Score Range Research Articles

Equipercentile linking of the Sheehan Disability Scale and the World Health Organization Assessment Schedule 2.0 scales in people with mental disorders

BackgroundThe Sheehan Disability Scale (SDS) and the World Health Organization Disability Assessment Scale (WHODAS 2.0) have been widely used to measure functional impairment and disability. To ensure that the scores from these two scales are practically exchangeable across diseases, therapies, and care programmes, the current study aimed to examine the linkage of the WHODAS 2.0 with the SDS and develop a simple and reliable conversion table for the two scales in people with mental disorders. MethodsA total of 798 patients (mean age = 36.1, SD = 12.7) were recruited from outpatient clinics of the Institute of Mental Health, and the Community Wellness Clinic in Singapore. Using a single-group design, an equipercentile equating method with log-linear smoothing was used to establish a conversion table from the SDS to the WHODAS 2.0 and vice versa. ResultsThe conversion table showed that the scores were consistent for the entire range of scores when the scores were converted either from the SDS to the WHODAS 2.0 or from the WHODAS 2.0 to the SDS. The agreement between the WHODAS 2.0's raw and converted scores and SDS's raw and converted scores were interpreted as good with intraclass correlation coefficient of 0.711 and 0.725, respectively. ConclusionThis study presents a simple and reliable method for converting the SDS scores to the WHODAS 2.0 scores and vice versa, enabling interchangeable use of data across these two disability measures.

Health-Related Quality of Life Correlates with Bladder and Bowel Dysfunction: the Need for a New Patient-Centered Questionnaire

Background and Hypothesis: Children with voiding dysfunction (VD), such as incontinence or urinary frequency, may report lower quality of life (QOL) compared to their peers. QOL questionnaires which could be used in this population have several limitations. PinQ is a bladder-specific, health-related QOL questionnaire, but it was developed without stakeholder input and fails to separate symptoms from QOL. Kidscreen-10 is a generic QOL questionnaire. We aimed to understand how QOL captured using existing instruments correlates with VD severity in a cross-sectional study. We hypothesized that large differences in symptoms would correspond with large differences in bladder-specific QOL but small differences in generic QOL.
 Methods: We recruited children 8-18 years old with VD at a pediatric urology clinic (June-July 2023). VD included daytime incontinence, enuresis, frequency, urgency, and dysuria. We excluded children with severe developmental delay, anatomical urological abnormalities, or history ofurologic surgery. We captured demographics, symptoms (Vancouver Dysfunction Voiding Symptom Score, DVSS), and QOL (PinQ and Kidscreen-10). Questionnaire scores were compared to weighted means from previous studies. We calculated Spearman correlations and QOL differences corresponding with the reported 20-point range of DVSS scores.
 Results: Twenty children (11 girls) at a median age of 10 years old participated (Table 1). Mean DVSS score was 14, similar to previous studies (weighted mean: 15). PinQ scores had a moderate positive correlation with DVSS scores (r = 0.37) with a 20-point DVSS difference corresponding to a 24% difference in PinQ scores (Figure 1). Kidscreen-10 scores had a moderate negative correlation with DVSS scores (r = -0.33) with a 20-point DVSS difference corresponding to a 12% difference in Kidscreen-10 scores (Figure 2).
 Conclusions: Previously published QOL questionnaires have significant limitations, limiting their clinical use in the care of patients with VD. A new, patient-centered, highly specific, and sensitive healthrelated QOL questionnaire is needed.

Expanding Medical Education to Include Substance Use Disorders During Pregnancy and Postpartum: Preliminary Effectiveness of a Pilot Curriculum for Medical Students.

