Change In Overall Score Research Articles

SAT459 Teprotumumab Pooled Efficacy From The European Study Sites Participating In The Phase 2, OPTIC (Phase 3) And OPTIC-X Pivotal Trials

Abstract Disclosure: G.J. Kahaly: Research Investigator; Self; Horizon Therapeutics plc. Q. Fu: Employee; Self; Horizon Therapeutics plc. Stock Owner; Self; Horizon Therapeutics plc. R.J. Holt: Employee; Self; Horizon Therapeutics plc. Stock Owner; Self; Horizon Therapeutics plc. Background: The pivotal clinical trial program for the formal approval of teprotumumab for the treatment of thyroid eye disease (TED) in the United States (US) has previously reported excellent overall results.1 These results included data from 9 unique European Union (EU) study sites. Teprotumumab is not currently approved in the EU. Here we report pooled efficacy results from the participating EU sites. Methods: Data from the EU sites in the integrated randomized, double-masked, placebo-controlled 24-week phase 2 and 3 trials and open-label OPTIC-X trial were analyzed for the primary outcome of proptosis reduction of ≥2 mm from baseline (BL). Secondary outcomes were diplopia response (a reduction from BL in diplopia of ≥1 grade [Gorman scale]), Clinical Activity Score (CAS) of 0 or 1, an Overall response (a reduction of ≥2 in CAS plus a reduction in proptosis of ≥2 mm), the least squares (LS) and mean BL change in proptosis (mm) and the LS and mean change in overall score on the Graves’ ophthalmopathy-specific quality-of-life (GO-QOL). Tobacco exposure was controlled for using a mixed-model repeated-measures analysis with an unstructured covariance matrix. Results: In the Integrated EU phase 2 and 3 trials, a total of 35 patients were assigned to the teprotumumab group and 39 to the placebo group. Tobacco use was 44.6% compared with 13.4% in US. Months since diagnosis of Graves’ disease was longer in EU than US (48.8 vs. 26.3). Fewer EU patients had constant diplopia (grade 3) at BL than US (13.5% vs. 25.8%). At week 24, the percentage of EU patients with a proptosis response was higher with teprotumumab than with placebo (77% [27] vs. 13% [5], P<0.001). All secondary outcomes were significantly better with teprotumumab than with placebo, respectively, including diplopia response (63% [17 of 27] vs. 22% [6 of 27], P<0.001), CAS 0/1 (71% [25] vs. 26% [10], P<0.001), Overall response (77% [27] vs. 13% [5], P<0.001), LS mean change in proptosis of −2.76 mm vs. −0.28 mm, P<0.001, BL line mean change in proptosis of -3.18 mm vs.-0.39 mm and LS mean change in GO-QOL overall score of 14.84 points vs. 4.16 points, P<0.001 with BL mean change in GO-QOL of 18.66 vs. 3.75. In the open-label OPTIC-X trial, a total of 19 EU OPTIC study placebo patients received teprotumumab for the first time. After 24 weeks of treatment, the percentage of patients with a proptosis response was 95% (18 out of 19), diplopia response was 54% (7 of 13), CAS 0/1 was 69% (11 out of 16), Overall response was 81% (13 out of 16), mean change in proptosis was −3.29 mm, and mean change in GO-QOL overall score was 11.71 points, indicating robust improvements. Conclusions: Among EU patients with TED, teprotumumab resulted in better outcomes with respect to proptosis, CAS, diplopia, and quality of life as compared with placebo.

Social justice attitudes of undergraduate nursing students: The impact of praxis.

Social justice is a foundational concept in nursing, yet studies on how best to impact change in nursing students' attitudes toward social justice are few. The intent of this work was to quantify the impact on attitudes of undergraduate nursing students toward social justice, after extended interactions with adults living in poverty. Undergraduate nursing students from three programs, university medical center, private university, and community college were given a validated survey of social justice attitudes before and after a clinical rotation with low-income adults in an inner-city neighborhood. All students did home social visits through the same social service agency. Students from the medical center were also involved with active care coordination for assigned clients. Each group showed significant increases in social justice attitudes following their experience. Students doing care coordination did not have significantly greater changes in overall scores but did show significant improvement in subtests others did not. Clinical opportunities placing nursing students in direct interaction with marginalized populations are recommended to increase social justice awareness.

