Wilcoxon Test For Paired Samples Research Articles

Healthcare professional motivation in Poland and Ukraine: The role of profession, gender, and country

The purpose of this study was to examine the differences in intrinsic vs. extrinsic motivation among medical students, doctors, and nurses in two countries – Ukraine and Poland. As a secondary aim, gender differences were considered as well. During 2019, until the beginning of 2020, before the COVID-19 pandemic started, healthcare professionals from two hospitals and medical students from one university in Poland and healthcare professionals from two hospitals and medical students from one university in Ukraine were recruited to participate in the study. The Wilcoxon test for paired samples was used to compare each participant’s score on the intrinsic vs. extrinsic motivation sub-scales. Differences were examined by country, gender, profession, and combinations of these factors. In Poland, 142 doctors, nurses, and medical students were recruited. In Ukraine, 126 doctors, nurses, and medical students were recruited. Respondents completed an anonymous paper-and-pencil survey that required minimal socio-demographic information (age, gender, profession, and years of experience) so that the respondent would remain unidentifiable. The results show that male doctors were more extrinsically vs. intrinsically motivated (p=0.003), while female doctors and students were more intrinsically vs. extrinsically motivated in both Ukraine and Poland (p=0.023). Male students and nurses from both countries were equally motivated by both intrinsic and extrinsic factors. Polish female doctors were more intrinsically vs. extrinsically motivated than Ukrainian ones (p=0.001), whereas Ukrainian and Polish male doctors were more extrinsically vs. intrinsically motivated (p=0.002). There were statistically different motivational patterns concerning gender, occupation, and nationality, which may have important implications for the construction of motivational systems in both organizational and healthcare systems.

The effect of reflexology and pelvic floor muscle (Kegel) exercises on urinary incontinence in people with multiple sclerosis

Purpose: This study was conducted to determine the effects of reflexology and Kegel exercise on urinary incontinence in patients with multiple sclerosis (MS). Materials and methods: A single-blind, controlled pretest-posttest study was conducted. The study included 15 patients with MS who presented to the neurology outpatient clinic between March 2020 and February 2022. Patients were assigned to the reflexology, Kegel exercise, or control group using block randomization. Data were collected from all patients using a sociodemographic information form, and quality of life was assessed using the International Consultation on Incontinence Questionnaire–Short Form, Incontinence Quality of Life Scale, and Incontinence Severity Index. The Wilcoxon paired-samples test and Kruskal-Wallis test were used to analyze the data. Results: The mean age of the patients was 39.86 ± 9.99 years, and the mean MS duration was 104.46 ± 84.12 months. International Consultation on Incontinence Questionnaire–Short Form scores did not differ significantly between the groups before or after the intervention (P = 0.788). Incontinence Quality of Life Scale total and subscale scores also did not differ between the groups, but significant improvement was noted in the reflexology group between the pretest and posttest assessments (P = 0.970). Incontinence Severity Index scores did not differ between or within the groups (P = 0.193). Conclusion: Reflexology and Kegel exercise did not exert different effects on urinary incontinence, whereas reflexology improved incontinence-related quality of life.

The Effect of Bilateral Orchiectomy on Total Prostate Specific Antigen (TPSA) Levels in Prostate Adenocarcinoma Patients

AbstractBackground: Hormonal therapy is one treatment option for prostate cancer. There are two main categories of hormone therapy: surgical therapy and non-surgical therapy. Orchiectomy is the surgical method of hormone therapy; medication supplementation is the non-surgical method. Many kinds of indicators are used to track the advancement of patients with prostate cancer receiving hormone therapy. tPSA levels are one of the markers that are regularly evaluated.Methods: In this retrospective study, PSA levels in patients with prostate adenocarcinoma cancer were evaluated before and after bilateral orchiectomy. Use the search terms "prostate cancer" and "orchiectomy" to find research subject data in the UGM Academic Hospital's medical records installation between 2020 and 2023. The study's findings will be shown in a graphic and statistical analysis while protecting the subjects' anonymity.Results: Most of the participants (n=18, 60.0%) have pre-orchiectomy tPSA level of more than 30 ng/mL, while only almost a quarter (n=7, 23.3%) of participants have post-orchiectomy tPSA level of more than 30 ng/mL. The two research groups (p<0.0001) before and after the orchiectomy procedure, significantly differ between the two research groups based on Wilcoxon paired sample test analysis.Conclusion: TPSA levels are considerably decreased by bilateral orchiectomy.

