Use Of Scores Research Articles

Impact of gout flare on health-related quality of life: a multi-center cross-sectional study in Thailand.

Although the 5-level EQ-5D version (EQ-5D-5L) instrument has been used to determine health-related quality of life and health utility in gout, it is used in comparing health utility among gout flare (GF) and non-gout flare (non-GF) patients is still limited. This study aimed to compare health utility among GF and non-GF patients in Thailand. In this multi-center cross-sectional study, patients with GF and non-GF were interviewed for the EQ-5D5L and EQ-Visual Analog Scale (VAS) instruments by rheumatologists or trained research staffs. Patients with GF were subdivided into 2 subgroups (those who received no treatment and those who received treatment less than 48h after GF episode). Two hundred and sixteen patients (108 GF and 108 non-GF patients), males in 90.28%, were included. The gout disease duration was significantly longer in the non-GF than in the GF groups (median, 10 vs 5years; p = 0.004). There was no difference in the tophi present between the two groups. When compared with the non-GF group, the GF patients significantly had low health utility (0.34 ± 0.36 vs. 0.89 ± 0.15, p < 0.001) and EQ-VAS score (54.73 ± 25.14 vs. 84.06 ± 13.38, p < 0.001). In the subgroup analysis of the non-GF group, there was insignificant health utility and EQ-VAS score between those with tophi and those without tophi (0.87 ± 0.14 vs. 0.90 ± 0.15, p = 0.124 and 83.36 ± 14.92 vs. 84.33 ± 12.83, p = 0.938, respectively). This study found that GF clearly had a substantial impact on patients' quality of life. Targeted interventions in managing GF patients to improve their health outcomes are needed. Key Points •Patients with gout flare had lower health utility than those without gout flare. •The clinical significance of the utility and EQ-VAS was evaluated by the EQ-5D-5L instrument between gout flare and non-gout flare groups in Thai gouty patients. •Regarding the presence of tophi or disease duration, no significant differences in health utility and EQ-VAS were observed in the gout flare or non-gout flare group. •Targeted interventions for management of gout flare are needed to improve the health outcomes of gout flare patients.

Identifying Adolescent and Young Adults' Preferences for Oncology Symptom Management Clinical Trial Participation.

Most studies to date exploring facilitators and barriers to adolescent and young adults' (AYAs') participation in clinical trials have been focused on external factors to AYAs' participation or recruitment strategies. The purpose of this mixed-methods study was to determine AYA cancer survivors' preferences for oncology symptom management clinical trial participation. Semistructured interviews and conjoint analysis were conducted to clarify potential attributes (eg, characteristics) and levels (eg, value of the characteristic) that may be important to AYA cancer survivors when considering clinical trial participation (n = 19). The final list of attributes and levels was administered within a choice-based conjoint analysis survey (n = 52). The utility score for each level was analyzed using hierarchical Bayes estimation, and the feature importance for each attribute was quantified. The type of new treatment (22.9%) and perceived importance of study topic (19.5%) were the most important attributes identified by participants. The levels with the highest utility scores within each attribute included prescription medicine treatment with mild side effects, electronic surveys, under-30-minute study visits, no follow-up visits, 4-week treatment period, and once-a-week treatment frequency. The data support that study designs with low participant burden, interventions with few side effects, and the involvement of AYAs in determining the priority of the research topic are appealing to AYAs when considering participation in symptom management trials. AYA participation in clinical trials is necessary to develop new symptom management modalities. Clinicians may use the results to introduce clinical trials containing trial characteristics that appeal to AYA cancer survivors.

Quality of life is an independent predictor of mortality in patients with heart failure: a prospective cohort study from the Colombian heart failure registry (RECOLFACA).