Abstract P6-05-37: Comparing Changes in Depression and Anxiety Levels of Breast Cancer Patients throughout a Course of Radiation Therapy

Abstract An estimated 32.2% and 41.9% of breast cancer patients experience depression and anxiety, respectively. However, due to differences in the understanding of radiotherapy and variability in the severity of side effects, responses of patients with breast cancer receiving radiation therapy may vary at different time points and differ in comparison to other patients with breast cancer. This study sought to describe the changes in levels of depression and anxiety experienced by English and Spanish-speaking patients throughout a course of radiation therapy for breast cancer along with the impact of different variables on these levels to better understand and quantify potential gaps. Eligibility criteria included English and Spanish-speaking females, ages 18 or older, undergoing radiation therapy treatment for breast cancer at Boston Medical Center. Pre- and post-treatment surveys were completed before and after delivery of radiation therapy. Survey included sociodemographic questions along with the standardized PHQ-4 questionnaire, which uses a maximum total score of 12, to assess anxiety and depression. Results were analyzed using a least means square procedure. A total of 60 participants completed pre- and post- treatment surveys. Total baseline distress mean (BDM) was 3.32 (SD= 3.55) and final distress mean (FDM) was 3.22 (SD= 3.78). English-speaking patients comprised 70% (n=42) of the sample and had a BDM of 3.40 with an adjusted change mean (ACM) decrease of 0.48. Spanish-speaking patients comprised 30% (n=18) of the sample, with a BDM of 3.11 and an ACM increase of 0.79, differences in ACM trended toward significance with a p-value of 0.083. Sociodemographic characteristics included: race, ethnicity, marital status, education level and longest residency. Additional variables surrounding social determinants of health included housing and food insecurity, which showed statistically significant increasing distress with increased insecurity at baseline. While our study showed a higher BDM among English-speaking patients in comparison to Spanish-speaking patients, results showed that Spanish-speakers’ distress increased throughout treatment as opposed to English-speakers. Most of our patient population was English-speaking, though approximately one third Spanish-speaking and our participants were also primarily Black, non-Hispanic, never married, had a high school or associate level education, and had their longest residence in the US. Although the majority did not report housing or food insecurity, both had increasing DM with increased insecurity, with statistically significant results. As the number of Spanish-speakers in the US continues to increase, it will be important to continue assessing potential differences in cancer care. In addition, an understanding of the changes of distress throughout radiation treatment could help inform future interventions that address these disparities. Baseline distress values and adjusted change in overall score by sociodemographic factors Citation Format: Corina Beiner, Jenny Zhao, Muhammad Mustafa, Ariel Hirsch. Comparing Changes in Depression and Anxiety Levels of Breast Cancer Patients throughout a Course of Radiation Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-37.

A Randomized Cross-Over Trial Focused on Clinical Breast Exam Skill Acquisition Using High Fidelity versus Low Fidelity Simulation Models in Rwanda

