Practice Research Research Articles

Development of a tool to assess financial advocacy service delivery.

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5%

Facilitating Health-Promoting Self-Care in Older Adults: A Theory Synthesis.

The authors describe the development of a model that focuses on how primary care providers can facilitate health promotion in older adults. The health-promoting self-care in older adults (HPSOA) model was developed through a synthesis of key concepts from the Health Promotion model and the Modeling Role Modeling Theory. Walker and Avant's strategy for theory synthesis was used in its development. The model prioritizes rapport building to foster a trusting patient-provider relationship and focuses on long-term solutions to health promotion. Further model use through testing, research, and application in practice is recommended.

Advancing Education in Challenging Times: A Review of the XVI International Conference on Mathematics, Science and Technology Education (ICon-MaSTEd 2024)

Abstract This paper presents a comprehensive review of the XVI International Conference on Mathematics, Science and Technology Education (ICon-MaSTEd 2024), held from May 15-17, 2024, at Kryvyi Rih State Pedagogical University, Ukraine. The conference, organized in a hybrid format, brought together over 100 attendees from 9 countries, showcasing cutting-edge research and innovations in educational practices amid global challenges. The review synthesizes key themes and findings from 37 selected papers across various domains, including Mathematics Education, Science Education, Computer Science Education, and Educational Technology. Notable trends include the increased integration of artificial intelligence and digital technologies in education, the development of 21st-century skills, and adaptive strategies for education in crises. Particular attention is given to studies addressing the unique educational challenges faced in Ukraine, demonstrating the resilience and innovation of educators and researchers in conflict-affected regions. The paper highlights significant contributions in areas such as online learning environments, visual thinking in mathematics, AI applications in mental health education, and the design of university digital ecosystems.

Dɛnkyɛm: Identity Development and Negotiation Among 1.5-Generation Ghanaian American Millennials

Ghanaian immigrants are largely ignored in U.S.-based scholarship. Within this qualitative study, I explored the experiences of 1.5-generation Ghanaian American millennials with the purpose of understanding how they create, negotiate, and re-create identities. Using a phenomenological approach, I examined the experiences of eight individuals to specifically understand the creation and negotiation of national, ethnic, and racial identities in public and private spaces. I argue that the 1.5-generation is uniquely socially positioned and forced to code-switch and adapt based on age, race, and nationality, all while still learning to adjust to living in the U.S. The findings suggest that many individuals of this generation had unrealistic expectations of what life in the United States was like, which made the initial transition difficult. Participants also discussed a common theme of bullying at school and a distinct difference between their home life and public life. Racialization was the most challenging aspect of life participants faced as it related to their adjustment to mainstream U.S. society and revealed complex layers that are involved in identity development and negotiation. I close with suggestions for future research and implications for practice for scholars, policymakers, and community members.

Societal Trust and Modified Audit Opinions: International Evidence

ABSTRACT This study examines how societal trust influences auditors’ likelihood of issuing modified audit opinions. Analyzing cross-country data, we find that auditors in countries with high levels of societal trust are less prone to issue modified audit opinions. Specifically, our findings indicate that this effect is moderated by formal audit-related institutions, such as heightened auditor liabilities, the presence of Public Company Accounting Oversight Board (PCAOB) inspections, and a more advanced audit profession. These results are consistent even when applying a difference-in-differences (DiD) approach. Further analysis shows that the moderating impact of formal institutions is more pronounced for clients operating domestically, clients of non-Big N auditors, and auditors with long tenure. Overall, our findings highlight societal trust as a significant informal institution influencing auditor opinions, with a complex interplay between this trust and formal audit-related institutions. The study offers important implications for policy, practice, and future research. Data Availability: Data are available from the public sources cited in the text. JEL Classifications: M40; M41.

[Artículo traducido] Un nuevo paradigma en el tratamiento del prurito del cuero cabelludo: hallazgos del estudio SCALP-PR