Patients with heart failure (HF) commonly have poor quality of life (QoL), secondary to the persistence and severity of HF symptoms. We aimed to evaluate the prognostic value of QoL measures on all-cause mortality in patients with HF from the Colombian registry of heart failure (RECOLFACA). We analysed data from patients registered in RECOLFACA during 2017-19. QoL was measured using the EuroQol-5D questionnaire (EQ-5D). From the questionnaire, two independent predictors of mortality were obtained, the visual analogue scale (VAS) and the utility score (US). The primary outcome was all-cause mortality, and secondary variables evaluated were demographic factors, comorbidities, NYHA classification, medications used, and laboratory test results. To analyse survival among patients, the Kaplan-Meier method and the hierarchical Cox proportional hazards regression model were used. This study included 2514 patients from RECOLFACA. Most patients were male (57.6%), and the mean age was 67.8 years. The mean value and standard deviation (SD) of the VAS score was 78.8 ± 20.1 points, while the mean and SD of the US score was 0.81 ± 0.20. As the Kaplan-Meier curve illustrated, patients in the lower quartiles of both VAS and US scores had a significantly higher probability of mortality (log-rank test: P < 0.001 for both scores). QoL, as calculated by the EQ-5D questionnaire, served as an independent predictor of mortality in patients from RECOLFACA. Further studies may be needed to evaluate whether the provision of optimizing therapies and follow-up care based on patients' perceived QoL reduces short- and long-term mortality rates in this population.

Performance of spondyloarthritis-specific health utilities based on ASAS Health Index: an ancillary analysis from ASAS-HI validation study.

To compare the utility values of Spondyloarthritis (SpA)-specific ASAS Health Index (U-ASAS-HI) to generic utilities and to understand the contribution of health outcomes, personal- and country-level factors to the U-ASAS-HI. Ancillary analysis of the ASAS-HI international validation study. SpA patients who completed the ASAS-HI, 5-level EuroQol-5D (EQ-5D-5L) and Short Form-36 (SF-36) questionnaires were selected, and utilities calculated. Correlations between U-ASAS-HI and generic utility values were tested. Potential explanatory variables were evaluated in a linear multivariable mixed-effects model analysis with multilevel modeling fitted by country. 1425 patients were included, with a mean age of 42 (Standard Deviation, SD : 13.5) and 65% male. The mean utility scores were EQ-5D-5L 0.75 (SD : 0.11), SF-6D 0.72 (SD : 0.24), and U-ASAS-HI 0.42 (SD : 0.29). Correlation between U-ASAS-HI and EQ-5D-5L and SF-6D was strong (r = 0.75 and r = 0.72; p< 0.001, respectively). The linear mixed-effects model showed that worse disease activity (ASDAS) and lower physical function (BASFI) were associated with lower U-ASAS-HI. Additionally, younger age, female gender, higher comorbidity score, and symptoms of depression were associated with lower U-ASAS-HI. SpA subtype had no influence on health utility. The random effects model indicated an intercept SD : 0.045 with a 5.5% variance ratio between countries and the total U-ASAS-HI variation. The U-ASAS-HI captures the physical and mental impact of SpA, as well as personal contextual factors such as age, gender, and comorbidities. The influence of the country of residence seems negligible. The U-ASAS-HI algorithm has sufficient support to be used in health economic evaluations for SpA patients across different countries.

P-332. A Discrete Choice Experiment to Evaluate Healthcare Personnel Preferences Regarding Risk-Tailored Policies for Contact Precautions for Patients with Methicillin-Resistant Staphylococcus aureus in Hospitals

Abstract Background The risk of MRSA transmission differs by healthcare personnel (HCP) role and care activity. An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage is a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles. A discrete choice experiment is a proven method to assess HCP perspectives on varied implementation strategies. Methods We distributed a discrete choice experiment survey to HCPs at medical centers in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission (Fig 1). In each comparison, respondents selected their preferred policy option. Using mixed logit modeling we calculated the utility derived from each policy component, the probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role. Results 384 HCP completed the survey: 138 from New York, 128 from Pittsburgh, and 118 from Baltimore. Respondents’ occupations were physicians or advanced practice providers (93, 24%), nurses (87, 23%), environmental services (56, 15%), respiratory therapists (55, 14%), occupational or physical therapists (44, 11%), and “other” (46, 11%). 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07-0.18), when touching the patient (utility, 0.11; 95% CI 0.06-0.17) (Fig 2). Sixty-three percent (95% CI 60-66%) of respondents would support a risk-tailored approach over an approach where contact precautions are used by all HCP in all settings and for all activities. The support for this policy varied by HCP role (p&amp;lt; 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72-82%) and the least support from environmental services (45%, 95% CI 37-53%) (Fig 3). Conclusion This discrete choice survey demonstrates that most HCP prefer a risk-tailored approach to contact precautions when caring for patients with MRSA. Disclosures Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Nathan N. O'Hara, PhD MHA, Arbutus Medical Inc.: Stocks/Bonds (Private Company)