Breast cancer incidence is rising for women in low and middle income country (LMIC)s. Growing the health care workforce trained in clinical breast exam (CBE) is critical to mitigating breast cancer globally. We developed a CBE simulation training course and determined whether training on a low-fidelity (LF) simulation model results in similar skill acquisition as training on high-fidelity (HF) models in Rwanda. A single-center randomized educational crossover trial was implemented. A preintervention baseline exam (exam 1), followed by a lecture series (exam 2), and training sessions with assigned simulation models was implemented (exam 3)-participants then crossed over to their unassigned model (exam 4). The primary outcome of this study determined mean difference in CBE exam scores between HF and LF groups. Secondary outcomes identified any provider level traits and changes in overall scores. The study was implemented at the University Teaching Hospital, Kigali (CHUK) in Rwanda, Africa from July 2014 to March 2015 PARTICIPANTS: Medical students, residents in surgery, obstetrics and gynecology, and internal medicine residents participated in a 1-day CBE simulation training course. A total of 107 individuals were analyzed in each arm of the study. Mean difference in exam scores between HF and LF models in exam 1 to 4 was not significantly different (exam 1 0.08 standard error (SE) = 0.47, p = 0.42; exam 2 0.86, SE = 0.69, p = 0.16; exam 3 0.03, SE = 0.38, p = 0.66; exam 4 0.10 SE = 0.37, p = 0.29). Overall exam scores improved from pre- to post-intervention. Mean difference in exams scores were not significantly different between participants trained with HF versus LF models. LF models can be utilized as cost effective teaching tools for CBE skill acquisition, in resource poor areas.

Teprotumumab for the Treatment of Active Thyroid Eye Disease

BackgroundThyroid eye disease is a debilitating, disfiguring, and potentially blinding periocular condition for which no Food and Drug Administration–approved medical therapy is available. Strong evidence has implicated the insulin-like growth factor I receptor (IGF-IR) in the pathogenesis of this disease.MethodsIn a randomized, double-masked, placebo-controlled, phase 3 multicenter trial, we assigned patients with active thyroid eye disease in a 1:1 ratio to receive intravenous infusions of the IGF-IR inhibitor teprotumumab (10 mg per kilogram of body weight for the first infusion and 20 mg per kilogram for subsequent infusions) or placebo once every 3 weeks for 21 weeks; the last trial visit for this analysis was at week 24. The primary outcome was a proptosis response (a reduction in proptosis of ≥2 mm) at week 24. Prespecified secondary outcomes at week 24 were an overall response (a reduction of ≥2 points in the Clinical Activity Score plus a reduction in proptosis of ≥2 mm), a Clinical Activity Score of 0 or 1 (indicating no or minimal inflammation), the mean change in proptosis across trial visits (from baseline through week 24), a diplopia response (a reduction in diplopia of ≥1 grade), and the mean change in overall score on the Graves’ ophthalmopathy-specific quality-of-life (GO-QOL) questionnaire across trial visits (from baseline through week 24; a mean change of ≥6 points is considered clinically meaningful).ResultsA total of 41 patients were assigned to the teprotumumab group and 42 to the placebo group. At week 24, the percentage of patients with a proptosis response was higher with teprotumumab than with placebo (83% [34 patients] vs. 10% [4 patients], P<0.001), with a number needed to treat of 1.36. All secondary outcomes were significantly better with teprotumumab than with placebo, including overall response (78% of patients [32] vs. 7% [3]), Clinical Activity Score of 0 or 1 (59% [24] vs. 21% [9]), the mean change in proptosis (−2.82 mm vs. −0.54 mm), diplopia response (68% [19 of 28] vs. 29% [8 of 28]), and the mean change in GO-QOL overall score (13.79 points vs. 4.43 points) (P≤0.001 for all). Reductions in extraocular muscle, orbital fat volume, or both were observed in 6 patients in the teprotumumab group who underwent orbital imaging. Most adverse events were mild or moderate in severity; two serious events occurred in the teprotumumab group, of which one (an infusion reaction) led to treatment discontinuation.ConclusionsAmong patients with active thyroid eye disease, teprotumumab resulted in better outcomes with respect to proptosis, Clinical Activity Score, diplopia, and quality of life than placebo; serious adverse events were uncommon. (Funded by Horizon Therapeutics; OPTIC ClinicalTrials.gov number, NCT03298867, and EudraCT number, 2017-002763-18.)