Improved exercise ventilatory efficiency with nasal compared to oral breathing in cardiac patients.

Objectives: To assess whether nasal breathing improves exercise ventilatory efficiency in patients with heart failure (HF) or chronic coronary syndromes (CCS). Background: Exercise inefficient ventilation predicts disease progression and mortality in patients with cardiovascular diseases. In healthy people, improved ventilatory efficiency with nasal compared to oral breathing was found. Methods: Four study groups were recruited: Patients with HF, patients with CCS, old (age≥45years) and young (age 20-40years) healthy control subjects. After a 3-min warm-up, measurements of 5min with once nasal and once oral breathing were performed in randomized order at 50% peak power on cycle ergometer. Ventilation and gas exchange parameters measured with spiroergometry were analysed by Wilcoxon paired-sample tests and linear mixed models adjusted for sex, height, weight and test order. Results: Groups comprised 15 HF, CCS, and young control and 12 old control. Ventilation/carbon dioxide production ( E/ CO2), ventilation ( E), breathing frequency (fR), and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups, with large effect sizes for most parameters. For patients with HF, median E/ CO2 was 35% lower, fR 26% lower, and PETCO2 10% higher with nasal compared to oral breathing, respectively. Exercise oscillatory ventilation (EOV) was present in 6 patients and markedly reduced with nasal breathing. Conclusion: Nasal breathing during submaximal exercise significantly improved ventilatory efficiency and abnormal breathing patterns (rapid shallow breathing and EOV) in 80% of our patients with HF and CCS.

Effect of School-Based Educational Intervention on Childhood Obesity in Croatian Urban and Rural Settings.

Childhood obesity is a global public health concern. Development of effective public health interventions represents the only viable option for decreasing the prevalence of childhood obesity. The objective of this study was to assess the effectiveness of a school-based "PETICA-Play for Health" obesity prevention program in urban and rural areas in Croatia. This before-and-after study included 28 elementary schools in Croatia focused on pupils (n = 753, 2nd grade) and their guardians (n = 753) during the school year 2022/2023. "PETICA" multicomponent lessons and workshops (10) were implemented in the school curriculum and home settings (parents) as part of the intervention. Knowledge and lifestyle habit changes were evaluated via the questionnaire on knowledge and habits regarding nutrition and physical activity pre-/post-education. The Wilcoxon test for paired samples, Student's t-test (dependent and independent samples), multiple Mann Whitney U tests (p < 0.05), Spearman's correlation, and heatmaps were used. The analysis showed a significant increase in acquired knowledge among pupils (both settings) and habits in the rural setting (increase in sports activities participation, breakfast, and vegetables consumption (p < 0.001, p = 0.003, p = 0.004)), decrease of sweets and salty snacks intake (p = 0.027, p = 0.011), and also, the link between parents' and children's physical activity levels (p = 0.028 vs. p = 0.022), emphasizing the importance of parents as healthy lifestyle role-models. The study shows that "PETICA" is an efficient school-based educational model that contributes to positive changes in children's knowledge and lifestyle habits that are a prerequisite for childhood obesity prevention.

IN VITRO EVALUATION OF THE EFFECT OF SELANT APPLICATION AT THE INTERFACE OF A SCREWED TAPERED CONNECTION IMPLANT: MICROSCOPIC, MECHANICAL AND MICROBIOLOGICAL STUDY

The objective of this in vitro study was to assess the effect of sealant at the interface of a screwed conical connection implant, regarding its mechanical behavior and bacterial infiltration. For this purpose, 60 conical implant-abutment sets were selected and divided into four groups (n=15): Group A, submitted to mechanical cycling without sealant; Group B, submitted to mechanical cycling with sealant; Group C, without mechanical cycling but with sealant; Group D, without mechanical cycling or sealant, but it was analyzed with scanning electron microscopy (SEM). The mechanical cycling test was performed with 500,000 cycles per sample with a load of 120 N and 2 Hz frequency at an angle of 30º. For microbiological analysis, 10 sets of each group (with mechanical cycling or not), were immersed in suspension containing Escherichia coli, and incubated at 37oC. After 14 days, the abutments were separated from the implants, the detorque forces were recorded and the presence of bacterial penetration was assessed. The remaining 5 sets of each group were cut longitudinally and analyzed, using SEM, at three points in the region of the implant-abutment interface. Mann Whitney tests were used for statistical calculations for comparisons between groups with and without sealant and between groups with and without cycling, and the paired samples Wilcoxon test for comparisons between distances. The analysis of bacterial growth was performed using Fisher’s exact test. The analyzes were performed using the R and SAS program, with a significance level of 5%. The results showed that at a distance of 500 µ, in the presence of sealant, there was a greater misfit with cycling than without cycling (p &lt;0.05). In the absence of cycling there was a greater misfit without sealant than with sealant (p&lt;0.05), in both distances. There was no significant difference between the distances regarding maladjustment (p&gt; 0.05). There was no growth of Escherichia coli on the external part in the four groups. The group without sealant and with mechanical cycling showed significantly higher internal bacterial growth than the other groups (40% of the samples), p &lt;0.05.

