of an earthquake. Methods: The structural assessment took the form of a binary question, requiring a simple yes or no response. Findings: To reduce the risk of earthquakes in the special needs education sector, a review of the preparedness of the special needs school building and community was carried out by implementing “Satuan Pendidikan Aman Bencana (SPAB)” or Disaster Safe Education Unit guidelines. The findings suggest that SLB Sekar Melati Muh. Imogiri (78,26) was classed as having moderate earthquake risk, whereas SLB Dharma Bhakti Piyungan (88,55), SLB Insan Mandiri Dlingo (90,29), and SLB Purworaharjo (88,41) featured infrastructure that was rated as very vulnerable. With respect to SLB Dharma Bhakti Piyungan (64,52), SLB Insan Mandiri Dlingo (60,11), and SLB Purworaharjo (76,94), their average community readiness index scores put them in the intermediate capability category for earthquake preparedness. SLB Sekar Melati Muhmmadiyah Imogiri, however, was categorized as having a low capacity for earthquake readiness with an average index score of 56,92 for community preparedness. Conclusion: special needs school communities should raise their level of preparedness by undertaking seismic socialization and regular simulations to boost the community's understanding of earthquakes and reduce the likelihood of harm following an earthquake. Novelty/Originality of this Study: The study breaks new ground by assessing earthquake preparedness and accessibility in special needs schools within a high-seismicity region, addressing a critical gap in disaster risk reduction for vulnerable populations.

HIV self-test performance evaluation among priority populations in rural Mozambique: Results from a community-based observational study.

In 2021, Mozambique initiated community-based oral HIV self-testing (HIVST) to increase testing access and uptake among priority groups, including adult males, adolescents, and young adults. Within an HIVST pilot project, we conducted a performance evaluation assessing participants' ability to successfully conduct HIVST procedures and interpret results. A cross-sectional study was performed between February-March 2021 among employees, students (18-24 years of age), and community members, using convenience sampling, in two rural districts of Zambézia Province, Mozambique. We quantified how well untrained users performed procedures for the oral HIVST (Oraquick®) through direct observation using a structured checklist, from which we calculated an HIVST usability index (scores ranging 0-100%). Additionally, participants interpreted three previously processed anonymous HIVST results. False reactive and false non-reactive interpretation results were presented as proportions. Bivariate analysis was conducted using Chi-square and Fisher exact tests. A total of 312 persons participated (131[42%] community members, 71[23%] students, 110[35%] employees); 239 (77%) were male; the mean age was 28 years (standard deviation 10). Average usability index scores were 80% among employees, 86% among students, and 77% among community members. Main procedural errors observed included "incorrect tube positioning" (49%), "incorrect specimen collection" (43%), and "improper waiting time for result interpretation" (42%). From the presented anonymous HIVST results, 75% (n = 234) correctly interpreted all three results, while 9 (3%) of study participants failed to correctly interpret any results. Overall, 36 (12%) gave a false non-reactive result interpretation, 21 (7%) a false reactive result interpretation, and 14 (4%) gave both false non-reactive and false reactive result interpretations. Community members generally had lower performance. Despite some observed testing procedural errors, most users could successfully perform an HIVST. Educational sessions at strategic places (e.g., schools, workplaces), and support via social media and hotlines, may improve HIVST performance quality, reducing the risk of incorrect interpretation.

Prediction of the Global Distribution of Arhopalus rusticus under Future Climate Change Scenarios of the CMIP6