213. Adult spinal deformity patients with a decline in certain activities of daily living are likely to fail nonoperative treatment

BACKGROUND CONTEXT The impact of worsening activities of daily living (ADL) such as spine-related financial difficulty and attending work/school have not been studied as potential independent predictors of failing nonoperative management of adult spinal deformity (ASD). PURPOSE To identify which specific ADLs assessed with the Scoliosis Research Society 22r (SRS-22r) can identify patients with ASD who are likely to fail nonoperative management. STUDY DESIGN/SETTING Prospective, observational study. PATIENT SAMPLE A total of 482 patients initially selected for nonoperative treatment of ASD patients were identified from a multicenter database. Of these, 55 (11%) had eventual crossover to operative intervention. Propensity score matching (PSM) was performed using age, gender and baseline Oswestry Disability Index (ODI) to create matched cohorts of 46 crossover (CX) and 46 noncrossover (NC) patients. OUTCOME MEASURES Our primary outcome was crossover to operative treatment among patients who were originally intended to be treated nonoperatively. METHODS Scoliosis Research Society (SRS-22r) questionnaire was administered at baseline, 6-weeks, 6-months and both 1 and 2 years. Change in overall score, subdomains and responses to specific questions over time were classified as increasing, decreasing or unchanged in relation to baseline. Kaplan-Meier curves were produced for time to crossover among patients by change in SRS-22r domains, and compared using log-rank test. Significant was set at 0.05. RESULTS NC and CX groups were similar among age, baseline ODI, and SVA (p>0.05). Patients had a mean age 55 ± 15 years; ODI of 35 ± 15; SVA of 3.5 ± 5.9cm. Mean time to crossover was 1.7 ± 1.4yrs. Decline in SRS-22r Total and Activity domains were associated with increased risk of failing nonoperative management (p=0.005, p=0.006), while decline in SRS-22r pain, appearance and mental health domains were not significantly associated with failure. Analysis of specific ADLs within the activity domain showed worsening financial hardship, level of activity and going out with friends/family to be associated with failure, while work/school activity and doing household chores were not. CONCLUSIONS Decline in SRS-22r Activity is the primary SRS-22r domain independently associated with failing nonoperative management of ASD. Within this domain, worsening physical activity, spine-related financial hardship and decreasing time with family/friends drive patients to undergo surgery, while the ability to perform household chores and attend work/school are not independently associated with failing nonoperative management. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Assessment of health systems guidance using the Appraisal of Guidelines for Research and Evaluation – Health Systems (AGREE-HS) instrument

Health systems guidance (HSG) documents contain systematically developed statements or recommendations intended to address a health system challenge. The concept of HSG is fairly new and considerable effort has been undertaken to build tools to support the contextualization of recommendations. One example is the Appraisal of Guidelines for REsearch and Evaluation - Health Systems (AGREE-HS), created by international stakeholders and researchers, to assist in the development, reporting and evaluation of HSG. Here, we present the quality appraisal of 85 HSG documents published from 2012 to 2017 using the AGREE-HS. The AGREE-HS consists of five items (Topic, Participants, Methods, Recommendations, and Implementability), which are scored on a 7-point response scale (1=lowest quality; 7=highest quality). Overall, AGREE-HS item scores were highest for the 'Topic' and 'Recommendations' items (means above the mid-point of 4), while the 'Participants', 'Methods', and 'Implementability' items received lower scores. Documents without a specific health focus and those authored by the National Institute for Health and Care Excellence group, achieved higher AGREE-HS overall scores than their comparators. No statistically significant changes in overall scores were observed over time. This is the first time that the AGREE-HS has been applied, providing a current quality status report of HSG and identifying where improvements in HSG development and reporting can be made.

Intelligence and Academic Achievement With Asymptomatic Congenital Cytomegalovirus Infection.

To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants. We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing (n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age (n = 11) and controls (n = 40). Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls. Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children.

Quality-of-life outcomes in patients who underwent subcutaneous immunotherapy and sublingual immunotherapy in a real-world clinical setting.