To effectively combat the simultaneous overdose and maternal mortality crises, a multimodal approach is needed. The aim of this study is to evaluate the preliminary effectiveness of a pilot, experiential learning, substance use disorder (SUD) curriculum embedded into a third-year medical student obstetrics and gynecology clerkship to improve self-reported confidence in SUD clinical skills. This SUD curriculum was designed and implemented in an outpatient clinic, which provides integrated obstetric, gynecologic, and addiction medicine services for pregnant and parenting people with SUD. Third-year medical students on their obstetrics and gynecology clerkship rotated 1 full day through the OB MOTIVATE clinic between August 2020 and April 2022 and completed this curriculum. Students completed preclinic assignments and in-clinic tasks (eg, practicing SBIRT under supervision: screening, brief intervention, referral to treatment). Paired t tests assessed changes in outcomes, with increasing scores (range 1-5) demonstrating improvement. Sixty-three students rotated through the OB MOTIVATE clinic; 57 completed the curriculum and surveys. Results from the self-assessment tools demonstrated significant improvements in confidence in SUD clinical skills, including performing SBIRT (2.46 ± 0.80 vs 4.07 ± 0.59, P < 0.01), motivational interviewing (2.98 ± 0.86 vs 4.16 ± 0.65, P < 0.01), using evidence-based medicine (2.91 ± 1.09 vs 4.23 ± 0.66, P < 0.01), and collecting an SUD history (3.25 ± 1.04 vs 4.35 ± 0.55, P = 0.01). The integration of interventional curriculums into medical school and residency programs could be an effective avenue to reinforce addiction knowledge and teach new skills. This practical 1-day pilot curriculum demonstrated preliminary effectiveness at introducing third-year medical students to the complexities of SUD in pregnancy and postpartum. Further investigations of feasible and acceptable SUD educational interventions are warranted.

Metrics for weight management success: an examination of the lifestyle score

ABSTRACT Multiple weight loss attempts, and weight regain are common. Various lifestyle changes are often required for success, but just diet and exercise are often promoted. The amount of lifestyle changes needed for successful weight management is still unclear. Lifestyle metrics, such as the Lifestyle Score (LS) of The Lifestyle Questionnaire for Weight Management (LQ-WM), may provide clarification and predict success rates. The range of possible scores on this measure is from −49 to 77, where higher scores suggest healthier lifestyles. Hypotheses are that higher lifestyle scores will be found with successful weight management outcomes. Method: 1,007 online participants completed the LQ-WM and other items related to weight management. Results: 90.7% (39/43) of participants with an LS of 50 + reported successful weight loss, while just 5% (2/40) reported weight regain. 35.7% (20/56) of those with LS below zero reported weight loss success, and 39.4% (13/33) reported weight regain. Significant (p < .001) mean LS differences existed between those with healthy BMI versus the obese range (m = 22.2, SD = 15.51; m = 6.70, SD = 15.97) and those reporting success versus those not reporting success (m = 26.92, SD = 17.03; m = 13.68, SD = 14.95). Discussion and Conclusions: Future studies should employ more diverse samples and use causal designs. The LS from the LQ-WM may be a helpful tool in research and clinical interactions to raise patients’ awareness of behavioral patterns, increase the likelihood of success, and prevent future weight gain.

Visualizing Severity of Alopecia Tool (SALT) scores in the clinical setting using patient images from a clinical trial

AbstractBackgroundThe Severity of Alopecia Tool (SALT) is a standardized method for quantifying scalp hair loss in alopecia areata (AA). SALT scores can be used to guide treatment decisions and are widely used as eligibility criteria and endpoints for clinical trials in AA. However, clinicians may be unfamiliar with assessing and envisioning SALT scores in practice.ObjectivesTo aid clinicians in the determination and application of SALT scores in a clinical setting, this manuscript seeks to contextualize SALT scores using patient images from a clinical trial of adults with severe AA.MethodsImages from 722 patients enrolled in BRAVE‐AA1, a phase 2/3 study of baricitinib in adults with severe AA (SALT score ≥50; ≥50% scalp hair loss), were obtained at baseline and Weeks 12, 36, and 52 and compiled into a repository. Photographs were selected to represent SALT scores across the full range of disease (SALT scores 0–100) and to demonstrate the progression of SALT scores during the course of treatment.ResultsImages of six patients depict the range of SALT scores (0–100). Photographs are of male and female patients of different ages (21–69) and races (Asian, Black, White) with varying extent, density, and patterns of hair loss. Images of two additional patients demonstrate the use of SALT to monitor treatment progress, showing distinct patterns and timing of clinical response over 52 weeks of therapy.ConclusionsThe SALT is widely used in clinical trials for AA, but clinicians may lack familiarity. Presented patient images show SALT scores commonly used as eligibility criteria and endpoints in clinical trials, which may be useful in identifying patients eligible for systemic treatment and in visualizing therapeutic response.