Arhopalus rusticus is a significant forestry pest known for its destructive impact on various host plants. This species, commonly found in coniferous forests across the Northern Hemisphere, has successfully spread to regions like New Zealand, Australia, and South America. This research is based on the known distribution sites of A. rusticus. Projections are made for the potential global distribution of A. rusticus under historical climatic conditions (1970–2000) and future climatic conditions (2081–2100) for the four forcing scenarios of the Coupled Model International Comparison Program 6 (CMIP6). The aim was to analyze the effects of climate change on the distribution range of this pest and its invasion trend in the southern hemisphere, and to support relevant departments in enhancing the effectiveness of forestry pest control strategies. The study utilized the Biomod2 software package in R to compare six models: generalized linear models (GLMs), generalized additive models (GAMs), multivariate adaptive regression splines (MARSs), artificial neural networks (ANNs), classification and regression trees (CTAs), and random forests (RFs) for modeling species distributions. The optimal model was selected based on evaluation indexes such as AUC and TSS. Projections of A. rusticus distribution under historical and future climate scenarios were created. The prediction results were visualized using ArcGIS software (version 10.2) to classify fitness levels and calculate distribution areas. Based on evaluation metrics, random forests (RFs) demonstrated the highest average assessment index scores, indicating high prediction accuracy (AUC = 0.99, TSS = 0.91, Kappa = 0.93). Model predictions revealed that, under historical climatic conditions, A. rusticus was predominantly found in northern Europe, eastern Asia, eastern and southwestern coastal regions of North America, and there were also highly suitable regions in parts of the southern hemisphere, including central and southwestern Argentina, southern Australia, New Zealand, and South Africa. Among these models, each of the CMIP6’s different climate prediction scenarios had a significant impact on the predicted distribution of A. rusticus. The SSP126 scenario depicted the broadest range of suitability, while the SSP585 scenario presented the narrowest and, overall, the extent of highly suitable regions was contracting. Multi-model predictions suggested that the potential distribution area of A. rusticus during the period of 2081–2100 would likely expand compared to that of 1970–2000, ranging from an increase of 1.13% (SSP126) up to 6.61% (SSP585), positively correlating with the level of radiative forcing. Notably, the most substantial growth was observed in potentially low-suitability region, escalating from 1.17% (SSP126) to 5.55% (SSP585). The distribution of A. rusticus shows decreasing trends from coastal areas to inland areas and from high to low level suitability of regions, and further expansion into the southern hemisphere under future climate conditions. Therefore, quarantine efforts at ports of entry should be strengthened in areas that are not currently infested but are at risk of invasion, and precise preventive measures should be strengthened in areas that are at risk of further expansion under future climatic conditions to prevent its spread to inland areas.

IS MESH TERROR ENDEMICAL? A GEOGRAPHICAL ANALYSIS OF TRENDS

Abstract Introduction Mesh reinforcement for hernia repair has demonstrated to reduce recurrence rates for many scenarios of ventral and inguinal defects. In recent years, many hernia surgeons from specific geographies have encountered patients who feel strongly against the use of mesh, while physicians from other areas of the world have not reported this situation. This study aims to explore the regional trends associated with this phenomenon. Methods A global Google Trends search using the query “hernia”, “mesh complications” and “hernia mesh lawsuit” was used for data analysis. Search results are normalized to the time and location of a query by the following process: each data point is divided by the total searches of the geography, language, and time range it represents to compare relative popularity. The popularity index is represented as a percentile. Results An increase in popularity of hernia-related topics has been consistent for the past 15 years and this phenomenon has been consistent almost worldwide. The search term “mesh complications” also showed an increase in popularity mainly among English-speaking countries: the average popularity index since 2004 for this term has been 12% for the United States, 8% for the United Kingdom and <1% for Australia. “Hernia mesh lawsuit” has shown a significant increase in its popularity within the United States with an average popularity index score of 4% since 2004 and growing to 10% after 2016; while remaining relatively low (1–2%) for the rest of English-speaking countries. Even after adjusting for proportionality, non-English (Spanish, Mandarin, Portuguese and Hindi) mentions of “mesh complications” and “hernia mesh lawsuit” were significantly less frequent and were, in fact, very often advertising translations of legal firms within the United States. Conclusion Parallel to a global increase in the interest in hernia knowledge, there has been an escalation in the search for mesh complications information especially within the United States. This increase appears to be related to a surge in law firm advertising for hernia related issues. Further studies should focus on improving understanding of the general public perception and refining education mechanisms to assist patients and surgeons.

Cost-effectiveness and cost–benefit analyses of fluoride varnish for caries prevention in Guangxi, China