To compare changes in quality of life (QOL) that resulted from sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) in a real-world clinical setting. SLIT is established as a viable alternative to SCIT for the treatment of allergic rhinitis. Although comparative trials are increasingly available, few studies have examined QOL outcomes between these two treatments. One hundred and five participants who underwent immunotherapy for airborne allergies were enrolled in this prospective, single-center study. Forty participants completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) at initiation of therapy, after 6 months, and after 1 year of therapy. Only patients with complete time points were included in the ultimate analysis. Twenty-nine of these participants underwent SCIT and 11 underwent SLIT. The effects of age, sex, and asthma history were also examined. The participants in both groups demonstrated improvements in QOL regarding allergic rhinoconjunctivitis over the study period. However, the change in the RQLQ score from both baseline to 6 months and baseline to 1 year was only statistically significant in the SCIT group (p = 0.002, 6 months and 1 year). The participants in the SCIT group also demonstrated statistically significant improvement from baseline to 1 year in the specific domains of practical and emotional functioning, nasal symptoms, non-nasal/eye symptoms, and sleep. After 1 year, both SCIT and SLIT demonstrated a minimally important difference from baseline in the overall RQLQ score. Age <35 years in the SCIT group had a significant positive impact on QOL improvement (p = 0.038). Although improvements in QOL were noted in both groups, changes in overall scores and the majority of domains only achieved statistical significance in the SCIT group. A small study population and difficulties adhering to immunotherapy dosing schedules in the SLIT group may be contributing factors.

MP51-19 MULTI-COMPONENT VIDEO-BASED FEEDBACK USING ADDITIONAL WEBCAM INPUTS IMPROVES DAVINCI SURGICAL SKILLS SIMULATOR (DVSSS) PERFORMANCE

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2017MP51-19 MULTI-COMPONENT VIDEO-BASED FEEDBACK USING ADDITIONAL WEBCAM INPUTS IMPROVES DAVINCI SURGICAL SKILLS SIMULATOR (DVSSS) PERFORMANCE Scott Quarrier, Aisha Siebert, and Ahmed Ghazi Scott QuarrierScott Quarrier More articles by this author , Aisha SiebertAisha Siebert More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1628AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ergonomics is the study of the efficient movement in working environments. The da Vinci operating system is unique in that it consists of a separate human-machine interface at the operating console including master controls, camera pedal, and clutch. However, current robotic training approaches lack the ability to deliver specific feedback addressing each component. We demonstrate the use of additional web-camera inputs, offering multi-component summative feedback to improve virtual reality (VR) daVinci surgical skills simulator (DVSSS) training. METHODS 18 medical students were enrolled in a study on a VR DaVinic surgical skills curriculum. They were randomized into three groups: Group A (n=6, control), no performance feedback; Group B (n=6, standard formative expert feedback), Group C (n=6, summative expert feedback using multicomponent video feedback of the VR task + webcam feedback of master controls and foot pedal). Each trainee completed each task six times. 4 tasks (Peg Board 2, Camera targeting 2, Ring walk 3 & Suture sponge 3) were chosen. Simulator-measured performance metrics included differences in total score, time and economy of motion over the five trials. Data were analyzed using SPSS version 15. RESULTS A learning curve was observed across the five trials in all groups. A significant difference was seen between the three groups for change in overall score across the five trials. Ergonomic metric assessment showed that Groups B and C performed better than Group A (P .002 and P .000, respectively) and that the multicomponent feedback was more effective in tasks involving the use of multiple controls (Camera targeting & Ring walk). CONCLUSIONS Multi-component summative feedback (combination of task, master control, and camera pedal) is effective in significantly shortening the learning curve in the robotic training process, especially in complex tasks. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e701-e702 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Scott Quarrier More articles by this author Aisha Siebert More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract 24: Helping to Educate Women About the Risk of Stroke (HER-Stroke): Initial Results from a Teaching Intervention