PurposeThe “Impact of scalp pruritus in dermatological consultations in Spain: The SCALP-PR trial” was initiated to address the common yet often insufficiently examined issue of scalp pruritus in dermatology. This condition leads to an uncontrollable urge to scratch, affecting the patients’ quality of life and potentially causing scalp damage. This study aimed to explore the prevalence, patient profile, underlying conditions, and therapeutic approaches for scalp pruritus in Spain, and to assess the safety and efficacy profile, as well as the tolerability of a non-pharmacologic treatment. MethodsFrom 2021 through 2022, 75 dermatologists enrolled a total of 359 patients in a study on scalp pruritus, approved by the Bellvitge University Hospital Research Ethics Committee, Barcelona, Spain. This evidence-based research combined a meta-analysis with observational study techniques focused on real-world evidence to examine the therapeutic impact on quality of life (QoL). Utilizing the Dermatology Life Quality Index (DLQI) for QoL assessments, the study evaluated the effectiveness of the topical product over 15 days. Data collection was conducted via an eCRF and analyzed with statistical methods to provide reliable insights into the management of scalp pruritus. ResultsThe prevalence of scalp pruritus in Spain was found to be 6.9%, predominantly among women with a mean age of 52.5 years. The leading causes identified were seborrheic dermatitis and pruritus of undetermined etiology or sensitive scalp. Stress was noted as a key factor, with corticosteroids and hygienic measures being common therapies. The topical product demonstrated significant reductions in pruritus and scratching in more than 90% of patients after 15 days. Improvements were also seen in dermatological quality of life, with 87.1% of patients showing enhancements in DLQI scores. The product was well-received thanks to its cosmetic properties, with high ratings in texture, ease of application, and fragrance. ConclusionThe topical product studied is a safe, effective, and cosmetically appealing treatment, improving scalp pruritus in various etiologies for most patients. The results highlight the need for patient-center treatments in dermatology, providing important insights for clinical practice and future research.

Effect of the particle shape on the shear mechanical behavior of coral sand

Abstract Coral sand particles exhibit a wide range of shapes, which can be divided into four shapes, e.g., blocky, dendritic and rodlike, flaky, and shell debris. The particle shape of these mixtures is defined by the sphericity, concavity, aspect ratio, flatness and overall regularity, which ranges from 0 to 1. The effect of particle shape on the strength, crushing characteristics, and critical state parameter is systematically investigated through a series of triaxial drainage shear tests under different confining pressures. And the relationship between critical state parameters and mechanical parameters is established. The test results demonstrate the existence of an evident strain-hardening phenomenon in the stress–strain curve of coral sand, accompanied by a strain-softening phenomenon when the bias stress reaches its peak value. The sample is initially subjected to shear shrinkage, followed by shear expansion. The volumetric deformation of the coral sand decreased with increasing peripheral pressure. The particles are transformed from rough irregular shapes to smooth spheres as evidenced by an increase in the shape parameter. The greater the degree of irregularity in the shape of the particles, the more pronounced the resulting change in size reduction. In addition, the critical state parameter was found to be influenced by the shape of the coral sand particles and the mode of particle accumulation. The overall shear resistance of coral sand particles was found to depend on particle rearrangement in addition to particle surface roughness and interparticle friction. It is proposed that the general regularity critical state parameter equation relates the particle shape of coral sand to its critical state mechanical properties, which is of great importance to the practical application and research of coral sand in engineering, and provides an effective means of predicting mechanical properties granular materials.

Narrative review on efficacy and safety of anti-angiogenesis in combination with immunotherapy in the treatment of breast cancer.

Breast cancer was the second frequently diagnosed cancer in 2022 among all cancers. Besides classical chemotherapy and radiation, immunotherapy and targeted therapy are both identical treatment options for patients with advanced breast cancer. Immunotherapy is a therapeutic approach to control and eliminate tumors by restarting and maintaining the tumor-immunity cycle and restoring the body's normal anti-tumor immune response. Immunotherapy alone or in combination with other therapies has been shown to be clinically beneficial in a variety of solid tumors with a manageable safety profile. However, immunotherapy alone cannot fully satisfy the therapeutic needs for patients with breast cancer. Therefore, there is an urgent need for immunotherapy to be combined with other therapeutic approaches to increase treatment efficacy. We systematically searched PubMed database for relevant studies published over the past 5 years. Articles were screened for eligibility and key data extracted. We assess the current breast cancer treatment landscape, summarizing efficacy and safety of recent immunotherapy, chemotherapy combined with immunotherapy, immunotherapy combined with anti-angiogenic therapy. In the treatment of breast cancer, aiming to promote further research and applications of this novel treatment regimen in patients with breast cancer. Since anti-angiogenic therapy can reprogramme the tumor immune microenvironment, immunotherapy in combination with anti-angiogenic therapy might have a synergistic effect, igniting a new hope for immunotherapy for breast cancer patients. The review's conclusions offer insightful information on the state of breast cancer treatment today. In the end, improving clinical practice and pertinent research for immunotherapy combination therapy will contribute to bettering patient outcomes, raising quality of life, and creating more potent treatments. This review emphasizes the potential of immunotherapy combinations, especially with anti-angiogenic therapeutic regimens, as a viable strategy for the treatment of breast cancer through a thorough study of the literature. To improve treatment approaches, lessen side effects for patients, and find trustworthy biomarkers to forecast response to immunotherapy combo medicines, further research is necessary.