Impact of root canal disinfection on the bacteriome present in primary endodontic infection: A next generation sequencing study.

To investigate the bacteriome present in teeth with primary endodontic infection (PEI) and apical periodontitis (AP) and to determine quantitatively and qualitatively the impact of chemomechanical preparation (CMP) using 2.5% sodium hypochlorite NAOCl on the bacteriome found in PEI with AP using the Illumina MiSeq platform. Thirty-six paired samples from 18 patients were successfully sequenced and analysed. Samples were collected at two sampling times: before (s1) and after (s2) CMP using 2.5% NaOCl. The DNA was extracted from s1 and s2 samples and quantified using quantitative PCR (qPCR). All 36 samples were sequenced using the Illumina MiSeq platform. Raw V3-V4 amplicon sequencing data were processed with the DADA2 pipeline to generate amplicon sequence variants (ASVs). Alpha diversity metrics representing abundance (Chao1) and diversity and evenness (Shannon, Simpson) were computed. The paired-sample Wilcoxon's test was used to compare alpha diversity metrics and qPCR counts between s1 and s2. The PERMANOVA method (with 999 permutations) was applied to compare community composition between sample types (s1 versus s2) and between patient IDs. ALDEx2 (ANOVA-like differential expression tool for high-throughput sequencing data) to investigate differentially abundant taxa between s1 and s2. A paired-sample Wilcoxon's test was used to compare alpha diversity metrics and qPCR counts between s1 and s2. The qPCR counts were significantly higher in s1 compared to s2 (p = .0007). The Chao1 index indicated no difference in alpha diversity (p < .7019); whereas Shannon (p = .0056) and Simpson (p = .02685) indexes showed higher values in s2. The PERMANOVA test using Adonis2 showed a significant effect of sample time on community composition (R2 = .0630, p = .012). Patient ID also showed a significant effect on community composition (R2 = .6961, p = .001). At the genus level, Dialister, Mogibacterium, Prevotella, and Olsenella were differentially enriched at s1, while Actinomyces, Stenotrophomonas_unclassified, Enterococcus_unclassified, and Actinomyces_unclassified were differentially enriched in s2. The bacteriome present in teeth with PEI with AP is complex and diverse. CMP using 2.5% NaOCl showed a high quantitatively and qualitatively disinfectant impact on the bacteriome present in PEI with AP.