Novel brain SPECT imaging unravels abnormal cerebral perfusion in patients with postural orthostatic tachycardia syndrome and cognitive dysfunction

Cognitive dysfunction is frequently reported in individuals with postural orthostatic tachycardia syndrome (POTS), possibly resulting from reduced cerebral blood flow (CBF). We used brain SPECT, an accessible imaging modality that has not been systematically evaluated in this patient group. Retrospective review of participants from our registry was undertaken to identify those who had a brain SPECT performed for investigation of cognitive dysfunction. Abnormal CBF was taken as z-score > 2 standard deviations of healthy control reference values. Patient reported outcome measures (PROMs) such as autonomic, gastric and quality of life symptom scores were analyzed. From a total of 56 participants (mean 34.8 ± 10.7 years, 88% females), PROMs indicate: moderate to severe autonomic dysfunction in 75%; at least mild to moderate gastroparesis in 23%; low global health rating and utility scores. Abnormal CBF was seen in 61% but did not differ by POTS triggers. The regions with the lowest mean z-scores were the lateral prefrontal and sensorimotor cortices. Hierarchal regression analyses found number of brain regions with abnormal CBF, autonomic and gastric symptoms to account for 51% of variances in health utility. Cerebral hypoperfusion is prevalent in those with POTS and cognitive dysfunction even whilst supine, contributing to reduced quality of life.

Proximal humerus fracture dislocations: outcomes of management.

Proximal humerus fracture dislocations are amongst the most severe proximal humerus injuries, presenting a challenging management problem. The aim of this study was to report on long-term outcomes of management of proximal humerus fracture dislocations. Patients with a proximal humerus fracture dislocation managed at a Level 1 trauma centre from January 2010 to December 2018 were included. Patients with isolated tuberosity fracture dislocations or pathological fractures were excluded. Outcome measures were the Oxford Shoulder Score (OSS), EQ-5D-5L, return to work and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, non-union/malunion and avascular necrosis. Sixty-nine patients were included with a proximal humerus fracture dislocation in the study period; 48 underwent surgical management and 21 were managed successfully with closed reduction alone. The mean (SD) age of the cohort was 59.7 (±20.4), and 54% were male. Overall patients reported a mean OSS of 39.8 (±10.3), a mean EQ-5D utility score of 0.73 (±0.20), and 78% were able to return to work at a median of 1.2 months. There was a high prevalence of complications in both patients managed operatively or with closed reduction (25% and 38% respectively). In patients undergoing surgical management, 21% required subsequent surgery. Patient reported outcome measures post proximal humerus fracture dislocations do not return to normal population levels. Further, these injuries are associated with a high prevalence of complications. Appropriate patient counselling should be undertaken before embarking on definitive management.

Mechanism evaluation of a digitally enabled rehabilitation intervention for people in aged care and neurological rehabilitation: mediation analysis of the AMOUNT trial

Purpose To investigate potential mechanisms of a digital rehabilitation intervention associated with improved mobility among adults undertaking rehabilitation. Materials and methods Causal mediation analysis of the AMOUNT trial (ACTRN12614000936628). Participants were randomised to digitally-enabled rehabilitation (virtual reality video games, activity monitors, and handheld computer devices prescribed by a physiotherapist) and usual care or usual care alone. Outcomes were mobility (Short Physical Performance Battery; continuous version; range 0–3), physical activity (average steps per day), and quality of life (EQ-5D-5L; utility score; range 0–1) measured at 6-months post-randomisation. Hypothesised mediators included mobility, physical activity, cognition, balance confidence, pain, activity and participation, and computer self-efficacy, assessed at 3-weeks post-randomisation. Results 216 participants with complete data were included. Three-week sit-to-stand ability mediated 6-month mobility (indirect effect 0.09 points, 95%CI 0.03–0.16), explaining 48% of the intervention’s effect. Dynamic single-leg-stance balance mediated physical activity (indirect effect 345 steps per day, 95%CI 63–678) and composite mobility mediated quality of life (indirect effect 0.03 points, 95%CI 0.00–0.05). Conclusion Digital rehabilitation outcomes appear to be mediated through sit-to-stand ability, dynamic single-leg-stance balance, and overall mobility. While future research is required to better understand these mediators, our findings recommend sit-to-stand training as a core element of digital rehabilitation interventions targeting mobility.