Cumulative exposure to impaired fasting glucose and gastrointestinal cancer risk: A nationwide cohort study.

Impaired fasting glucose (IFG) is associated with the risk of various cancers, but the cumulative effect of IFG on gastrointestinal cancer risk remains unclear. This study evaluated the association between the cumulative exposure to IFG and gastrointestinal cancer risk. The authors extracted data from the Korean National Health Insurance Service and health examination data sets. Among individuals ≥40 years old who were free of diabetes or cancer, 1,430,054 who underwent national health examinations over 4 consecutive years from 2009 to 2012 were selected and followed up until gastrointestinal cancer diagnosis, death, or December 31, 2019. The IFG exposure score (range, 0-4) was based on the number of IFG diagnoses over 4years. The median follow-up duration was 6.4years. Consistent normoglycemia for 4years was found in 44.3% of the population, whereas 5.0% had persistent IFG and 50.7% had intermittent IFG. Compared to the group with an IFG exposure score of 0, groups with IFG exposure scores of 1, 2, 3, and 4 had a 5%, 8%, 9%, and 12% increased risk of gastrointestinal cancer, respectively (score 1: adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 1.01-1.08; score 2: aHR, 1.08; 95% CI, 1.04-1.12; score 3: aHR, 1.09; 95% CI, 1.05-1.14; score 4: aHR, 1.12; 95% CI, 1.06-1.19). Persistent IFG exposure was also associated with higher risks of individual cancer types (colorectum, stomach, pancreas, biliary tract, and esophagus). Cumulative exposure to IFG is associated with an increased risk of developing gastrointestinal cancer, in a dose-dependent manner. Hyperglycemia, including both diabetes and prediabetes, has been associated with an increased risk of various cancers. However, the cumulative effect of impaired fasting glucose on the risk of developing gastrointestinal cancer remains unclear. A frequent diagnosis of impaired fasting glucose was dose-dependently associated with a higher risk of developing overall gastrointestinal cancer. Furthermore, risks of individual cancer types increased with persistent impaired fasting glucose. Early detection of hyperglycemia and strict glycemic control can lower the risk of gastrointestinal cancer by reducing hyperglycemic burden. Additionally, for some individuals, lifestyle changes such as managing metabolic syndrome or abstaining from alcohol may also be helpful.

Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure

More than 80% of patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. With more than 1 million annual hospitalizations for AHF in the US, safe and effective alternatives are needed. Care for AHF in short-stay units (SSUs) may be safe and more efficient than hospitalization, especially for lower-risk patients, but randomized clinical trial data are lacking. To compare the effectiveness of SSU care vs hospitalization in lower-risk patients with AHF. This multicenter randomized clinical trial randomly assigned low-risk patients with AHF 1:1 to SSU or hospital admission from the ED. Patients received follow-up at 30 and 90 days post discharge. The study began December 6, 2017, and was completed on July 22, 2021. The data were analyzed between March 27, 2020, and November 11, 2023. Randomized post-ED disposition to less than 24 hours of SSU care vs hospitalization. The study was designed to detect at least 1-day superiority for a primary outcome of days alive and out of hospital (DAOOH) at 30-day follow-up for 534 participants, with an allowance of 10% participant attrition. Due to the COVID-19 pandemic, enrollment was truncated at 194 participants. Before unmasking, the primary outcome was changed from DAOOH to an outcome with adequate statistical power: quality of life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The KCCQ-12 scores range from 0 to 100, with higher scores indicating better quality of life. Of the 193 patients enrolled (1 was found ineligible after randomization), the mean (SD) age was 64.8 (14.8) years, 79 (40.9%) were women, and 114 (59.1%) were men. Baseline characteristics were balanced between arms. The mean (SD) KCCQ-12 summary score between the SSU and hospitalization arms at 30 days was 51.3 (25.7) vs 45.8 (23.8) points, respectively (P = .19). Participants in the SSU arm had 1.6 more DAOOH at 30-day follow-up than those in the hospitalization arm (median [IQR], 26.9 [24.4-28.8] vs 25.4 [22.0-27.7] days; P = .02). Adverse events were uncommon and similar in both arms. The findings show that the SSU strategy was no different than hospitalization with regard to KCCQ-12 score, superior for more DAOOH, and safe for lower-risk patients with AHF. These findings of lower health care utilization with the SSU strategy need to be definitively tested in an adequately powered study. ClinicalTrials.gov Identifier: NCT03302910.