Introduction: Recent studies reveal deficiencies in educating women about stroke. The vast majority of stroke education is presented as gender neutral or with a male bias. This study examined if a computer-based, gender-specific education program (HER-Stroke) increased women’s awareness of stroke signs and symptoms. Methods: This 2-phase prospective study with 2-week follow-up examined gender-specific education based on Knowles’ Theory, enrolled 225 women with at least one stroke risk factor from any inpatient setting or neurology outpatient setting. Phase I, 75 women received standard stroke education (Group A). Phase II, 150 women randomized to standard (Group B) vs HER-Stroke education (Group C). Knowledge is scored as the percent of questions answered correctly; confidence is the percent of questions attempted; and accuracy is percent correct of those attempted. Results: Mean age was similar for Group A, B, C (54.4, 57.9, 52.5 years) respectively. There were no statistically significant differences in mean knowledge scores comparing groups A B and C: (69.4%, 71.6%, 69.0%; p=0.67), mean confidence scores for groups A, B, and C respectively (80.8%, 83.2%, 80.2%; p=0.77), or mean accuracy scores for group A B and C (86.2%, 85.6%, 85.0%; p=0.75). Regression analysis revealed that older age was associated with lower knowledge scores (p&lt;.001) and lower confidence scores (p&lt;.001). After controlling for age, the intervention was associated with a statistically significant difference in knowledge and confidence (p&lt;.001). Conclusions: Enhanced efficacy among younger participants may reflect experience and comfort using technology. While the intervention was not associated with a change in overall scores, after controlling for age there was a statistically significant difference among groups. Further research including unmeasured covariates is needed to explore optimal stroke education formats for older learners.

Does video feedback analysis improve CPR performance in phase 5 medical students?

BackgroundThe use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen’s University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen’s University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance.MethodsFinal year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen’s University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using ‘StudioCode’ software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation.ResultsOne hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8–15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3–15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3–7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7–3.8) of cohort B participants, from session one to session two.ConclusionsThere is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0726-x) contains supplementary material, which is available to authorized users.

Effects of ethics education on moral sensitivity of nursing students.

While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established. This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea. A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of the Moral Sensitivity Questionnaire. Critical thinking disposition was measured using the Critical Thinking Disposition Questionnaire. Participants and research context: Participants were 70 undergraduate nursing students who were attending a university located in Seoul, Korea. The nursing ethics education was provided 7 times, from September to December 2010, and comprised 90-min sessions each week. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines. After the education, the levels for the patient-oriented care, a sub-domain of moral sensitivity, and inquisitiveness, a sub-domain of critical thinking disposition, significantly improved. There were no changes in overall scores for moral sensitivity and critical thinking disposition. There were significant positive correlations between moral sensitivity and critical thinking disposition both pre- and post-intervention. These results reflect the need for ongoing efforts to develop innovative content, structure, and instructional methods for undergraduate nursing ethics education programs.

Military veteran use of visual journaling during recovery

This paper details a pilot study that used a six-week visual journaling art therapy group with military veterans in recovery in order to reduce symptoms of stress, anxiety, depression, and trauma. Two participants completed the journaling group, pre- and posttest Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), and an individual interview. The data from the CORE-OM were analyzed to determine change in overall score as well as the domains of life functioning, risk/harm, problems/symptoms, and subjective well-being. The individual interviews were analyzed to determine themes. The following themes were identified: self-knowledge gained via the journaling process, therapist qualities, individual versus group therapy, art-making benefits, and art communicates the “real” me. Although the CORE-OM did not show clinically significant change, the interviews revealed that the participants benefited from their participation in the journaling group. Due to the small sample size and the fact that both participants were receiving other mental health treatment at the time of the study, the results cannot be generalized. However, the results indicate that further study is warranted.

BENCHMARKING PROGRESS ON CHILD SAFETY ACTION IN EUROPE—THE RESULTS OF THE 2012 CHILD SAFETY REPORT CARDS

BackgroundDespite the existence of effective measures to reduce child unintentional injury, they are not always adopted and implemented. A lot of what is known to work requires government action in...