The Urgency of Stakeholder Roles and Environmental Politics in Achieving SDGs through Environmental Management in Malaumkarta Village, Sorong

This study examines the implementation of Sustainable Development Goals (SDGs) through the traditional egek/sasi practices in Malaumkarta Village, Sorong Regency, Indonesia. It explores the roles of various stakeholders in integrating indigenous ecological knowledge with modern conservation efforts to achieve sustainable development. Using a qualitative case study approach, it highlights the role of a multi-stakeholder collaboration, including local youth, NGOs, religious institutions, local government, and the customary council. The study reveals that the successful localization of SDGs in Malaumkarta is attributed to a robust multi-stakeholder collaborative framework, encompassing local youth, NGOs, religious institutions, local government, and the customary council. The inaugural Egek Festival in 2023 exemplifies this collaboration, symbolizing the Moi tribe's commitment to sustainable resource management and cultural preservation. The research highlights the potential of integrating traditional ecological knowledge into modern conservation efforts and the importance of adapting global sustainability goals to local contexts. While the study's geographical scope and timeframe present limitations, its findings have significant implications for policy, practice, and future research in sustainable development, particularly in indigenous contexts. The Malaumkarta case offers valuable insights for achieving SDGs while preserving cultural heritage and ecological integrity, potentially informing similar initiatives worldwide

Technological Greenery. Exploring cutting-edge solutions for performant Greenery integration in building envelope design

In recent years, there has been a growing integration between nature and technology, which has led to the emergence of Greenery as a bio-based building technology that can provide not only aesthetics but also ecosystem services. Similar to photovoltaic in its early days, Greenery is undergoing extensive design experimentation to make it an expression of contemporary culture rather than a mere ’greenwashing’ practice. In urban areas, competition for space is driving the development of innovative envelope designs, often stemming from the combination of different disciplines and, therefore, not easy to be systematized.This study aims to explore potential technological systems from both practice and academic research to maximise the integration of Greenery into building envelopes. The systems are categorised as Technological Greenery and are classified according to their primary function, such as insulation, air purification, electricity generation, and food production. This classification makes it easier to identify the most pressing and innovative technological research topics related to building envelopes and greenery integration. The resulting abacus of solutions accompanied by performance data might be helpful for building designers and architects.

Research of Practices of Formation and Development of Human Capital in Companies of Various Industries on the Russian Market

Almost all global trends create a synergistic effect, which increases the importance of forming and developing human capital to ensure the survival of companies in the market and their confidence in the future, regardless of their size and type of activity. However, despite the unflagging and continued interest of the scientific community in the issues related to human capital, there are still many “white spots” in this area. The aim of this work is to explore the approaches to forming and developing human capital applied by companies doing business in Russia in the current realities and modern conditions, to identify industry specifics and to outline recommendations. To achieve this goal, the authors conducted a questionnaire survey of managers of enterprises from different segments of the economy. As a result of the analysis of the obtained data, the conclusions were made that not all organisations have a generally accepted definition of HR and not everywhere there are procedures for its assessment. The problems related to personnel development, creation of competitive labour conditions for employees, search for potential employees and internal filling of vacancies were also revealed. The methodology of this work is based on a systemic approach and surveying, as well as general scientific methods such as synthesis, analysis, comparison, and generalization. Research results: Despite the fact that, in the opinion of the authors of the study, it did not consider all the problems of human capital formation and its impact on the sustainability of organisations, the obtained results allowed for the identification of the peculiarities of approaches to forming and developing human capital, considering industry specifics, and can be useful to develop practical recommendations for managers of companies aimed at improving this activity. Originality: This study presents, for the first time, a comprehensive overview of the approaches to forming and developing human capital in companies across various industries in the Russian labor market.

The Effect of EAP on Job Performance Based on Psychological Contract and Perceived Organizational Support

In order to study whether employee assistance programs have a significant impact on job performance, whether psychological contract and perceived organizational support play a mediating role in job performance, and thus provide practical operational strategies for relevant enterprises to propose human resource management suggestions to promote job performance, the implementation of employee assistance programs has been the subject of practical research. The findings indicate that addressing issues related to high turnover, job burnout, and absences cannot be separated from the importance of the psychological contract, perceived organizational support, and employee performance in organizational change. By applying structural equation modeling (SEM) to the data from front-line employees of several units in China, this research tested the relationships among employee assistance programs, psychological contracts, perceived organizational support, and job performance using SPSS and AMOS. The results indicate that employee assistance programs positively affect job performance; psychological contracts and perceived organizational support play a mediating role between employee assistance programs and employee job performance (JOP). Our research suggests that an employee assistance program can optimize frontline employee assistance work, build a mechanism to stimulate frontline employees' psychological contracts, and create an organizational environment full of perceived organizational support. This study innovatively uses the structural equation model for quantitative research. In addition, most previous studies on EPA were based on a single variable, psychological contract, and POS were used as the main intermediary variables to explore the mechanism of their impact on job performance so as to enhance the explanatory power of employee job performance. Doi: 10.28991/ESJ-2024-08-05-018 Full Text: PDF