Faculty Entrustment and Resident Entrustability

As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs. To assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs. This cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level. Observed resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients. A total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years' experience: 67 [20.9%]; 6-14 years' experience: 186 [58%]; ≥15 years' experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions. Faculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

Association between emergency department computed tomography utilization rate and patient satisfaction: A clinician level analysis across a regional healthcare system

BackgroundComputed Tomography (CT) use is common during emergency department (ED) visits, and ED clinicians may order CTs for myriad reasons, including desire to improve patient satisfaction. ObjectivesTo determine if greater CT use by ED clinicians is associated with increased average patient satisfaction scores for those providers. MethodsThe study took part across 15 non-pediatric hospitals in a regional healthcare system. We compared clinician CT use rate for adult patients discharged from the ED with Net Promotor Score (NPS) for that clinician. NPS is a patient satisfaction metric with a possible range of scores from −100 to +100. We included ED clinicians (physicians and non-physician providers (NPPs)) with at least 500 adult patient encounters resulting in ED discharge from July 2020 through June 2022. We assessed for an association between CT use and clinician NPS using univariate and multivariate regression models. ResultsAcross the 15 hospitals, 166 physicians and 74 NPPs were included in the study. The median CT rate was 25.7 ​% (range 7.1 ​%–48.9 ​%). In both models, there was a statistical association between CT utilization and NPS such that every absolute increase in CT use by 10 ​% resulted in a 3-point improvement in provider NPS on the 200-point scale. When examined in a sensitivity analysis, none of the hospitals individually showed this same association. ConclusionsWe found a 26 ​% rate of CT use by clinicians for adults discharged from the ED, with wide variation in utilization between clinicians. There was a small and inconsistent association between CT utilization and clinician specific NPS scores.

Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation

Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.

Quantifying the Impact of Street Greening during Full-Leaf Seasons on Emotional Perception: Guidelines for Resident Well-Being

Quantifying the emotional impact of street greening during the full-leaf seasons in spring, summer, and fall is important for well-being-focused urban construction. Current emotional perception models usually focus on the influence of objects identified through semantic segmentation of street view images and lack explanation. Therefore, interpretability models that quantify street greening’s emotional effects are needed. This study aims to measure and explain the influence of street greening on emotions to help urban planners make decisions. This would improve the living environment, foster positive emotions, and help residents recover from negative emotions. In Hangzhou, China, we used the Baidu Map API to obtain street view images when plants were in the full-leaf state. Semantic segmentation was used to separate plant parts from street view images, enabling the calculation of the Green View Index, Plant Level Diversity, Plant Color Richness, and Tree–Sky View Factor. We created a dataset specifically designed for the purpose of emotional perception, including four distinct categories: pleasure, relaxation, boredom, and anxiety. This dataset was generated through a combination of machine learning algorithms and human evaluation. Scores range from 1 to 5, with higher values indicating stronger emotions and lower values indicating less intense ones. The random forest model and Shapley Additive Explanation (SHAP) algorithm were employed to identify the key indicators that affect emotions. Emotions were most affected by the Plant Level Diversity and Green View Index. These indicators and emotions have an intricate non-linear relationship. Specifically, a higher Green View Index (often indicating the presence of 20–35 fully grown trees within a 200 m range in street view images) and a greater Plant Level Diversity significantly promoted positive emotional responses. Our study provided local planning departments with support for well-being-focused urban planning and renewal decisions. Based on our research, we recommend the following actions: (1) increase the amount of visible green in areas with a low Green View Index; (2) plant seasonal and flowering plants like camellia, ginkgo, and goldenrain trees to enhance the diversity and colors; (3) trim plants in areas with low safety perception to improve visibility; (4) introduce evergreen plants like cinnamomum camphor, osmanthus, and pine.

