Instrument Scores Research Articles

Patient-Reported Indicator Surveys (PaRIS): measuring patient reported experiences and outcomes across populations and health systems

Abstract We aimed to develop and test the performance of a questionnaire for adults (aged 45 or older) with one or more chronic conditions who use primary/ambulatory care across populations and health systems in multiple countries. Candidate scales and items were identified through a systematic process supported by international stakeholders (PaRIS Patient Advisory Panel, Technical Advisory Community and Working Party members of participating countries). Four instruments for each domain, covering patient reported outcome measures (PROMs), patient reported experience measures (PREMs), health behaviours, and health and health care capabilities, were shortlisted using predefined criteria and evaluated using the EMPRO method. A modified Delphi supported selecting a core instrument for each domain and additional relevant scales/items. Consultations took place with the stakeholders to confirm the suitability of the proposed questionnaire. The questionnaire was evaluated through cognitive testing and further modified accordingly. The survey was piloted in a Field Trial. Psychometric evaluation was conducted with data from a Field trial on an item level and scale level. Out of 217 instruments, the Delphi resulted in consensus on a core instrument for each main domain and additional questions to ensure comprehensiveness. The cognitive testing of the draft survey (17 languages, 20 countries) confirmed that most questions were interpreted as intended. The version of the survey developed for the field trial included 118 questions. The field trial psychometric evaluation was based on 10,145 patients, across 18 countries. The questionnaire performed well at item level and at scale level. Performance in terms of structure and validity was good overall. A revised version of the patient questionnaire was created with 115 items. A comprehensive questionnaire has been constructed based on the PaRIS survey framework for people living with chronic conditions and following an inclusive approach.

Validation of the Portuguese MDS-UPDRS: Challenges to Obtain a Scale Applicable to Different Linguistic Cultures.

The MDS-UPDRS has been available in English since 2008, showing satisfactory clinimetric results and being proposed as the new official benchmark scale for Parkinson's disease (PD), being cited as a core instrument for PD in the National Institutes of Neurological Disorders and Stroke Common Data Elements program. For this reason, the MDS created guidelines for development of MDS-UPDRS official, clinimetrically validated translations. This study presents the formal process used to obtain the officially approved Portuguese version of the MDS-UPDRS. The study consisted of three phases: (1) Independent translation by Portuguese and Brazilian teams followed by a challenging consensus process that this article particularly emphasizes; (2) Cognitive pretest involving raters and patients from both Portugal and Brazil; (3) Validation test with a sample of 367 native Portuguese-speaking PD patients. The overall factor structure of the Portuguese version was consistent with the English version based on a comparative fit index ≥0.96 for all four parts of the MDS-UPDRS. This version can be designated as the official Portuguese version of the MDS-UPDRS.

Psychological morbidity and quality of life of patients with pulmonary tuberculosis.

Tuberculosis (TB) is associated with psychological distress, poor coping, deterioration in health-related quality of life (HRQL), and stigma. However, these issues have never received sufficient attention as a part of routine care. The healthcare workers and physicians of primary contact are not sensitized to use discrete screening questionnaires to identify and address these issues. A longitudinal study was hence conducted in the Department of Pulmonary Medicine in collaboration with the Department of Psychiatry. 75 microbiologically confirmed 'new' pulmonary TB patients were enrolled. Socio-demographic and clinical details were noted. The patients were then evaluated for psychological distress using the General Health Questionnaire-12-Hindi version (GHQ-12) and Patient Distress Thermometer (PDT); coping strategies using the Coping Strategy Check List-Hindi Version (CSCL); HRQL using the World Health Organization Quality of Life-Brief-Hindi version (WHOQOL-Bref), and stigma using the Explanatory Model Interview Catalogue-affected persons Stigma Scale (EMIC-SS), at the start of treatment. Those having a GHQ-12 score ≥3 were labeled as 'screen positive' for psychological distress and referred to a consultant psychiatrist for detailed psychological assessment. Treatment was given by the psychiatrist if diagnosed with a psychiatric illness. All those without the diagnosis of a psychiatric illness were counseled by a pulmonologist. All patients were called for a follow-up visit and repeat assessments on the 15th day at the end of the intensive phase, using the same instruments employed at baseline. The patients already on treatment by the psychiatrist were again evaluated for their psychiatric illness. 32 (42.7%) patients had psychological distress (GHQ-12≥3) at baseline. 20 of them (26.7%) were diagnosed with a psychiatric illness. However, only 2 (2.7%) patients had psychological distress and psychiatric illness at follow-up (p<0.001). Mean scores of GHQ-12, PDT, CSCL, WHOQOL-Bref-26, and EMIC-SS at baseline were 3.000±1.9590, 2.333±1.2980, 3.480±2.2017, 311.63±30.201 and 5.267±1.8478, respectively. All the scores improved significantly at follow-up (p<0.001). The scores of the various instruments used in the study significantly correlated with each other. Comprehensive screening for psychological distress and assessment of HRQL should be part of routine TB care. The healthcare workers under the program should be sensitized to use the various screening tools on a day-to-day basis to identify patients who require expert psychiatrist care. The majority of the patients with distress, but without a psychiatric illness, can be handled well with dedicated counseling sessions by the healthcare workers themselves. The ancillary staff should be encouraged and trained to meet the demands in resource-constrained settings. A multidisciplinary approach, with close integration of TB programs with mental health services, is urgently required to eliminate TB.