The relationship between self-monitoring and cognitive strategy use in midlife and older adults

ABSTRACT Introduction Self-monitoring abilities, both in the moment (online) and general self-knowledge (offline) of one’s errors, are crucial to implementing modification to tasks to support healthy, independent aging. Cognitive strategies (CS) aid in functional, physical, and cognitive abilities, but without recognition of their need, individuals may struggle to complete daily tasks. The current study examined whether higher levels of self-monitoring would predict higher use and quality of real-world cognitive strategies in older adults. Methods Participants included 80 community-dwelling midlife and older adults. Participants completed a remote battery of neuropsychological tasks, including a computerized go-no-go task that evaluated online self-monitoring, and a self-reported questionnaire to measure offline self-monitoring (Cognitive Self-Efficacy Questionnaire). To assess CS, a count score (CS Quantity) and utility score (CS Quality) were computed based on strategies utilized in completion of real-world prospective memory tasks. Results Online self-monitoring was not significantly related to offline self-monitoring (r(77) = –.07, p = .52). A hierarchical regression revealed that while offline self-monitoring significantly predicted 7% of the variance in CS Quality, above and beyond age, global cognition, and premorbid functioning (ΔR 2 = .07, ΔF = 6.23, p = .02), the addition of online self-monitoring did not contribute significant incremental validity (ΔR 2 = .001, ΔF = 0.12, p = .73). The second hierarchical regression revealed that neither online nor offline self-monitoring significantly predicted CS Quantity, after controlling for sex (ΔR 2 = .004, ΔF = 0.29, p = .60). Conclusion The results support the distinction between online and offline self-monitoring concepts and their assessment. For community-dwelling midlife and older adults without dementia, clinicians may consider an individual’s perceptions of their ability to self-monitor when working to facilitate the use of cognitive strategies.

A comparison of health-related quality of life between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis in children with stage 5 chronic kidney disease in Thailand: a randomized controlled trial.

Improving health-related quality of life (HRQoL) is one of the main goals in managing stage 5 chronic kidney disease (CKD). However, limited evidence compares HRQoL between continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in children. This open-label randomized controlled trial (RCT) aimed to compare HRQoL in pediatric patients with stage 5 CKD receiving CAPD vs. APD in Thailand. Children with stage 5 CKD were randomized 1:1 to receive APD or CAPD. The primary outcome was HRQoL, measured by EQ-5D-5L, EQ-5D-3L, and PedsQL at baseline, week 16 and week 48. Outcomes were analyzed using linear mixed models. A total of 60 patients were recruited: 30 with CAPD and 30 with APD. General characteristics, utility scores measured by EQ-5D and HRQoL score measured by PedsQL were comparable between both groups at baseline. During follow-up, no significant differences in terms of utility and HRQoL scores could be identified at week 16 and week 48. Although the children in the APD group seemed to have more favorable changes in some PedsQL domains of PedsQL (school and social domain), as compared to the CAPD group, it was not found that the improvement from baseline was significantly different between both groups. No significant benefit of APD was found over CAPD in terms of HRQoL improvement. However, larger studies are warranted along with qualitative studies to examine the complete impacts of APD on HRQoL among pediatric patients with stage 5 CKD and their families.