ObjectivesThe objectives of this study were to evaluate the cost-effectiveness and cost-benefit of fluoride varnish (FV) interventions for preventing caries in the first permanent molars (FPMs) among children in rural areas in Guangxi, China.MethodsThis study constituted a secondary analysis of data from a randomised controlled trial, analysed from a social perspective. A total of 1,335 children aged 6–8 years in remote rural areas of Guangxi were enrolled in this three-year follow-up controlled study. Children in the experimental group (EG) and the control group (CG) received oral health education and were provided with a toothbrush and toothpaste once every six months. Additionally, FV was applied in the EG. A decision tree model was developed, and single-factor and probabilistic sensitivity analyses were conducted.ResultsAfter three years of intervention, the prevalence of caries in the EG was 50.85%, with an average decayed, missing, and filled teeth (DMFT) index score of 1.12, and that in the CG was 59.04%, with a DMFT index score of 1.36. The total cost of caries intervention and postcaries treatment was 42,719.55 USD for the EG and 46,622.13 USD for the CG. The incremental cost-effectiveness ratio (ICER) of the EG was 25.36 USD per caries prevented, and the cost–benefit ratio (CBR) was 1.74 USD benefits per 1 USD cost. The results of the sensitivity analyses showed that the increase in the average DMFT index score was the largest variable affecting the ICER and CBR.ConclusionsCompared to oral health education alone, a comprehensive intervention combining FV application with oral health education is more cost-effective and beneficial for preventing caries in the FPMs of children living in economically disadvantaged rural areas. These findings could provide a basis for policy-making and clinical choices to improve children’s oral health.

The impact of unions on the Australian enterprise bargaining framework

AbstractThis paper explores the effects of union involvement in enterprise bargaining agreements (EBAs) on non‐wage outcomes. My research is carried out through using a dataset of all federal EBAs in Australia from 1997 to 2021 and utilises fixed effects regressions. An index was constructed of 10 variables to capture a comprehensive overview of non‐wage outcomes. This paper finds that union involvement in an EBA, on average, is associated with a 0.494 unit increase in the index, or a 13.5% increase on the average index score. Overall, these results provide further insight into union impacts on the labour market within the enterprise bargaining framework.

The Great Canadian (Electric) Road Trip: Evaluating EV Use in National Park Tourism

As part of its 2050 net zero emission commitment, Canada has a mandate to transition to electric vehicles (EVs) to decarbonize transportation. While the EV charging infrastructure is expanding in urban areas, the infrastructure for inter-city and nature-based tourism has not been assessed. This study combined four metrics of feasibility and convenience into an EV readiness index to evaluate 94 road trip itineraries associated with Canada’s iconic national parks. Index scores ranged from not possible (0) to equal to the travel experience of internal combustion vehicle (20). With the summer range, the average one-day route score was 19.2, as 82% of one-day itineraries could be completed without requiring additional charging. Multi-day routes scored lower (14.0), with 24% being highly inconvenient or impossible due to gaps between charging stations. With a reduced winter EV range, average index scores for one- and multi-day trips declined as charging needs increased (18.4 and 13.2, respectively). Across the 94 travel routes, EVs were estimated to produce only 17% of the carbon dioxide emissions of internal combustion vehicles (this was much lower in some provinces). The findings also highlight key regional differences in tourism EV readiness and where infrastructure is needed to provide equitable access to Canada’s national parks for tourists seeking to decarbonize their holiday travel.

Internet Addiction and Its Effect on Sleep Quality Among Medical Students

Aim: This study was carried out to determine the prevalence of internet addiction in medical school students, and to examine the relationship between internet addiction and sleep quality, sleepiness and psychological resilience. Method: The study was conducted with 213 participants studying at Bolu Abant Izzet Baysal University Faculty of Medicine. A sociodemographic questionnaire, Young Internet Addiction Test-Short Form, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Brief Psychological Resilience Scale were applied to all participants, and the results were statistically evaluated. Results: The average age of the participants was found as 21.25±2.00. 65.3% (n=139) of the participants were women and 27.2% (n=58) were first-year students. The average score of Young's internet addiction was 27.15±7.35; the average Pittsburgh Sleep Quality Index score was 5.49±2.47. 60% of them were evaluated as having poor sleep quality. Average Epworth Sleepiness Scale scores were 6.62±4.22; average scores of the Psychological Resilience Scale were 19.35±5.04. There was a positive and significant relationship between Young Internet Addiction and Pittsburgh Sleep Quality. As internet addiction increased, sleep quality decreased. A negative significant relationship was found between Young's Internet Addiction and the Brief Psychological Resilience Scale. As internet addiction increased, psychological resilience decreased. Conclusion: In our study, it was determined that as internet addiction increased, sleep quality and psychological resilience decreased, and daytime sleepiness increased. We can improve sleep quality by preventing internet addiction, and increase participation in daily activities and psychological resilience by reducing daytime sleepiness. Keywords: internet addiction disorder, sleeplessness, resiliency, psychological

Dental and oral health e-book on knowledge of debris index for elementary school students