Superior Capsular Reconstruction Versus Middle Trapezius Tendon Transfer for Isolated Irreparable Supraspinatus Tendon Tears: Static Versus Dynamic Reconstruction

Background: Both superior capsular reconstruction (SCR) and middle trapezius tendon (MTT) transfer can be performed in nonarthritic young and active patients with isolated irreparable supraspinatus tendon tears (IISTTs). However, to our knowledge, no comparative clinical studies have been conducted on these procedures. Purpose: To evaluate and compare the clinical and radiological outcomes of SCR and arthroscopic-assisted MTT transfer in patients with IISTTs. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 60 patients with IISTTs were categorized into 2 groups according to the surgical procedure—Group S underwent SCR (n = 34); Group M underwent MTT transfer (n = 26). The clinical outcomes included the visual analog scale score for pain, active shoulder range of motion, American Shoulder and Elbow Surgeons score, and University of California, Los Angeles, shoulder score. Radiological outcomes included the assessment of the acromiohumeral distance, progression of cuff tear arthropathy (Hamada grade), subacromial bone erosion, and graft failure. Results: The mean follow-up time was 39.3 ± 5.2 months (range, 26-59 months) and 37.6 ± 9.8 months (range, 27-54 months) in Group S and Group M, respectively. Significant improvements in clinical outcomes were observed in both groups, while the active forward flexion (148.2°± 24.1° vs 165.9°± 8.7°; P = .003) and abduction (131°± 37.3° vs 152.5°± 17.9°; P = .035) were significantly higher in Group M at the final follow-up. No significant differences were found in the postoperative Constant, American Shoulder and Elbow Surgeons, and University of California, Los Angeles, shoulder scores between the 2 groups. Radiologically, although no difference was found in the Hamada grade at the final follow-up between the 2 groups (P = .143), the rates of acromial wear (58.8% vs 15.4%; P < .001) and graft retear (47.1% vs 7.7%; P < .001) were significantly higher in Group S than in Group M. Conclusion: Both SCR and MTT transfer improved the overall clinical outcomes of IISTTs postoperatively, whereas MTT transfer was superior to SCR in terms of active forward flexion and abduction range of motion. Although higher rates of graft failure and subacromial bone erosion were observed in Group S, no difference was found in the clinical scores between the 2 groups at the short-term follow-up. However, further well-structured, prolonged comparative trials should be conducted in the future.

Individuals With Multiple Sclerosis Exhibit More Regular Center of Mass Accelerations After Physical Therapy

ObjectiveThe purpose of this investigation was to explore if a physical therapy program involving strength, flexibility, balance, and walking can improve the uncharacteristic gait variability and overall mobility of persons living with multiple sclerosis (pwMS). DesignPre-post design to evaluate the mobility improvements after undergoing 6 weeks of a gait and balance physical therapy intervention. SettingThe initial 2 weeks were conducted at a medical center under close supervision of a physical therapist. The remaining 4 weeks were performed by the patient at their home and monitored via teleconferences. ParticipantsFifteen pwMS with relapsing-remitting (N=11) or secondary progressive multiple sclerosis (N=4) were enrolled in this study (7 women; mean age: 54.8±9 years; Kurtzke Expanded Disability Status Score range: 3.0-6.5). A group of healthy age-matched controls (N=15) were used for comparisons. InterventionsThe 6-week physical therapy intervention included exercises that targeted strength, flexibility, balance, and walking. The initial 2 weeks of the intervention were performed on-site with the remaining 4 weeks home-based. The therapy was performed twice-a-day for 5 consecutive days each week. Each session was 45 minutes in length. Main Outcome MeasuresPreferred walking speed, spatiotemporal gait kinematics, and a 6-minute walk test were completed before and after therapy. The standard deviation (SD) and sample entropy were used to evaluate the amount of variability and the regularity of the time-dependent variations in the center of mass (COM) accelerations during the 6-minute walk test. ResultsBefore the intervention, the SD of the COM was reduced, and the time-dependent variations were less regular in the pwMS than the control group. After therapy, the SD was 12% larger, and the time-dependent variations were more 7% regular in the pwMS. The effect size for these changes were large (0.91 and 0.94, respectively), suggesting these changes were meaningful. The changes in the regularity of the COM were related to the mobility improvements in the preferred walking velocity and 6-minute walk test. ConclusionsThe results suggest that pwMS have altered COM variability during gait, which can be improved with a similar physical therapy program. These changes appear to be linked with the extent of the mobility improvements.