Mild to moderate cognitive impairment does not bias the Geriatric Depression Scale in a large US sample of older adults.

The Geriatric Depression Scale (GDS) is widely used to screen for depression in clinical practice and to assess symptoms of depression in research about older adults. To determine whether the 15-item GDS can be used in adults with dementia, this study investigated whether item- or test-level bias in the GDS-15 is associated with the respondent's level of cognitive impairment. Using a large U.S. sample of 24,674 adults, we first conducted sample matching procedures between the five groups defined by CDR® Dementia Staging Instrument scores to control for potential confounding effects of common demographic variables. Then, we employed confirmatory factor analysis (for single-group and configural-invariance models only) and item response theory models to test potential differential item/test functioning effects associated with the GDS-15 across the five CDR groups. Practical consequences of the identified biases were quantified using sample-based Cohen's d effect sizes and misclassification rates. In general, people with higher CDR scores were older and had fewer years of education. In comparison to the normal cognition group (CDR-0), negligible biases in GDS-15 scores were found for the groups with questionable, mild, or moderate cognitive impairment (CDR-0.5/1/2). For individuals with severe cognitive impairment (CDR-3), their responses were inconsistent with the normal cognition group and their depression scores were significantly biased with a small-to-medium effect size. The GDS-15 can be used to assess depression in individuals with mild or moderate cognitive impairment, but not in individuals with severe cognitive impairment.

Characteristics associated with gait speed improvements from walking interventions for older adults: A responder analysis

BackgroundSome older adults benefit to a great degree from walking interventions and others experience little improvement. Understanding the personal characteristics associated with greater treatment response to different interventions could assist clinicians in providing patients with matched interventions to optimize both outcomes and resource use. Research questionWhat personal characteristics are associated with improved gait speed for older adults participating in walking interventions? MethodsThis was a secondary analysis of 236 older adults from a trial comparing “Standard” (lower-extremity strength and walking endurance) to “Plus” (additional task-specific training for walking) interventions on gait speed in older adults (≥65 years). Predictors included sociodemographic characteristics, health status, physical performance, and self-reported function. We fitted linear regression models to 12-week change in gait speed. ResultsPredictors of improved gait speed in Standard group included: younger age (β=-0.015), lower BMI (β=-0.005), slower gait speed (β=-0.015), longer Figure 8 Walk time (β=0.010), and higher Late Life Function and Disability Instrument scores (β=0.003). The parsimonious set of multivariable predictors were never married (β=0.081), not a caregiver (β=0.208), no cancer history (β=-0.052), slower chair rise times (β=0.010), slower gait speed (β=-0.021), and better overall function and disability (β=0.006).Predictors of improved gait speed in Plus group included: lower BMI (β=-0.004), farther Six-Minute Walk distance (β=0.014), and greater modified Gait Efficacy Scale (β=0.002). The parsimonious set of multivariable predictors were increased age (β=0.026), no cardiovascular disease (β=0.137), greater total physical activity counts per day (β=0.003), slower baseline gait speed (β=-0.072), and longer Six-Minute Walk distance (β=0.054). SignificanceThose with the combination of suboptimal physical performance and strong self-report of function may benefit from standard strength and conditioning. Individuals may best respond to task-specific training when health status and physical performance are suboptimal and not overtly compromised. Matching interventions with personal characteristics may enhance efficacy of treatments to improve walking in older adults.