Background: Based on information from Basic Health Research in 2013, around 28.9% of children aged 5-9 years and 25.2% of children aged 10-14 years experienced dental and oral health problems. Especially in childhood, dental caries is a problem that must be avoided, especially when they attend elementary school. Therefore, it is important for us to provide knowledge about how important it is to maintain healthy teeth in children. It is hoped that the educational program can increase public awareness about the importance of maintaining dental and oral health and motivate them to actively maintain their own dental and oral health. Providing e-books about dental and oral health as a learning tool is one innovative way to change children's behavior in maintaining dental and oral health. Objective: To analyze the effectiveness of dental health e-books on knowledge and debris index in elementary school students. Method: This research uses a quasi experimental research design. This research was conducted on class V students of SDN Krukut 03 Limo Depok. The number of samples used was 54 people using purposive sampling technique. Data collection was carried out by direct examination and filling out a questionnaire sheet. Data were analyzed using the paired sample t-test. Results: Of the 54 samples, the average debris index score before counseling was 1.59, medium criteria and after counseling the average debris index was 0.95, medium criteria with the results of paired sample t-test p <0.001. There is a difference in the average knowledge score, namely from the previous 75.85, sufficient criteria to 88.52, good criteria, with the results of paired sample t-test p <0.001. Conclusion: Dental and oral health e-books are effective in increasing knowledge and reducing debris index scores in elementary school students.

Predicting the work ability of security guards at a university in Nakhon Si Thammarat province, Thailand

Objectives. The number of security guards in universities has increased significantly. This study aimed to predict work ability of university security guards. Methods. A cross-sectional study of 97 university security guards in Thailand was performed. Data were collected through interviews using a questionnaire covering social demographics, behavioral health and work ability. The data were analyzed using χ 2 tests and logistic regression models. Results. The average work ability index (WAI) score was 38.1 ± 3.8, with 65.0% of participants scoring ‘good’. Social support significantly influenced the WAI (p = 0.004). Those with insufficient support were 4.3 times more likely to show poor work ability. Mental health also impacted the WAI (p = 0.006); those with poor mental health were 4.7 times at risk. Additionally, work experience affected the WAI (p = 0.039). Those with ≥5 years of experience showed reduced work ability compared to their less-experienced counterparts (adjusted odds ratio 0.4; 95% confidence interval [0.20, 0.96]). Conclusions. Supervisors should provide social support and offer rewards and commendations to enhance employees’ abilities, health behaviors and management of underlying diseases. Additionally, organizations should prioritize health and safety in the workplace to ensure their employees are healthier and perform their tasks more effectively.

Rapid response of nail psoriasis to secukinumab in patients with moderate to severe psoriasis after 12 weeks of treatment with a total of 24 weeks of follow-up.

Nail psoriasis, a subtype of psoriasis, can cause significant pain, disability, and reduced quality of life. Despite the established efficacy of anti-IL17 secukinumab in improving skin psoriasis, there is a lack of clinical trials focusing on nail psoriasis as primary endpoint. This study aims to investigate the efficacy of secukinumab in treating nail psoriasis in patients with moderate to severe psoriasis. We prospectively recruited patients newly diagnosed with moderate to severe psoriasis in single centre from January 2021 to January 2022 who were treated with secukinumab. A total of 16 patients consisting of 9 males and 7 females were included. Their mean age was 38.88 ± 10.29 years. They had an average initial Nail Psoriasis Severity Index (NAPSI) score of 45.06 ± 20.39 and an average NAPSI score at 12 weeks of 8.94 ± 13.50, showing a significant (p < 0.05) decrease of NAPSI score after 12 weeks of secukinumab treatment. After 24 weeks of treatment, NAPSI score was decreased to 5.12 ± 8.52. Secukinumab rapidly improved nail psoriasis after 12 weeks of treatment, with further enhancement at 24 weeks, suggesting its potential as a potent therapeutic option for nail psoriasis.

The role of 755-nm alexandrite picosecond laser in melasma management.