Abstract PO5-06-05: DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE

Abstract Introduction: Breast cancer (BC) is a heterogeneous disease, and during its progression, the tumor phenotype can undergo changes that are often associated with a poor prognosis. In this study, we aim to compare the discordance in estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression between primary and recurrent/metastatic lesions. Methods: This study is a retrospective analysis of 132 non-advanced breast cancer patients who experienced confirmed recurrence/metastasis at the Instituto Nacional de Enfermedades Neoplasicas between 2011 and 2022. Descriptive analysis was conducted to assess the expressions of ER, PgR, HER-2, and Ki-67 in primary and metastatic breast cancer, as well as clinical variables. Normality tests, including Kolmogorov-Smirnov and Shapiro-Wilk, were performed. The paired samples Wilcoxon test was used to determine significant differences between primary and recurrent/metastatic tumors. Additionally, Spearman's rank correlation coefficient was employed to evaluate the relationships of expression discordance. Results: Fifty-nine percent of patients presented locoregional recurrence, while 41% presented visceral metastasis. In the primary tumor, ER and PR expression were found in 63.6% and 55.3% of cases, respectively. HER2 status was determined as 0 (36.3%), +1 (22%), +2 (14.4%), +3 (26.5%), and not determined (0.8%) by IHC. For the recurrent/metastatic tumor, ER and PR expression were found in 59% and 34% of cases, respectively. HER2 status was determined as 0 (27.3%), +1 (19.7%), +2 (25%), +3 (25%), and not determined (3%). The median Ki-67 levels were 37% in the primary tumor and 40% in the recurrent/metastatic tumor. Significant differences were found for ER (p=0.014), PR (p&amp;lt; 0.001), and HER2 (p=0.019), but not for Ki-67 percentage (p=0.139). The discordance rates of ER, PR, HER2, and Ki-67 expression were 27.9%, 47.7%, and 26.3%, respectively. Conclussions: Discordance in hormone receptor expression between primary and recurrent/metastatic tumors is a common phenomenon, with ER showing a discordance rate of 27.9% and PR showing a higher rate of 47.7%. HER2 status also displayed significant discordance, with a 26.3% rate of discordant expression between primary and recurrent/metastatic tumors. The findings from this study emphasize the dynamic nature of breast cancer and the importance of comprehensive evaluation of biomarker expression in both primary and recurrent/metastatic tumors, to choose the best treatment options. Citation Format: Katia Roque, Iris Otoya, Natalia Valdivieso, Zaida Morante, Hugo Fuentes, Silvia Neciosup, Henry Gómez, Jorge Cotito, Gonzalo Ziegler, Estefania Peña, Tatiana Vidaurre, Ramon Andrade de Mello, Carlos Castañeda. DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-05.

Beneficial impact of visual stimulation-based digital therapeutics on blood pressure control in non-hypertensive individuals.

Hypertension-related diseases occur in both hypertensive and non-hypertensive individuals. However, few studies to date have explored blood pressure (BP) control in non-hypertensive individuals. This before-after study aimed to examine the impact of visual stimulation-based digital therapeutics (VS-DTx) on BP and heart rate (HR). Eighty-three eligible non-hypertensive participants were included in this study. The McNemar test and Paired Samples Wilcoxon Signed Rank Test were employed to assess decline rates and differences in BP and HR between the control phase and the intervention (using VS-DTx) phase. Pairwise correlation analysis was used to analyze the correlation between the two phases. This study found the systolic BP (SBP) and mean arterial pressure (MAP) in the VS-DTx phase showed a downward trend (66.2% vs 49.3%; 68.7% vs 55.4%). The mean SBP decreased from 114.73 mm Hg to 111.18 mm Hg, and the mean MAP decreased from 87.96 mm Hg to 84.88 mm Hg in the VS-DTx phase. Paired Samples Wilcoxon Test showed differences in both ΔSBP (Z = -3.296; P < 0.01) and ΔMAP (Z = -2.386; P < 0.05) (Δ is defined as the difference between baseline and post-stimulus). The pairwise correlations analysis revealed that VS-DTx affected the MAP reduction (r = 0.33; P < 0.01) between the browsing digital devices phase and the VS-DTx phase. The results indicated that VS-DTx may have a certain effect on BP, including SBP and MAP. This study preliminarily explored the possible effects of VS-DTx on BP, providing certain useful insights for future research in digital BP management.

Advantages of UltrafastTM ultrasound in the screening for renal artery disease

Aim: Renal artery disease is the most common cause of secondary hypertension worldwide. B-mode and Doppler ultrasound are considered the modalities of choice for the imaging of the renal arteries. However, an adequate examination can be plagued by difficulties in patients with unfavorable anatomy. UltraFastTM ultrasound is faster, performed with higher frame rates, and enables prospective and ret- rospective data analysis with quantification of flow data in the obtained image, so it may be able to resolve some of the difficulties encountered during conventional ultrasound examinations in patients with suspected renal artery disease. Material and methods: Comparison of the duration of conven- tional and UltraFastTM Doppler examinations of segmental renal arteries was performed on 52 young, healthy volunteers. Duration times were summarized using the median and interquartile range, and comparisons between the two methods were performed using the Wilcoxon test for paired samples. Results: The duration of UltraFastTM ultrasound examinations was significantly shorter in comparison to conventional ultrasound for both kidneys and in total (p &lt;0.001, median difference in duration 65 s, median 64% shorter duration of analysis), while both conventional and UltraFastTM ultrasound examina- tions demonstrated consistent velocity measurements with very high correlation (Rho = 0.94, p &lt;0.001). Conclusions: The study provides evidence that UltraFastTM ultrasound is faster than conventional Dop- pler ultrasonography for the assessment of renal artery disease in healthy adults without a history of renal disease. The findings have important implications for clinical practice, as they suggest that Ultra- FastTM imaging could offer a more efficient and time-saving approach to vascular imaging in patients with suspected renal artery disease.