Transformer-based neural marked spatio temporal point process model for analyzing football match events

Predictive modeling plays a crucial role in machine learning, data analysis, and statistics. In sports, predictive modeling methods have emerged to provide insights and evaluate performances based on key performance metrics. However, most existing models tend to focus on predicting only partial aspects of an event, such as the outcome, action type, or location, while neglecting the temporal factors involved. To address this gap, this study introduces the Transformer-Based Neural Marked Spatio-Temporal Point Process (NMSTPP) model, specifically designed for football event data. The NMSTPP model predicts a comprehensive set of future event components, including inter-event time, zone, and action. Additionally, it features a dependent prediction layers architecture to enhance model performance. The Holistic Possession Utilization Score (HPUS) metric is also proposed to evaluate the effectiveness and efficiency of possession periods in football based on the NMSTPP model. With open-source football event data, the NMSTPP model successfully predicted the aforementioned three components of future events, with an improvement of up to 4% overall and 9% for individual components compared to baseline models. The HPUS demonstrated a 0.9 correlation with existing performance metrics, highlighting its utility in performance evaluation. The NMSTPP and HPUS were applied to the Premier League to demonstrate their practical feasibility.

Preferences for HIV PrEP care among gay, bisexual, and other men who have sex with men: a large discrete choice experiment.

We aimed to identify preferences for PrEP care among diverse gay, bisexual, and other men who have sex with men (BLGBM) in the US with discrete choice experiment (DCE). We conducted two DCEs to elicit care delivery preferences for Starting and Continuing PrEP among 16-49 year-old HIV negative GBM not using PrEP from across the United States. DCEs assessed preferences for care options including location, formulation (pills, injectable), lab testing, and costs. Participants completed 16 choice tasks and utility scores and relative importance were estimated. We performed latent class analyses to identify groups within each DCE, and multivariable logistic regression to identify sociodemographic characteristics associated with class membership. Among 1514 participants, 46.5% identified as Latino, 21.4% Black, and 25.2 White. For Starting PrEP DCE, two latent classes were identified: "In-Person" (28.5%) which preferred in-person care and lab testing, and "Virtual" (71.5%) which preferred telehealth and at-home lab testing. For Continuing PrEP DCE, two latent classes were identified: "Pills" (23.6%) which preferred oral PrEP with low-cost options and "No Cost/Injectable" (76.4%) which strongly preferred no-costs and injectable PrEP. In multivariable models for Starting PrEP and for Continuing PrEP, latent class membership was significantly associated with a range of sociodemographic characteristics including race/ethnicity, income, housing instability, and provider and PrEP stigma. The preferences identified for PrEP care in this diverse GBM sample indicate the need for multiple care and formulation choices including elimination of costs to improve PrEP uptake. DCE findings can guide implementation efforts to improve equitable access to PrEP.

A systematic review and network meta-analysis of RCTs: The effect of systemic immunotherapies on treatment outcomes and quality of life in patients with metastatic colorectal cancer.

The impact of different systemic treatments on the health-related quality of life (HRQoL) in patients with metastatic colorectal cancer (mCRC) is still unclear. To compare and evaluate the effects of various systemic interventions on the HRQoL in patients with mCRC. A thorough search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to locate relevant literature published in peer-reviewed journals. The risk ratio (RR) and 95% confidence intervals (95% CIs) were calculated. The heterogeneity was examined using p-value, Cochrane Q and I² statistics. The analysis was performed with RevMan 5.4. At least 2 treatment regimens were tested in phase II or III trials. The primary objectives were shortand long-term mean changes in EORTC QLQ-C30 GHS/QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30, Global Health Status/Quality of Life) and EQ-5D health utility scores (EuroQol 5 Dimension). Multivariate meta-regression was used to combine direct and indirect comparison data into a network meta-analysis with a random-effects consistency model. The surface under the cumulative ranking (SUCRA) probability curve was used to compare different systemic therapy combinations. This meta-analysis involved 15 relevant randomized clinical trials (RCTs) with 7,699 patients with mCRC. The study had a low risk of bias (RoB) (p > 0.05 for Egger's regression test) and moderate heterogeneity (I2 < 60%). Results indicated that systemic therapies were substantially more effective than other agents in improving the overall survival (OS) of patients (RR: 0.85 (95% CI: 0.79-0.90); p < 0.001, I2 < 60%], ensuring progression-free survival (PFS) (RR 0.80 (95% CI: 0.75-0.85); p < 0.001; I2 < 60%), suggesting that there was moderate heterogeneity. Long-term findings demonstrated that cetuximab was the most effective treatment and was linked to a significant improvement in GHS/QoL.(coefficient [95% CI] = 0.23 [-0.68 to 0.96], p = 0.747). In terms of the longand short-term results of change in QLQ-C30 GHS/HUS QoL score, cetuximab performed the best (SUCRA 95.12%) among all therapies. It also showed a substantial advantage in comparison to chemotherapy (mean deviation (MD) 0.06, 95% CI: 0.01 to 0.09). This network meta-analysis found that cetuximab monotherapy improves HRQoL and prolongs OS and PFS in patients with mCRC.