Melasma is a skin dyspigmentation condition that disproportionately affects women, particularly those of Latino, Black, and Asian ethnicities, significantly impacting their quality of life. Efforts to identify effective treatment options have led to the exploration of picosecond laser technology which utilizes brief pulse durations to break down pigment while minimizing thermal damage to surrounding tissue. The 755-nm alexandrite picosecond laser, currently FDA approved for benign pigmented lesion removal, including melasma, is a promising solution. We aim to assess the efficacy and safety of the 755-nm alexandrite picosecond laser both as a stand-alone treatment for melasma and in combination with topical agents. We conducted a PubMed search using "755-nm picosecond" AND "melasma," "755-nm picosecond" AND "hydroquinone," and "755-nm picosecond" AND "tranexamic acid." English-written studies examining this laser as monotherapy or in combination with the topical agents were included. Those not meeting the criteria or lacking data related to melasma improvement were excluded. Monotherapy with the 755-nm picosecond laser led to a 50-75% improvement in melasma appearance in 40% of participants and a significant reduction in the average Melasma Area and Severity Index (MASI) score (p < 0.001) in all patients of one study. Notably, the use of topical tranexamic acid (TTA) in conjunction with the picosecond laser exhibited the most significant degree of improvement in hemi-MASI scores compared to the laser monotherapy group at one- and three-months post-treatment (p < 0.05). Patient satisfaction was also significantly higher for the combination group (p < 0.05). In contrast, combining hydroquinone (HQ) with the picosecond laser demonstrated no significant difference in outcomes compared to HQ alone, both of which were less effective than TTA with picosecond laser. The combination of the 755-nm picosecond laser with TTA proves promising, outperforming both laser monotherapy and laser with HQ. While monotherapy with the picosecond laser or topical agents is effective, literature favors combination therapy, especially the 755-nm picosecond laser with TTA, for superior benefits and minimal side effects. Ultimately, individualized regimens, considering factors like skin type, should be prioritized, given the heightened risk of postinflammatory hyperpigmentation, especially in skin of color patients.

Has COVID-19 influenced household food security in the Timorese population?

Food scarcity as an effect of the COVID-19 pandemic has caused famine around the world. The solution of the COVID-19 problem, will involve the minor elements of the community, such as overcoming household food security. This cross-sectional study was carried out to assess whether composite index of household food security, nutrient intake, nutritional status, individual and household dietary diversity score with food and agricultural organization measuring household and individual dietary diversity score among the Timorese family with toddlers’ population during pandemic period, using interviews and direct measurements of respondents, involving 1444 participants. Areas prone to food insecurity had a lower average index score than food-insecure areas. There was a strong correlation between the index score and the level of nutritional adequacy of children under five in: energy, protein, fat, calcium, iron, zinc, and vitamin B12. In addition, the index scores also had a strong positive correlation with the dietary diversity of children under five years old, as seen from the individual dietary diversity score (IDDS) score with r value 0.231 (p value 0.000). There was a strong positive correlation between the index score and the nutritional status of children under five according to body weight for age (BW/A), height for age (H/A), and body weight for height (BW/H). In general, the index developed from this study described the status of household food security. In addition, the total index score could be a fairly strong predictor of nutrient intake and nutritional status in children under five years old.

THE ROLE OF OUTDOOR LIGHT EXPOSURE ON SLEEP QUALITY IN OLDER INDIVIDUALS WITH FRAILTY OF DIFFERENT LIVING TYPES

Abstract The study investigates the relationship between outdoor light exposure and sleep quality in older individuals with frailty in institutions and the community, where sleep disorders are common, and outdoor light exposure is inadequate.The study includes older individuals with frailty in community and institutions in Taiwan. Participants must be aged 65 or above and have a Clinical Frailty Scale score between 4 to 8. We collect sleep quality and outdoor light exposure data using questionnaires and actigraphy.The study includes 77 older individuals: 29 from day-care centers, 22 from conventional long-term care institutions, and 26 from unit care institutions. The average outdoor light exposure is 15 minutes per day, with an average Pittsburgh Sleep Quality Index (PSQI) score of 8, 74% sleep efficiency, and 125.8 minutes of wake after sleep onset. After controlling for multiple variables. Outdoor light exposure shows no relationship with PSQI, sleep efficiency, and wake after sleep onset.The average PSQI score is &amp;gt; 5, indicating poor subjective sleep quality. Additionally, Wake After Sleep Onset &amp;gt; 60 minutes, and sleep efficiency &amp;lt; 75%, suggesting poor objective sleep quality. The average outdoor light exposure time &amp;lt; 20 minutes, indicating a lack of outdoor light exposure. However, our study does not observe the effects of light exposure, possibly because the average daily light exposure is below the 30-minutes threshold. Older individuals with frailty experience poor sleep quality. It is possible that a longer duration of outdoor light exposure may be needed to observe its impact on sleep quality.