Comparison of subjective quality of life domains in schizophrenia, mood, and anxiety disorders; an individual patient data meta-analysis

This study sought to compare satisfaction with different subjective quality of life domains across individuals with three different mental health disorders. Samples from four separate studies were combined to conduct a one-step individual patient data meta-analysis. 5329 individuals with either a schizophrenia (n = 1839), mood (n = 1650), or anxiety disorder (n = 1840) were included. Mean satisfaction ratings for each life domain were compared across disorders. Associations between satisfaction ratings and personal characteristics were investigated using multivariable mixed effect models. Results showed that individuals with an anxiety disorder had the widest range of scores and reported lower satisfaction in most domains compared to those with a schizophrenia or mood disorder. Individuals with a schizophrenia disorder rated domains to do with ‘others’, such as relationships with family and sex life, as lower than individuals with a mood or anxiety disorder. Satisfaction ratings were often more impacted by personal characteristics, such as employment status, than by diagnostic category. These results demonstrate that specific life areas are impacted differently in the three mental health disorders studied. However, further research needs to consider the impact of personal characteristics across disorders, and the subjective quality of life in individuals with anxiety disorders in particular warrants further investigation.

The role of psychosocial well-being and emotion-driven impulsiveness in food choices of European adolescents

BackgroundIt is unclear whether a hypothetical intervention targeting either psychosocial well-being or emotion-driven impulsiveness is more effective in reducing unhealthy food choices. Therefore, we aimed to compare the (separate) causal effects of psychosocial well-being and emotion-driven impulsiveness on European adolescents’ sweet and fat propensity.MethodsWe included 2,065 participants of the IDEFICS/I.Family cohort (mean age: 13.4) providing self-reported data on sweet propensity (score range: 0 to 68.4), fat propensity (range: 0 to 72.6), emotion-driven impulsiveness using the UPPS-P negative urgency subscale, and psychosocial well-being using the KINDLR Questionnaire. We estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness on sweet and fat propensity applying a semi-parametric doubly robust method (targeted maximum likelihood estimation). Further, we investigated a potential indirect effect of psychosocial well-being on sweet and fat propensity mediated via emotion-driven impulsiveness using a causal mediation analysis.ResultsIf all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a decrease in average sweet propensity by 1.43 [95%-confidence interval: 0.25 to 2.61]. A smaller effect was estimated for fat propensity. Similarly, if all adolescents had high levels of emotion-driven impulsiveness, compared to low levels, average sweet propensity would be decreased by 2.07 [0.87 to 3.26] and average fat propensity by 1.85 [0.81 to 2.88]. The indirect effect of psychosocial well-being via emotion-driven impulsiveness was 0.61 [0.24 to 1.09] for average sweet propensity and 0.55 [0.13 to 0.86] for average fat propensity.ConclusionsAn intervention targeting emotion-driven impulsiveness, compared to psychosocial well-being, would be marginally more effective in reducing sweet and fat propensity in adolescents.

Moral distress and intention to leave work among nurses: a prospective survey study in Oman

Background/Aims Moral distress can have a substantial impact on nurses, contributing to burnout and staff turnover. This study aimed to assess the level of moral distress, identify the situations considered to cause the most moral distress and measure the relationship between moral distress, demographic factors and intention to leave one's role or the nursing profession in a hospital in Oman. Methods A descriptive correlational design was used. The study sample comprised 167 nurses working in intensive care, oncology, medical or surgical units in a referral hospital in Muscat, Oman. A survey was distributed to participants in their place of work. Data were collected using the Measure of Moral Distress – Healthcare Professionals tool, measuring frequency of morally distressing events and the level of distress caused. The survey also collected demographic details and information on whether participants were currently considering (or had ever considered) leaving their role because of moral distress. Results were summarised using descriptive statistics, with relationships between variables analysed using Mann–Whitney and Kruskal–Wallace tests, Spearman's rho and logistic regression. Results The mean total moral distress score was 81.0 (±59.4) out of a possible score range of 0–432. The situations that participants found the most morally distressing were excessive documentation requirements that compromise patient care and feeling pressured to provide what they considered to be unnecessary or inappropriate tests and treatments. Area of work was not significantly associated with level of moral distress, but moral distress was significantly higher in participants with less nursing experience and those considering leaving their role. Conclusions Practical solutions are required to support nurses who may be at high risk of experiencing moral distress. This could include mentoring schemes and strategies to reduce or streamline clinical documentation requirements.