Collective free improvisation in the Flemish general music classroom: Probing student’s lived experience through flow

The aim of this study is to explore the lived experience of students ( N = 1,282) in general education engaging in collective free improvisation (CFI). Fourteen music teachers implemented a CFI lesson in 69 classes in Flanders (Belgium). Lived experience was measured using a Dutch version of the Flow State Scale for Occupational Tasks. This scale reflects the degree of Sense of Control, Positive Emotional Experience and Absorption by Concentrating. In addition, teachers’ reflections were mapped by means of an online survey. Overall scores on the 3 dimensions of the Flow scale averaged greater than or equal to 5 (7-point Likert scale). Results show a difference in total flow between students who already played an instrument and those who did not. Students who play an instrument score significantly higher on the factor ‘Sense of Control’. Conversely, the flow scores on the factors ‘Absorption by Concentration’ and ‘Positive Emotional Experience’ do not differ between instrumentalists and non-instrumentalists. Given the relatively high flow scores, we conclude that this type of musical engagement can be used for instrumentalists as well as non-instrumentalists. Although CFI was a new experience for the teachers, they indicated to continue using it in the future.

Personal values and moral reasoning: An empirical study

This exploratory study examined the personal values (using the Rokeach values survey) and moral reasoning (according to the DIT-2 P-scores) of a sample of 51 students taking business courses at a Canadian University in Winter 2020, at the beginning of the COVID-19 epidemic. The mean P-Score of the sample was 32.16 with females having a mean P-score (37.4) significantly higher (at 5% level) than the males (mean of 28.62). Health was ranked as the most important terminal value, followed by Family Security and Self-Respect while Honest was considered as the highest-ranking instrumental value, followed by Responsible and Ambitious. Female respondents considered the value of Self-Respect to be of more priority than the male respondents. The results suggest that most of the respondents (66%) according to the Musser-Orke classification, place emphasis on social than on personal goals and thus on serving others rather than themselves. No significant correlation was, however, detected between the respondents’ P-Scores and either their social terminal or moral instrumental value scores.

Using Administrative Data to Identify Factors Associated with Healthy Development After Experiencing Household Challenge Adversity in Early Childhood

This study aimed to identify factors associated with healthy development after experiencing household challenge adversity in early childhood. A cohort of 42,505 children born in Manitoba, Canada was created using linkable health, social, and education administrative data. Children were divided into 5 groups according to whether they experienced adversity between birth and four years of age in the following categories: 1) having a parent diagnosed with a mental health disorder, 2) having a parent diagnosed with a substance use disorder, 3) having a parent who received income assistance for at least 2 months, 4) experiencing at least one of the 3 adversities, and 5) having none of the adversities listed. For each group, multiple linear regression models were computed to determine the association of the independent variables (age, sex, birth order, team parenting, neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, not having a major illness, residential stability, program participation, and connectedness to health care services) on child development, represented by their Early Development Instrument scores. In each group, factors associated with healthy development included at minimum: older age, being female, being firstborn, team parenting, higher neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, and not having a major illness. Several of these factors are associated with increased access to material resources. As such, policies that facilitate the delivery of resources to lower-income families and neighbourhoods with lower socioeconomic status could translate into improved developmental outcomes for children.

Online Patient Education in Obstructive Sleep Apnea: ChatGPT versus Google Search.

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5's capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch-Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60-91% vs. 44-80%) and actionability for ChatGPT-3.5 (0-40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance.