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

The Prevalent New-User Design to Study Drug-Drug Interactions: The Example of Sulfonylureas and Warfarin Interaction on the Risk of Severe Hypoglycemia.

The optimal design for pharmacoepidemiologic drug-drug interactions (DDIs) studies is unclear. Using the association between concomitant use of sulfonylureas and warfarin and the risk of severe hypoglycemia as a case study, a DDI with little or no clinical impact, we tested whether the prevalent new-user design can be applied in the area. Among all patients initiating sulfonylureas in the UK's Clinical Practice Research Datalink (1998-2020), we identified those adding-on warfarin while on a sulfonylurea. For each co-exposed patient, we defined a prescription-based exposure set including other sulfonylurea users not adding-on warfarin (comparators). Within each exposure set, we matched each co-exposed patient to five comparators on time-conditional propensity scores (TCPS) and followed them using an as-treated approach. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of severe hypoglycemia associated with concomitant use of sulfonylureas and warfarin compared to use of sulfonylureas alone. Sensitivity analyses addressed the impact of different potential sources of bias. The study cohort included 17 890 patients co-exposed to sulfonylureas and warfarin and 88 749 matched comparators. After TCPS matching, patient characteristics were well-balanced between groups. Compared to use of sulfonylureas alone, concomitant use of sulfonylureas and warfarin was not associated with the risk of severe hypoglycemia (HR, 1.04; 95% CI, 0.92-1.17). Sensitivity analyses were consistent with the primary analysis (HRs ranging from 1.01 to 1.15, all not statistically significant). Our study suggests that the prevalent new-user design could be used for the assessment of clinical effects of DDIs.

Pharmacologic Treatments for Dementia and the Risk of Developing Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness among people aged 50 years or older worldwide. There is a need for new strategies for the prevention and treatment of AMD. There is some limited evidence to suggest the possibility of a protective association of dementia medications with the development of some types of AMD, but the evidence is weak. To investigate whether the dementia medications memantine and donepezil are associated with the risk of developing AMD. Three population-based cohort studies were performed using data from the Clinical Practice Research Datalink GOLD and Aurum databases from May 15, 2002, to June 21, 2022. Participants included individuals with dementia (vascular dementia, nonvascular dementia, or Alzheimer disease) aged 40 years or older. Statistical analysis was carried out between February and November 2023. Exposures were dementia medications. Cohort 1 compared patients prescribed donepezil with those prescribed rivastigmine or galantamine using the new-user design. Cohort 2 compared memantine with donepezil, rivastigmine, or galantamine using the prevalent new-user design. In a sensitivity analysis, cohort 3 compared memantine with rivastigmine or galantamine only. New diagnosis of AMD. There were 132 846 individuals (mean [SD] age, 80.4 [7.6] years; 61.8% women; mean [SD] body mass index [BMI], 25.5 [4.6]) with a diagnosis of dementia included in cohort 1, 159 419 individuals (mean [SD] age, 81.2 [7.6] years; 59.7% women; mean [SD] body mass index [BMI], 25.6 [4.7]) with a diagnosis of dementia included in cohort 2, and 92 328 individuals with a diagnosis of dementia included in cohort 3 (mean [SD] age, 80.9 [7.7] years; 58.5% women; mean [SD] body mass index [BMI], 25.5 [4.7]). The adjusted hazard ratio (HR) for donepezil compared with rivastigmine or galantamine (cohort 1) was 0.95 (95% CI, 0.67-1.35). The adjusted HR for memantine compared with donepezil, rivastigmine, or galantamine (cohort 2) was 1.03 (95% CI, 0.83-1.27). The adjusted HR for memantine vs rivastigmine or galantamine only (cohort 3) was 1.24 (95% CI, 0.83-1.86). This cohort study of patients with dementia found no significant associations between memantine or donepezil compared with other dementia medications and the risk of development of AMD. Further research is recommended to examine any possible pathophysiological protective action of memantine and other dementia medications against the development of AMD.