Development and validation of Simulation Scenario Quality Instrument (SSQI)

BackgroundDue to the unmet need for valid instruments that evaluate critical components of simulation scenarios, this research aimed to develop and validate an instrument that measures the quality of healthcare simulation scenarios.MethodsA sequential transformative mixed-method research design was used to conduct the study. The development and validation of the instrument involved two phases: the qualitative phase, which included defining the instrument's theoretical background and instrument construction, followed by the quantitative phase, where the instrument was piloted and validated. The qualitative study included 17 healthcare simulation experts, where three focus group was conducted, and the first version of the instrument was constructed based on the focus group analysis and the theoretical framework constructed using the literature review. During the quantitative phase, the instrument’s quantitative piloting included 125 healthcare simulation scenarios; then, the instrument went through construct validity and reliability testing.ResultsContent experts confirmed the theoretical model and instrument framework. The average item content validity index (I-CVI) scores and the average of the I-CVI scores (S-CVI/Ave) for all items on the scale or the average proportion relevance judged by all experts was 0.87. The conformity factor analysis results showed a good fit for the proposed 10-factor model (CFI (the comparative fit index) = 0.998, Tucker-Lewis index = 0.998, Root mean square error of approximation (RMSEA) = 0.061. The final instrument included ten domains: 1. Learning objectives, 2. Target group, 3. Culture, 4. Scenario case, 5. Scenario narrative briefing, 6. Scenario complexity, 7. Scenario flow, 8. Fidelity, 9. Debriefing, and 10. Assessment. The SSQI included 44 items that are rated on a 3-point scale (Meets Expectations = (2), Needs Improvement, (1), Inadequate (0)).ConclusionThis validated and reliable instrument will be helpful to healthcare educators and simulation experts who want to develop simulation-based training scenarios and ensure the quality of written scenarios.

Isotretinoin-Related Eye Dryness in Acne Patients in Qassim, Saudi Arabia.

Background Isotretinoin is a commonly prescribed agent mainly used to treat acne vulgaris. Since its Food and Drug Administration (FDA) approval, the subject of its associations with various medical conditions has become a growing interest in many investigational studies. Methodology A retrospective study was conducted using the validated Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. All statistical calculations were performed using the Statistical Package for the Social Sciences (SPSS)version 27.0.1 (IBM SPSS Statistics, Armonk, NY). Results The research study involved 107 participants, predominantly Saudi nationals (98.1%), with an average age of 22 years. Regarding the total cumulative dose (TCD), 40.2% had less than 50 mg/kg, 33.6% had between 50 and 100 mg/kg, and 15.9% had more than 100 mg/kg. The majority (73.8%) did not stop using isotretinoin. The average Ocular Surface Disease Index (OSDI) score, indicating ocular surface disease symptoms, was 26.78. There was no significant association between gender, dose/duration of isotretinoin, TCD, and age, and OSDI scores. However, participants with severe OSDI scores were more likely to have worsened pre-existing eye symptoms compared to those with non-severe OSDI scores (35.1% versus 11.4%, p = 0.011). Conclusions This study contributes to the understanding of the impact of isotretinoin usage on ocular surface health. While no significant associations were found between gender, dose, duration, TCD, and age, and OSDI scores, participants with pre-existing eye symptoms were more likely to experience worsened symptoms during isotretinoin treatment.

Good Health and Well-Being in Asian Arab Countries: Some Critical Observations

The main objective of this study was to examine the status of Sustainable Development Goal (SDG) 3, Good Health and Well-Being, in Asian Arab countries and to explore some challenges through critical observations. Utilising the Meta-Analysis method and the Search, Appraisal, Synthesis and Analysis framework, the UNDP’s ‘Arab Region SDG Index and Dashboard Report 2022’, and relevant secondary sources were analysed. Calculations were based on the value, rate and trend of the targets of SDG3. Results showed that (i) the average SDG Index Score (0–100) for the Asian 12 Arab countries was 60.06; (ii) seven countries’ targets showed significant challenges remaining and four countries faced major challenges; (iii) 11 countries were experiencing modern improvements; (iv) nine countries had better achievements on nine targets and lower achievements on the remaining seven targets, with some exceptions; and (v) the challenges encountered were regional-level policy gaps, state-level health structural problems, socio-economic and demographic settings, and community/individual-level unawareness about health and well-being. The analysis would be useful to the governments of the Arab Asian countries, development practitioners, health experts and policymakers.