Calibrating families: Data behaviourism and the new algorithmic logic

Abstract Family intervention is a long-established mechanism of state control, but recent technological developments are facilitating new regulatory capacities and objectives. This paper will explore how contemporary welfare policy interventions in the UK are converging around a technological solutionist ideology that centres family relationships as core instruments of social management. The last decade has seen a marked techno-administrative turn, with family/state relationships increasingly mediated through online portals and dashboards. Over the last few years this data-centric model has accelerated towards an algorithmic approach to governance through the incorporation of big data surveillance, predictive analytics and behavioural interventions to monitor and socially engineer populations. In this paper we draw on policy analysis and freedom of information requests to trace the embedding of data collection frameworks into apparently conventional family intervention programmes in the UK, and show how this “datification” was made into a core delivery tool. We also highlight how secrecy, or at the very least strategic silence, has restricted public knowledge of how and why data is being collected and used in the UK. We show how parents and children are being quantified and translated into datapoints to support new logics of choice manipulation, ceding unprecedented power to financiers, data analytic and social marketing companies, platform developers and big tech industries. The resulting financialization of family welfare services tracks the contours of longstanding social divisions, reconfiguring and in many cases compounding the injustices of race, class and gender. This algorithmic calibration of children and parents is extending the regulatory powers of the state far beyond previous efforts to govern and control poor families, with under-explored consequences for the principles of democracy and justice.

Whether coagulation dysfunction influences the onset and progression of diabetic peripheral neuropathy: A multicenter study in middle-aged and aged patients with type 2 diabetes.

Nearly half of patients with diabetes experience diabetic peripheral neuropathy (DPN), resulting in a mere 53% survival rate within 3 years. Aberrations in coagulation function have been implicated in the pathogenesis of microvascular complications, prompting the need for a thorough investigation into its role as a contributing factor in the development and progression of DPN. Data were gathered from 1211 type 2 diabetes patients admitted to five centers from September 2018 to October 2022 in China. DPN was evaluated by symptoms and electromyography. Motor and sensory nerve conduction velocity (NCV) was appraised and the NCV sum score was calculated for the median, ulnar, and peroneal motor or sensory nerves. Patients with DPN exhibited alterations in coagulation function. (i) Specifically, they exhibited prolonged thrombin time (p = 0.012), elevated fibrinogen (p < 0.001), and shortened activated partial thromboplastin time (APTT; p = 0.026) when compared to the control group. (ii) After accounting for potential confounders in linear regression, fibrinogen, and D-dimer were negatively related to the motor NCV, motor amplitude values, and mean velocity and amplitude. Also, fibrinogen was associated with higher Michigan neuropathy screening instrument (MNSI) scores (β 0.140; p = 0.001). This result of fibrinogen can be validated in the validation cohort with 317 diabetic patients. (iii) Fibrinogen was independently associated with the risk of DPN (OR 1.172; p = 0.035). In the total age group, DPN occurred at a slower rate until the predicted fibrinogen level reached around 3.75 g/L, after which the risk sharply escalated. Coagulation function is warranted to be concerned in patients with type 2 diabetes to predict and prevent the occurrence of DPN in clinical practice.

YouTube Video Clips on Breastfeeding Education and Promotion for Arabic-Speaking Populations: A Social Media Content Analysis.

Background/Objective: Although the benefits of breastfeeding are well-documented and widely recognized, reports indicate that optimal breastfeeding rates are low in Arabic-speaking countries. This is a significant concern given the health benefits associated with breastfeeding for both infants and mothers. Previous research has shown that education interventions can increase breastfeeding knowledge, attitudes, and practices in Arabic-speaking populations. The social media platform YouTube holds significant potential for distributing customized health education for diverse audiences; specifically, this platform has the potential to empower mothers and normalize long-term breastfeeding. The aim of this study was to evaluate the quality of YouTube videos on breastfeeding available in the Arabic language. Methods: We used standard procedures to search YouTube for Arabic breastfeeding videos posted on YouTube in December 2023. Videos were evaluated using the three scales of the DISCERN quality evaluation instrument (reliability, information quality, video quality) and total score. Comparative statistics were generated. Results: In total, 165 videos met the inclusion criteria, with 29.7% in the Education category; 43.6% were in Egyptian Arabic dialect. Almost all (91.75%) of the educational videos had a "medium" quality assessment. Educational videos and those using health professionals had higher quality assessments than those in other categories or done with other speakers. Conclusion: The results of this review suggest that most content on the topic of breastfeeding was of only medium reliability and informational quality. New mothers seeking breastfeeding information or support may be in need of specific problem-solving information at a time when they are living with the often-difficulty reality of caring for a newborn or very young infant. There is a clear need for accurate, culturally congruent information to effectively support breastfeeding in Arabic-speaking countries. Future efforts should focus on improving the quality of online health education content, with implications for public health strategies and policy development.