Association between game metrics in a simulation game and nursing students’ surgical nursing knowledge – a quasi-experimental study

BackgroundSimulation games are effective for acquiring surgical nursing knowledge during education by offering possibilities to learn theoretical knowledge through practical patient scenarios, thus preparing students for demanding surgical nursing care. Game metrics stored in the game system enable assessment of students’ behaviour while gameplaying. Combining game metrics with the assessment of a student’s surgical nursing knowledge allows versatile information to be obtained about the student’s learning outcomes. However, studies on game metrics stored in systems and their relationship with learning outcomes are scarce.MethodsThe aim here was to evaluate the association between game metrics in a simulation game and nursing students’ surgical nursing knowledge. Nursing students from three universities of applied sciences in Finland participated in a one-week simulation gameplaying intervention that included five surgical nursing scenarios. Students’ surgical nursing knowledge was investigated with a quasi-experimental, one-group, pre- and post-test design using a surgical nursing knowledge test. In total, 280 students filled in the knowledge tests. In addition, cross-sectional game data were collected at a single time point between pre- and post-tests. The data were analysed with descriptive statistics and multivariate analysis methods.ResultsStudents’ surgical nursing knowledge improved with the intervention. The total number of playthroughs was 3562. The mean maximum score was 126.2 (maximum score range 76–195). The mean playing time of all playthroughs by all players was 4.3 minutes (SD = 81.61). A statistically significant association was found between mean score and knowledge test total score (p < 0.0072), but no significant association emerged between mean playing time and knowledge test total score.ConclusionThe results indicated that the higher the mean score the better the students’ surgical nursing knowledge in the knowledge test. This study did not show that the time spent playing had an impact on students’ post-playing knowledge. Our findings support the idea that game metrics can be used in performance evaluation and the results can be used to improve nursing students’ readiness for challenging preoperative and postoperative clinical situations.

Evaluating the Reliability of YouTube as a Source of Information for Meniscal Ramp Lesions.

Videos uploaded to YouTube do not go through a review process, and therefore, videos related to medial meniscal ramp lesions may have little educational value. To assess the educational quality of YouTube videos regarding ramp lesions of the meniscus. Cross-sectional study. A standard search was performed on the YouTube website using the following terms: "ramp lesion" and "posterior meniscal detachment" and "ramp" and "meniscocapsular" and "meniscotibial detachment," and the top 100 videos based on the number of views were included for analysis. The video duration, publication data, and number of likes and views were retrieved, and the videos were categorized based on video source (health professionals, orthopaedic company, private user), the type of information (anatomy, biomechanics, clinical examination, overview, radiologic, surgical technique), and video content (education, patient support, patient experience/testimony).The content analysis of the information on the videos was evaluated with the use of the DISCERN instrument (score range, 16-80), the Journal of the American Medical Association (JAMA) benchmark criteria (score range, 0-4), and the Global Quality Score (GQS; score range, 1-5). A total of 74 videos were included. Of these videos, 70 (94.6%) were published by health professionals, while the remaining 4 (5.4%) were published by orthopaedic companies. Most of the videos were about surgical technique (n = 36; 48.6%) and all had an educational aim (n = 74; 100%). The mean length of the videos was 10.35 ± 17.65 minutes, and the mean online period was 18.64 ± 13.85 months. The mean DISCERN score, JAMA benchmark score, and GQS were 31.84 ± 17.14 (range, 16-72), 1.65 ± 0.87 (range, 1-4), and 2.04 ± 1.21 (range, 1-5), respectively. Videos that reported an overview about ramp lesions were the best in terms of quality for DISCERN and JAMA benchmark score, while biomechanics videos were the best according to GQS. The worst category of videos was about surgical technique, with all having lower scores. The educational content of YouTube regarding medial meniscal ramp lesions showed low quality and validity based on DISCERN score, JAMA benchmark score, and GQS.

Estimating the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) service addressing the wider determinants of mental health: a real-world evaluation

BackgroundAddressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.ObjectivesTo estimate the effectiveness of an enhanced ‘Improving Access to Psychological...

Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.