User Behavior Analysis and Security Strategy Optimization of College English Learning Platform Using Dynamic Graph Convolutional Network

This paper aimed to address the shortcomings of current college English learning platforms in user behavior analysis and security protection, especially the lack of accurate abnormal behavior detection and dynamic identity authentication measures. By adopting DGCN (Dynamic Graph Convolutional Network) and XGBoost (eXtreme Gradient Boosting) classification models for abnormal behavior detection, a dynamic identity authentication optimization strategy based on behavior risk scoring is proposed to improve the security of the platform. The user embedding features output from DGCN are input into XGBoost for user behavior classification. Based on the predicted probability of the XGBoost classification model, a risk score is generated for each user, and different identity authentication strategies are defined according to the risk score range. Experimental results show that by modeling multi-layer dynamic graph structures, the accuracy, precision, recall and F1 score of the XGBoost model reached 97.6%, 97.5%, 95.3%, and 96.4% respectively. In addition, when the step size of the DGCN model increases from 1 to 10, its accuracy only slightly decreases from 97.6% to 97.5%, and the user behavior classification performance is stable. The incidence of account theft with dynamic identity authentication is maintained between 3% and 8%, and the average authentication time is increased by 2.1 seconds compared with the traditional password authentication method. The proposed DGCN can optimize the security strategy of the college English learning platform based on the user behavior risk score, and it can select targeted identity authentication strategies according to the user's risk score.

Mapping the Washington Group on Disability Statistics disability measure to the Health Utilities Index Mark 3: Development and validation of a predictive multivariable model in a general population sample.

Statistics Canada routinely collects information on functional health and related concepts. Recently, the Washington Group on Disability Statistics (WG) measure of disability has been introduced to the Canadian Community Health Survey (CCHS). The WG measure is used as a tool for developing internationally comparable data on disability. In alternate cycles of the CCHS, it replaces the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health-related quality of life. The HUI3 is used to derive evaluative health measures common in population health and economic evaluations. Since the WG measure is not preference-based, it is unable to derive these measures. To address resulting data gaps, this study empirically maps the health state utility values of the HUI3 score from the WG measure. Empirical mapping used a "head-to-head" subsample of the 2017 CCHS where WG and HUI3 measures were collected from the same respondents aged 40 and over. Empirical mapping used regression models to estimate the statistical relationship between WG and HUI3 measures in addition to health and demographic variables. Out-of-sample predictive performance was assessed through descriptive statistics, mean absolute error, and other measures of predictive accuracy. The preferred estimation strategy resulted in reasonably precise estimates of the HUI3 score corresponding to trends across health and demographic characteristics and reflecting distributional properties of the HUI3 score. Inclusion of different components of the WG measure influenced predictive accuracy. Empirical mapping offers a potential method to estimate health state utility scores from the WG measure and addresses data gaps in health-related quality of life measures in the CCHS when HUI3 is not collected.

More self-efficacy is associated with longitudinally higher health-related quality of life in mechanically ventilated COVID-19 ICU survivors: The prospective MaastrICCht cohort.