Development of a Core Outcome Measure Instrument; "LeishCOM_LCL", for Localised Cutaneous Leishmaniasis.

Localized cutaneous leishmaniasis (LCL) is a chronic ulcerating disease. A literature review identified inconsistencies in clinical trials. The aims of this study were to reach a consensus on the most important domains to measure when assessing LCL, agree on parameters to measure the domains, and develop a tool representing a Core Outcome Set (COS), for use in clinical assessment of LCL. A literature review was conducted to identify any existing COS for LCL embracing agreed Outcome Domains, i.e. what to measure and any Outcome Measurement Instruments (OMIs). As no COS was available, potential outcome domains for assessment of LCL were identified through an international collaborative approach using e-consultations and virtual discussions with expert stakeholders (n = 20) from geographically different LCL endemic countries. Subsequent judgmental validation process included a face-to-face multidisciplinary stakeholders' meeting adopting the Nominal Group Technique. A final consensual agreement on outcome domains and items required to measure these domains was established. "Clinical Cure" was defined as the ideal overall "General Concept". The five Core Outcome Domains included Signs capturing clinical morphology, diameter, and induration of an index lesion with the aid of a palpability score, Treatment Efficacy assessing percentage change in size of the lesion and re-epithelialization compared to baseline, Treatment Impact which included an investigator and patient visual analogue score, and Clinical Sequelae rating pigment change, atrophic and hypertrophic/keloid scars. It was agreed that two open-ended questions should be included to capture some aspects of Health-Related Quality of Life as a means of capturing a patient-focused approach. LeishCOM_LCL was generated to reflect a COS for LCL. This captured demographic details, agreed outcome domains and measures to assess these domains. Validation of LeishCOM_LCL will be reported in a separate paper. Development of a Patient Reported Outcome Measure will be considered in the future.

Age-related differences in delta-beta phase-amplitude coupling in autistic individuals

ObjectiveWe aim to investigate the relationship between the core symptoms of autism, anxiety levels, and attention deficit hyperactivity disorder (ADHD) traits, and a non-autism-specific, neurophysiological metric, the Delta-Beta phase-amplitude coupling (PAC), extracted from the resting-state EEG for autistic and non-autistic populations across three different age groups (children, adolescents, and adults). MethodsWe analyze the eyes-open resting-state EEG of 371 individuals. We applied a phase de-biasing PAC algorithm expected to result in a more accurate PAC estimate than other PAC methodologies available in the literature. ResultsIn the adult group, we found a significant increase of the delta-beta PAC in the autistic subgroup who met the Autism Diagnostic Observation Schedule-2 (ADOS-2) Autism Diagnostic Interview-Revised (ADR-R) ADOS-2/ADI-R threshold compared to non-autistic individuals. The differences seem age-specific since we found no statistically significant differences in the children and adolescent populations. Moreover, we found a significant positive correlation with the restricted and repetitive behaviours score of the ADOS-2 diagnostic instrument and with ADHD hyperactivity/impulsivity in the entire autistic cohort. ConclusionsThe neurophysiological differences we found only in the autistic individuals that meet the thresholds also point out the need for future studies that look for autistic neurodiverse subgroups beyond age. SignificanceThe delta-beta debiasing PAC (dPAC) may potentially serve as a severity biomarker in the autistic population.

Shedding Light on the Black Box of Rehabilitation: Differential Short- and Long-Term Effects of Multidisciplinary Multiple Sclerosis Rehabilitation.