Comparison of an individual systematic interview method and the oral health impact profile. Responsiveness and ability of describing treatment effect of oral rehabilitation

The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) has shown potential for generating information and measuring Oral Health-Related Quality of Life (OHRQoL) in oral rehabilitation. The Oral Health Impact Profile-49 (OHIP-49) has been widely used in population studies. The purpose of this study was to compare the responsiveness and ability of the SEIQoL-DW and the OHIP-49 to qualitatively describe the change following oral rehabilitation. Twenty-two participants treated with fixed or removable prosthesis were interviewed before and after treatment using the SEIQoL-DW and the OHIP-49 questionnaire. The participants rated the subjective perception of change and answered two global oral rating questions. A clinical examination was performed to identify dental status variables. No significant difference was found between pre- and post-treatment SEIQoL-DW scores. A significant difference between pre- and post-treatment OHIP-49 scores was found. The SEIQoL-DW and OHIP-49 change scores was significantly correlated. The dental status variables such as number of teeth, number of teeth replaced, number of occluding units, type of treatment, extractions and removable dental prosthesis (RDP) before treatment did not influence the change scores. The effect size was low for the SEIQoL-DW (0.15) and moderate for the OHIP-49 (0.60). Improvement in subjective perception of change was related to both improvement and deterioration in change scores. More aspects were mentioned in the SEIQoL-DW compared to the OHIP-49. Based on the change in overall score and effect size, the SEIQoL-DW showed a weaker responsiveness than the OHIP-49. The SEIQoL-DW, however, described the change more detailed than the OHIP-49.

Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

Heart failure (HF) is an increasingly common condition affecting patients' health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses. Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach's alpha coefficients were generally high (0.83-0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] 'Physical' and 'Social Functioning') were moderate to strong (0.41-0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from -9.6 (95% confidence interval [CI]: -4.1; -15.2) for placebo to -17.7 (95% CI: -15.3; -20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change. Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ.

Psychological benefits for children and adolescents who have undergone transplantation of the heart from participation in the British Transplant Games

The British Transplant Games are held annually for children and adults who have received transplanted organs. The aim of our pilot study was to determine whether participation in such an event had an impact on psychological well-being. We asked 26 children participating in the Games to complete a specifically designed questionnaire before and after the event. The 13 questions covered areas such as state of mood, perceived physical health, fatigue, anxiety, and confidence. There were mean improvements over time on 10 of the 13 questions, and the change in overall score was significant (p = .036). For the majority of young people, participation in the Transplant Games was associated with a positive impact on psychological functioning in the short term. Further evaluation is now required to determine whether such benefits are maintained in the longer term.

Effect of Song Writing Versus Recreational Music on Posttraumatic Stress Disorder (PTSD) Symptoms and Abuse Attribution in Abused Children

The purpose of this study was to develop a song-writing technique which would reduce PTSD symptoms in abused children. Participants were patients of an inpatient psychiatric child/adolescent unit in the State of Florida. The participants were between the ages of 9 and 17 and had been physically and/or sexually abused. This research project was of a within-subjects, pre-/posttest design. The experimental condition (song writing) followed the control condition (recreational music). The dependent measures were a self-report questionnaire about selected PTSD symptoms, using a 4-point response scale, and a measure of off-task behavior. Results showed no significant change in overall scores due to treatment condition. However, a significant difference occurred between African-American and Caucasian scores, and a significant interaction occurred between age of participants and test conditions. Possible reasons for these results are explored.

The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK.

The Edmonton Symptom Assessment scale (ESAS) was used on 1004 occasions to assess 71 patients with advanced malignant disease admitted to a palliative care unit in the UK over a six-week period. The median length of inpatient stay was eight days (range 1-36) and the median survival from start of ESAS to death was 16 days (range 2-202). Across all patients there was a trend towards worsening symptom scores over the first five days from admission with a significant deterioration in appetite scores. When scores were analysed retrospectively over five days according to outcome (death--group 1, or discharge--group 2) there was a significant improvement in pain scores in group 2 but no change in overall score, and a significant deterioration in activity, drowsiness and appetite in group 1 with no change in overall score. ESAS did not seem an appropriate tool in this group of patients as the total symptom scores were so often biased by the inevitable increase in individual symptom scores immediately prior to death.