More self-efficacy leads to greater confidence in one's ability to perform actions to achieve treatment goals. Therefore, self-efficacy may affect patient recovery and health-related quality of life (HRQoL) after ICU discharge. In a cohort of mechanically ventilated COVID-19 survivors, we examined the associations between self-efficacy at 3 months and HRQoL at 3, 12 and 24 months after discharge. Mechanically ventilated survivors of the MaastrICCht cohort that completed a self-efficacy assessment with the General Self-Efficacy Scale (GSES) were included. HRQoL was measured using the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), subdivided into a health utility score (EQ-HUS) and visual analogue scale (EQ-VAS). Linear regression models were used to investigate associations between self-efficacy and HRQoL and were adjusted for age, sex, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ICU length of stay and hospital discharge location. In 87 ICU survivors, more self-efficacy at 3 months after ICU discharge was associated with longitudinally higher EQ-HUS (β = 0.01; 95% CI: 0.01-0.02; p < 0.001) and higher EQ-VAS (β = 1.00; 95% CI: 0.66-1.35; p < 0.001) up to 2 years after ICU discharge. After adjustment for age, sex, BMI, APACHE II score, ICU length of stay, and hospital discharge location, associations were similar. More self-efficacy at 3 months after ICU discharge was associated with longitudinally higher HRQoL up to 2 years after ICU discharge in mechanically ventilated COVID-19 survivors. Screening for self-efficacy in patients post-ICU as well as developing interventions to improve self-efficacy are a target post-ICU to enhance HRQoL over the long term.

Health utility scores of six common cancers in China measured by SF-6Dv2

PurposeGiven the recent update of SF-6Dv2, detailed data on utility scores for cancer patients by cancer type remain scarce in China and other regions, which limits the precision of cost-utility analyses (CUA) in cancer interventions. The aim of the study was to systematically evaluate utility scores of six common cancers in China measured using SF-6Dv2, and identify the potential factors associated with utility scores.MethodsA hospital-based cross-sectional survey was conducted from August 2022 to December 2023. It recruited 896 cancer patients from three tertiary hospitals in China, including 270 with lung cancer, 96 with stomach cancer, 88 with liver cancer, 71 with oesophagus cancer, 142 with colorectum cancer, and 160 with breast cancer. The validated Simplified Chinese version of the SF-6Dv2 was used to calculate utilities based on the Chinese value set, and the utility values were described using the mean and standard deviation (SD). Participants’ socio-demographic, behavioral and clinical characteristics were also obtained from the survey. Univariate and multivariate linear regression models were performed to explore the impact of these three categories of characteristics on utility scores derived from SF-6Dv2 for the total cancer patients and each cancer group.ResultsThe mean utility score was 0.66 (SD = 0.26) for the total cancer sample, 0.66 (SD = 0.25) for lung cancer, 0.75 (SD = 0.23) for stomach cancer, 0.69 (SD = 0.24) for liver cancer, 0.69 (SD = 0.24) for oesophagus cancer, 0.65 (SD = 0.31) for colorectum cancer, and 0.57 (SD = 0.24) for breast cancer. Multivariate linear regression analysis indicated that patients who were older, from larger families, under greater economic pressures, undergoing fewer health examinations, smoking, and in advanced cancer stages had lower utility scores in the total cancer sample (p<0.05), with variations observed across different cancer types.ConclusionsThis study is one of the first to apply the SF-6Dv2 to a heterogeneous group of cancer patients, providing evidence for conducting CUA with SF-6Dv2 across six common cancers in China. In addition, the study provides a basis for improving interventions for different cancer types.

Cost-utility of lumbar interbody fusion surgery: A systematic review.

Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value. While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use. Systematic review. This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain. Direct (healthcare) and indirect (non-healthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR). A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity. Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over 1 year (0.43, IQR 0.121-0.705), while PLIF was highest over 2 years (1.33). ALIF was most favorable over 1 year ($30901/QALY) and OLIF was most favorable over 2 years ($11187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over 2 years ($44383, $45628, $48576/QALY). MIS was substantially favorable to OS at 1 year ($42635 vs. $226304), though similar at 2 years ($48576 vs. $45628/QALY). Anterior approach was favorable to posterior approach at 1 year ($30901.5 vs. $81038) and 2 years ($29881.9 vs. $44383). Cost-utility comparisons substantially varied and were sensitive to utility measures, study methodology, cost sourcing, and follow-up duration. This is the first systematic review to comprehensively assess CUAs of all LIF approaches in the existing literature. While certain approaches, such as ALIF and OLIF, may demonstrate favorable outcomes, these conclusions are limited by high methodological heterogeneity and a limited study pool. By addressing existing gaps in study design and reporting, future comparative cost-utility research can better inform evidence-based decision-making and optimize the value of spinal surgical care.