The study of the effectiveness of multidisciplinary rehabilitation (MDR) and how the symptoms and needs of individuals with multiple sclerosis (MS) interplay with the diversity of MDR interventions is still a conundrum, often referred to as a black box. We conducted a partial crossover randomized controlled trial with follow-ups at 1 (discharge), 6, and 12 months. Based on their rehabilitation goals, each patient was categorized into 1 of 5 main focus areas (MFAs) prior to admission: Resilience, Cognitive Function, Energy, Physical Function, and Personal Needs. The Functional Assessment of Multiple Sclerosis (FAMS) instrument scores were the primary outcome. MFA groups varied in age (P = .036), MS type (P = .002), Expanded Disability Status Scale score (P < .001), time since diagnosis (P = .002), and FAMS at baseline (P < .001), as well as in composition and quantity of MDR services. At discharge, significant FAMS improvements were found in all 5 MFA groups (FAMS change > 10.4, P < .05), but the affected subdimensions and persistence of improvements varied among MFA groups. At the 6-month follow-up, estimates of controlled differences in FAMS were 9.9 (P =.001), 5.6 (P = .196), 8.5 (P = .008), -1.4 (P = .548), and 17.9 (P = .012) for the Resilience, Cognitive Function, Energy, Physical Function, and Personal Needs groups, respectively. This study demonstrated that inpatient MDR improves functioning and health-related quality of life in people with MS; the type, degree, and persistence of the benefits are associated with a patient's main focus area of rehabilitation, which signifies the importance of the goal-setting process in MDR.

Do risk measure scores and diagnoses predict evaluator opinions in sexually violent predator cases? It depends on the evaluator.

Field research increasingly reveals that forensic evaluators are not interchangeable. Instead, they tend to differ in their patterns of forensic opinions, in ways that likely reflect something about themselves, not just the persons evaluated. This study used data from sexually violent predator (SVP) evaluations to examine whether evaluator differences in making intermediate decisions (e.g., instrument scoring, assigning diagnoses) might explain their different patterns of final opinions. Although this study was generally exploratory and not strongly hypothesis driven, we expected that there might be evidence for a simple form of bias in which some evaluators would be more likely than others to consistently "find" indications of SVP status (i.e., consistently assigning higher risk scores and more SVP-relevant diagnoses) and, therefore, be more likely to find behavioral abnormality, the legal construct qualifying someone for commitment as an SVP. The study used data from 745 SVP evaluations conducted by 10 different evaluators who were assigned cases from the same referral stream. Potential evaluator difference variables included behavioral abnormality opinions, paraphilia and antisocial personality disorder diagnoses, and Psychopathy Checklist-Revised and Static-99 scores. Evaluator differences explained a statistically significant (p < .001) amount of variance in behavioral abnormality opinions (17%), paraphilia diagnoses (7%), and Psychopathy Checklist-Revised scores (16%). Contrary to our expectation of a simple tendency for some evaluators to find all indicators of SVP status more often than others, evaluators differed in the ways that underlying diagnoses and scores corresponded with their conclusions. The overall pattern was one in which different evaluators appeared to base their final opinions on different factors. Findings reveal further evidence of substantial forensic evaluator differences in patterns of assigning instrument scores and reaching forensic conclusions. But these findings are the first to also reveal wide variability in their patterns of reaching forensic conclusions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Escape room design in training crew resource management in acute care: a scoping review

BackgroundEffective teamwork is crucial to providing safe and high-quality patient care, especially in acute care. Crew Resource Management (CRM) principles are often used for training teamwork in these situations, with escape rooms forming a promising new tool. However, little is known about escape room design characteristics and their effect on learning outcomes. We investigated the current status of design characteristics and their effect on learning outcomes for escape room-based CRM/teamwork training for acute care professionals. We also aimed to identify gaps in literature to guide further research.MethodsMultiple databases were searched for studies describing the design and effect of escape rooms aimed training CRM/teamwork in acute care professionals and in situations that share characteristics. A standardized process was used for screening and selection. An evidence table that included study characteristics, design characteristics and effect of the escape room on learning outcomes was used to extract data. Learning outcomes were graded according to IPE expanded typology of Kirkpatrick’s levels of learning outcome and Medical Education Research Study Quality Instrument (MERSQI) scores were calculated to assess methodology.ResultsFourteen studies were included. Common design characteristics were a team size of 4–6 participants, a 40-minute time limit, linear puzzle organization and use of briefing and structured debriefing. Information on alignment was only available in five studies and reporting on several other educational and escape room design characteristics was low. Twelve studies evaluated the effect of the escape room on teamwork: nine evaluated reaction (Kirkpatrick level 1; n = 9), two evaluated learning (Kirkpatrick level 2) and one evaluated both. Overall effect on teamwork was overtly positive, with little difference between studies. Together with a mean MERSQI score of 7.0, this precluded connecting specific design characteristics to the effect on learning outcomes.ConclusionsThere is insufficient evidence if and how design characteristics affect learning outcomes in escape rooms aimed at training CRM/teamwork in acute care professionals. Alignment of teamwork with learning goals is insufficiently reported. More complete reporting of escape rooms aimed at training CRM/teamwork in acute care professionals is needed, with a research focus on maximizing learning potential through design.