Heart failure and major haemorrhage in people with atrial fibrillation

BackgroundHeart failure (HF) is not included in atrial fibrillation (AF) bleeding risk prediction scores, reflecting uncertainty regarding its importance as a risk factor for major haemorrhage. We aimed to report...

P66-3 Questionnaire survey on technical support for the research project on practical research for innovative cancer control

P66-3 Questionnaire survey on technical support for the research project on practical research for innovative cancer control

The Shape(s) of Information Practice: Using Radial Mapping Qualitatively

ABSTRACTInformation practices comprise both seeking and avoidance. Although information practices scholars use qualitative and visual methods to understand seeking practices, they rarely do so to understand avoidance. This paper proposes a new visual method that supports revealing and explaining the complex interplay of seeking and avoidance in rich qualitative data. We introduce seven dimensions of information seeking and avoidance practice (intensity, granularity, engagement, control, relevance, quality, and timeliness). We conceptualize these visually as axes radiating outward from a central origin. We use Excel radar charts to depict these dimensions, allowing us to identify and characterize the shapes of information seeking and avoidance in everyday information practices. We apply our approach to two cases from published literature to show how mapping reveals the interplay between seeking and avoidance at one point in time and over time. We propose potential data collection and analysis applications of this method for information practices research.

Time Series Methods to Assess the Impact of Regulatory Action: A Study of UK Primary Care and Hospital Data on the Use of Fluoroquinolones.

To illustrate the interest in using interrupted time series (ITS) methods, this study evaluated the impact of the UK MHRA's March 2019 Risk Minimisation Measures (RMM) on fluoroquinolone usage. Monthly and quarterly fluoroquinolone use incidence rates from 2012 to 2022 were analysed across hospital care (Barts Health NHS Trust), primary care (Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD), and linked records from both settings (East Scotland). Rates were stratified by age (19-59 and ≥ 60 years old). Seasonality-adjusted segmented regression and ARIMA models were employed to model quarterly and monthly rates, respectively. Post-RMM, with segmented regression, both age groups in Barts Health experienced nearly complete reductions (> 99%); CPRD Aurum saw 20.19% (19-59) and 19.29% ( 60) reductions; no significant changes in CPRD GOLD; East Scotland had 45.43% (19-59) and 41.47% ( 60) decreases. Slope analysis indicated increases for East Scotland (19-59) and both CPRD Aurum groups, but a decrease for CPRD GOLD's 60; ARIMA detected significant step changes in CPRD GOLD not identified by segmented regression and noted a significant slope increase in Barts Health's 19-59 group. Both models showed no post-modelling autocorrelations across databases, yet Barts Health's residuals were non-normally distributed with non-constant variance. Both segmented regression and ARIMA confirmed the reduction of fluoroquinolones use after RMM across four different UK primary care and hospital databases. Model diagnostics showed good performance in eliminating residual autocorrelation for both methods. However, diagnostics for hospital databases with low incident use revealed the presence of heteroscedasticity and non-normal white noise using both methods.

Single-inhaler triple versus LABA-ICS therapy for COPD: Comparative safety in real-world clinical practice

Recent treatment guidelines for chronic obstructive pulmonary disease (COPD) have replaced the long-acting beta2-agonist and inhaled corticosteroid (LABA-ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA-LABA-ICS). Yet, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS. Does single-inhaler triple therapy increase the incidence of major adverse cardiovascular events, compared with LABA-ICS, in a real-world clinical practice setting? We identified a cohort of COPD patients, 40 years or older, treated during 2017-2021, from the United Kingdom's Clinical Practice Research Datalink. Among LAMA-naïve patients, initiators of single-inhaler triple therapy were matched 1:1 to LABA-ICS users on time-conditional propensity scores. They were compared on the incidence of major adverse cardiovascular events (MACE), defined as hospitalization for myocardial infarction or stroke, or all-cause-mortality, over one year. The cohort included 10,255 initiators of triple therapy and 10,255 matched users of LABA-ICS. The incidence rate of MACE was 11.3 per 100 per year with triple therapy compared with 8.7 per 100 per year for LABA-ICS. The corresponding adjusted hazard ratio (HR) of MACE with triple therapy was 1.28 (95% CI: 1.05-1.55), relative to LABA-ICS, though the increase was mainly in the first four months (HR 1.41; 95%CI: 1.14-1.74). The HR of all-cause death was 1.31 (95% CI: 1.06-1.62), while for acute myocardial infarction and stroke hospitalization it was 1.00 (95% CI: 0.56-1.79) and 1.06 (95% CI: 0.48-2.36), respectively, with triple therapy, relative to LABA-ICS. In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACE compared with similar patients treated with a LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first four months after treatment initiation.