Evolving Real-World Characteristics and Step-up Dosing Among Early Initiators of Teclistamab for Multiple Myeloma - a National All-Payer Claims Database Study

Introduction: Teclistamab, a first-in-class B-cell maturation antigen (BCMA) x CD3 bispecific antibody with a personalized, weight-based dosing schedule, gained United States (US) regulatory approval in October 2022 for the treatment of triple-class exposed relapsed/refractory multiple myeloma (MM). Prior real-world analyses using hospital chargemaster or single-center data (Tan SOHO 2023, Firestone ASCO 2023) found that early initiators of teclistamab were elderly, diverse, frail, heavily pretreated, and had significant comorbidities. The evolving characteristics of patients receiving teclistamab over time and the operationalization of step-up dosing (SUD) nationally have not been characterized. Methods: This is a retrospective, observational, descriptive study using the All-payer Real-world Multiple Myeloma Research-ready Data (ARMMRD) registry, derived from STATinMED RWD Insights all-payer claims data that covers approximately 87% of the nationally insured population in the US, from January 1, 2014 to May 31, 2023. The intake period was October 26, 2022 to May 31, 2023; patients were indexed on the earliest outpatient claim of a teclistamab 30mg/3mL vial or admission date of the earliest hospitalization with teclistamab. A claims-based algorithm was applied to best approximate the SUD period per label which includes the first two step-up doses and the first treatment dose. Patients were included if they had ≥1 MM diagnosis claim on or any time prior to index, age ≥18 years on index, and continuous eligibility for 6 months before index (baseline period). Patients who received teclistamab on or before the approval date were excluded. Patient characteristics and length of SUD were analyzed descriptively across 4 index timing-based cohorts: 1) those indexed through February 2023; 2) in March 2023; 3) in April 2023; and 4) in May 2023. Results: A total of 124 patients were included in the study. Median (interquartile range [IQR]) age was 71.5 (14.5) years; 33.9% were age ≥75 years; 72.6% had Medicare insurance; 49.2% were male. Most were White (62.1%) and non-Hispanic (63.7%), with 12.1% Black. The mean (standard deviation [SD]) Quan-Charlson Comorbidity Index score was 4.2 (3.6) for the overall population; the cohort indexed in March 2023 had the highest score at 5.8 (3.9). Similarly, while the overall comorbidity burden was high in the overall population, the cohort indexed in March 2023 had the highest rates for many comorbidities (Table 1). Among 68 patients with continuous eligibility since the initial MM diagnosis, 16.2% had prior exposure to a commercial BCMA therapy: 10.3% were exposed to BCMA chimeric antigen receptor (CAR)-T therapy and 8.8% to belantamab mafodotin. Among 99 patients who completed SUD by the data cutoff, 87 (87.9%) completed SUD in one inpatient admission, 4 (4.0%) fully outpatient, and 8 (8.1%) in hybrid inpatient/outpatient settings. Among patients with ≥1 teclistamab hospitalization, the median (IQR) length of stay was 8.0 (4.0) days, with mean (SD) of 8.3 (2.9) days after omitting extreme outliers. Over time, the mean (SD) length of the SUD period shortened from 12.1 (9.0) days to 6.7 (1.2) days. However, the percentage of patients who received teclistamab SUD in one hospitalization remained relatively constant (Figure 1). Conclusion: This is the first national real-world study using all-payer claims data of patients initiating teclistamab in the first 7 months of market availability. Like prior reports, early initiators of this first-in-class bispecific represented a diverse and elderly population with substantial comorbidities; yet, across the index time-based cohorts, the average comorbidity index score fell. Teclistamab SUD was generally administered through a single hospitalization, which may reflect logistical considerations with adverse event monitoring and elective hospital readmissions. Nonetheless, the duration of SUD period appeared to shorten over time, and most admitted patients were discharged without delay. Study limitations include the nature of insurance claims data, small sample size per subgroup, and lack of granular data on CRS incidence and management; however, to our knowledge, this is the largest analysis of real-world teclistamab use to date. Additional analyses are warranted to understand evolving trends in teclistamab SUD and establish best practices as the field grows more familiar with bispecific antibodies in MM.