The Psychometric Properties of the EuroQol 5D Five Level in Survivors of Critical Illness.

The EuroQol 5D five level (EQ-5D-5L) instrument is a standardized measure of health-related quality of life and is routinely used in survivors of critical illness. However, information on its psychometric properties and minimal clinically important difference (MCID) in this patient group is lacking. Secondary analysis of data from the previously published PREDICT (a registry in critically ill patients to determine predictors of disability-free survival) study, a prospective, multicenter cohort study. Six ICUs in the state of Victoria, Australia. Four hundred fifty adult patients admitted to the ICU and ventilated for over 24 hours. None. The EQ-5D-5L was administered by telephone at 6 months following ICU admission. Internal consistency (inter-item correlations, Cronbach's α, and split-half reliability coefficients), construct validity (against age, body mass index, and other outcome measures), responsiveness (observing change over time and effect sizes), percentage of participants presenting no change, and MCID (triangulation of distribution-based and anchor-based estimates) were evaluated. The EQ-5D-5L showed high internal consistency, Cronbach α coefficients of 0.82 (between dimensions) and 0.79 (between the EuroQol-Visual Analogue Scale [EQ-VAS] and utility score), and average split-half coefficients of 0.79 each (between dimensions and between EQ-VAS and utility score). Construct validity was confirmed with a strong correlation between the EQ-5D-5L and the World Health Organization Disability Assessment Schedule 2.0 (EQ-VAS: r = 0.72; p < 0.001 and utility score: r = 0.81; p < 0.001). Effect sizes for change over time for EQ-VAS and utility score were low. The final MCID estimates were 10 (EQ-VAS) and 0.11 (utility score). The EQ-5D-5L, using the Australian value set, demonstrated evidence of good internal consistency and validity, but poor responsiveness in a critically ill population.

Health-Related Quality of Life in Long COVID: Mapping the Condition-Specific C19-YRSm Measure Onto the EQ-5D-5L.

Long COVID (LC) is a clinical syndrome with persistent, fluctuating symptoms subsequent to COVID-19 infection. LC has significant detrimental effects on health-related quality of life (HRQoL), activities of daily living (ADL), and work productivity. Condition-specific patient-reported outcome measures (PROMs), such as the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) do not provide the health utility data required for cost-utility analyses of LC interventions. The aim of this study was to derive a mapping algorithm for the C19-YRSm to enable health utilities to be generated from this PROM. Data were collected from a large study evaluating LC services in the UK. A total of 1434 people with LC had completed both the C19-YRSm and the EQ-5D. Correlation and linear regression analyses were applied to determine items from the C19-YRSm and covariates for inclusion in the algorithm. Model fit, mean differences across the range of EQ-5D-3L utility scores, and Bland-Altman plots were evaluated. Responsiveness (standardised response mean; SRM) of the mapped utilities was investigated on a subset of participants with repeat assessments. There was a strong level of association between 8 items and one domain on the C19-YRSm with the EQ-5D single-item dimensions. Model fit was good (R2 = 0.7). The mean difference between observed and mapped scores was <0.10 for the range from 0 to 1 indicating good targeting for positive values of the EQ-5D-3L. The SRM for the mapped EQ-5D-3L was 0.37 compared to 0.17 for the observed utility scores, suggesting the mapped EQ-5D-3L is more responsive to change. A simple, responsive, and robust mapping algorithm was developed to generate enable EQ-5D-3L health utilities from the C19-YRSm. This will facilitate economic evaluations of LC interventions, treatment, and management, as well as further helping to describe and characterise patients with LC irrespective of any treatment and interventions.