Effect of the postoperative pain management model on the psychological status and quality of life of patients in the advanced intensive care unit

Objectiveit was to explore the influence of the postoperative pain management mode on the psychological state, quality of life (QOL), and nursing satisfaction of late patients in the intensive care unit (ICU) and improve the nursing effect of late patients in the ICU.Methodsseventy patients who were admitted to the postoperative ICU for gastric cancer and received treatment in our hospital from March 2021 to May 2022 were selected. The patients were assigned into a research group and a control (Ctrl) group according to a random number table, with 70 cases in each group. The Ctrl group received routine nursing intervention, while research group received nursing intervention based on routine nursing intervention with postoperative pain management mode and received psychological care. Good communication was established with the patients, and the postoperative pain assessment was well conducted. The general information, state-trait anxiety (STAI) score, World Health Organization’s Quality of Life Instrument (WHO QOL-BREF) score, and care satisfaction were compared.Resultsthe general information differed slightly, such as sex, age, and ward type, between groups, with comparability (P > 0.05). S-AI scores (13.15 ± 1.53 vs. 16.23 ± 1.24) and T-AI scores (14.73 ± 3.12 vs. 18.73 ± 3.16) in research group were inferior to those in Ctrl group (P < 0.05). The scores of patients in research group in the physiological field (78.9 ± 6.1 points vs. 72.3 ± 5.6 points), social relationship field (76.9 ± 4.5 points vs. 71.3 ± 4.8 points), psychological field (78.6 ± 6.2 points vs. 72.4 ± 5.3 points), environmental field (78.6 ± 6.7 points vs. 73.5 ± 6.4 points), and total QOL (79.5 ± 7.4 points vs. 71.6 ± 5.4 points) were higher than those in Ctrl group (P < 0.05). The total satisfaction rate with nursing care in research group (82.85%) was dramatically superior to that in Ctrl group (62.85%) (P < 0.05).Conclusionthe adoption of a postoperative pain management model in postoperative nursing interventions for patients in advanced ICUs can alleviate anxiety and depression, improve patients’ QOL and nursing satisfaction, and have clinical promotion value.

Strategic autonomy of the EU in the light of CSDP and the changing world order

The development of the European Union’s activity as a security actor is closely linked to the need for global capacity for action in this domain, with a clearly “softer” role definition than NATO, which is derived from a collective security concept. The aim of this study is to identify how and under what circumstances the European Union’s self-definition in the field of security and defense policy has evolved, how it has attempted to make the EU be present in the changing world order as an independent actor asserting its strategic autonomy with a specific voice. The paper looks back not only on the development of the EU security and defense policy, but also highlights the two decades of Hungarian operational involvement in it. Our central assumption is that the strengthening of the EU’s strategic autonomy, in which CSDP is one of the core instruments, cannot be avoided amid the challenges of the modern era if the EU wants to preserve its competitiveness and adaptive responsiveness.

Application of a deep learning method for shower axis reconstruction in a 3D imaging calorimeter

We present a deep learning method based on Convolutional Neural Networks (CNN) to reconstruct the shower axis of isotropic electrons in a three-dimensional (3D) imaging calorimeter, which is one of the core instruments of the High Energy cosmic-Radiation Detection (HERD) payload. The CNN method is evaluated against the Principal Component Analysis (PCA) method, utilizing isotropic Monte Carlo (MC) simulation data covering an energy spectrum from 10 GeV to 1000 GeV, as well as beam test data ranging from 50 GeV to 250 GeV. The comparative analysis results indicate that the CNN outperforms the PCA by about 40% at 100 GeV in terms of angular resolution under isotropic conditions. Both methods are further validated using beam test data. The results demonstrate the effectiveness of the CNN method in reconstructing the shower axis, and they underscore the potential of incorporating advanced deep learning techniques into the comprehensive task of calorimeter reconstruction.