The Impact of Insecure Attachment on Social Functioning in Women with Schizophrenia

IntroductionAttachment styles is intrinsically related to the capacity for forming close social bonds, making it a vital lens through which to understand social functioning.ObjectivesThis study investigates the link between attachment styles and social functioning among women diagnosed with schizophrenia.MethodsWe carried out a descriptive and analytical cross-sectional study from May to June 2023, focusing on stabilized female patients diagnosed with schizophrenia or schizoaffective disorder. The study took place in the ‘B’ psychiatry department of Hedi Chaker University Hospital in Sfax, Tunisia. Data on attachment styles and social functioning were collected using self-report questionnaires: the Revised Psychosis Attachment Measure (PAM_R) and the Social Functioning Scale (SFS). In our study, we employed both the Wilcoxon test for paired samples and the Spearman correlation test to assess the differences and correlations between attachment scores and social functioning scores, respectively.ResultsIn the study, 41 female patients were included. The participants had a mean age of 49.19, ranging from 19 to 79 years old. Attachment styles were predominantly avoidant (60.97%), followed by anxious (24.39%) and disorganized (14.63%). A significant portion, 39%, exhibited low social functioning. The domains most affected were leisure (63.41%) and employment (60.97%). Our analysis revealed negative correlations between avoidant attachment and social functioning in leisure activities (Spearman’s ρ = -0.057, p &lt; 0.05) as well as between avoidant attachment and independence performance (Spearman’s ρ = -0.040, p &lt; 0.05). Also, the correlation coefficient for anxious attachment and leisure activities is 0.041, demonstrating a positive association (p &lt; 0.005).ConclusionsThese initial findings may imply a potential association between attachment styles and social functioning in schizophrenia.Disclosure of InterestNone Declared

Evaluating the usability and effectiveness of the Go PainFree telehealth system (beta version) for musculoskeletal pain management in the Philippines

Biomechanical Taping has been shown to effectively reduce pain and enhance function in patients with musculoskeletal pain. When used as an adjunct to physiotherapy, BMT may contribute to increased stability, leading to improved pain management and functionality. Telehealth has emerged as an effective and cost-efficient alternative to traditional physiotherapy. The Go PainFree Telehealth System, employs BMT to alleviate pain and improve functionality, enhancing the overall effectiveness of online therapy services for patients with musculoskeletal conditions.The study determined the usability of the system in managing musculoskeletal conditions for patients accessing healthcare online, focusing on its usefulness, ease of use and learnability, interface quality, interaction quality, reliability, satisfaction, and future use. Also, the study examined the effectiveness of BMT on pain and function in individuals with musculoskeletal conditions when integrated into the system after a single session.This retrospective study reviewed the records of the system between November 2022 and February 2023. Evaluating the system's usability involved the integration of the Telehealth Usability Questionnaire within the system survey, serving as a reliable instrument for assessing the quality of telehealth applications from the users' perspective. Participants rated various parts, including usefulness, ease of use and learnability, interface quality, interaction quality, reliability, and satisfaction and future use. To determine the effectiveness of BMT, the 100-mm Visual Analogue Scale (VAS) was used before and after a single session. Data analysis was conducted using descriptive statistics, allowing for the summarization of demographic information and the reporting of average mean (95 % (CI)) for each usability category of the TUQ. The effectiveness of BMT on pain and function was determined using the Wilcoxon test for paired samples after one session. P < 0.05 indicates significant improvement in pain and function. This study involved 33 participants, with a mean (SD) age of 34.94 ± 2.04, who used the system between November 2022 and February 2023. The majority of reported musculoskeletal conditions pertained to the upper extremity (n = 19), followed by the lower extremity (n = 8), and spine (6). The findings revealed that participants generally considered the system useful, easy to use and learn, and had good interface and interaction quality, as shown by average scores of five in these categories, indicating "somewhat agree." Conversely, participants expressed reservations about the system's reliability, with an average score of 3 reflecting "somewhat disagree." As for their satisfaction with the system and the likelihood of future use, participants showed mixed opinions, with an average score of 4 representing "neither agree nor disagree." The study showed BMT significantly reduced pain scores (Z = −4.80, p < 0.001, two-tailed) and enhanced function scores (Z = −4.87, p < 0.0001, two-tailed) for participants with musculoskeletal conditions.The system was generally regarded by the participants as useful, user-friendly, and characterized by high-quality interface and interaction. Despite these positive perceptions, concerns about the platform's reliability emerged, and opinions about satisfaction and future use were mixed. Still, the integration of BMT into the system yielded significant reductions in pain and improvement in function for the participants with musculoskeletal conditions.

Evolving or unchanged? Investigating perceptual profiles over time in psychosis and comparing with healthy controls

There is a growing body of evidence indicating altered perceptual profiles in psychosis, which can be assessed by evaluating exteroceptive (e.g., auditory and visual) and interoceptive (e.g., heartbeat and breathing) sensory processing through self-administered questionnaires. However, the unexplored question remains whether perceptual alterations depend on the phase of illness. In this observational, STROBE-compliant study, we adopted the Multidimensional Assessment of Interoceptive Awareness (MAIA; eight domains), Adult/Adolescent Sensory Profile (AASP; four domains), and Positive and Negative Symptoms Scale (PANSS) to measure interoception, exteroception, and symptom severity, respectively. Our primary aim was to compare MAIA, AASP, and PANSS differences in patients with psychosis (PSY patients) between post-acute (PSY-T1) and remission phases (PSY-T2). Student&amp;rsquo;s t-tests or Wilcoxon paired-sample tests were used based on the variable distribution. MAIA/AASP data were also collected from healthy controls (HCs). As a secondary aim, we examined MAIA/AASP differences between PSY-T1/T2 and HC using MANOVA and Mann&amp;ndash;Whitney tests. Bonferroni&amp;ndash;Holm correction was implemented. Data were collected from 23 PSY patients (55% females; mean age: 38.35 &amp;plusmn; 12.46 years) and 210 HC (46% females; mean age: 39.81 &amp;plusmn; 13.78 years). No differences were found between PSY-T1 and PSY-T2 (Bonferroni&amp;ndash;Holm P &gt; 0.05) for MAIA/AASP scores, while PANSS total and positive scores were higher in PSY-T1 compared to PSY-T2, with Bonferroni&amp;ndash;Holm p-values of 0.032 and 0.045, respectively. Although MAIA/AASP domains (noticing/body listening and low registration) were increased in PSY-T1 compared to HC, no differences were observed between PSY-T2 and HC. The heterogeneous results in the literature regarding perceptual profiles should be contextualized by considering that fluctuations in patients with psychosis can become significant when compared to the general population.

Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study

BackgroundThe global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training. AimsThis study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model. Methods and procedures247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution. Outcomes and resultsBoth populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement. Conclusions and implicationsThis study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.

Comparison of Multiple Segmentation Methods for Volumetric Delineation of Primary Prostate Cancer with Prostate-Specific Membrane Antigen-Targeted 18F-DCFPyL PET/CT.

This study aimed to assess the accuracy of intraprostatic tumor volume measurements on prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT made with various segmentation methods. An accurate understanding of tumor volumes versus segmentation techniques is critical for therapy planning, such as radiation dose volume determination and response assessment. Methods: Twenty-five men with clinically localized, high-risk prostate cancer were imaged with 18F-DCFPyL PET/CT before radical prostatectomy. The tumor volumes and tumor-to-prostate ratios (TPRs) of dominant intraprostatic foci of uptake were determined using semiautomatic segmentation (applying SUVmax percentage [SUV%] thresholds of SUV30%-SUV70%), adaptive segmentation (using adaptive segmentation percentage [A%] thresholds of A30%-A70%), and manual contouring. The histopathologic tumor volume (TV-Histo) served as the reference standard. The significance of differences between TV-Histo and PET-based tumor volume were assessed using the paired-sample Wilcoxon signed-rank test. The Spearman correlation coefficient was used to establish the strength of the association between TV-Histo and PET-derived tumor volume. Results: Median TV-Histo was 2.03 cm3 (interquartile ratio [IQR], 1.16-3.36 cm3), and median TPR was 10.16%. The adaptive method with an A40% threshold most closely determined the tumor volume, with a median difference of +0.19 (IQR, -0.71 to +2.01) and a median relative difference of +7.6%. The paired-sample Wilcoxon test showed no significant difference in PET-derived tumor volume and TV-Histo using A40%, A50%, SUV40%, and SUV50% threshold segmentation algorithms (P > 0.05). For both threshold-based segmentation methods, use of higher thresholds (e.g., SUV60% or SUV70% and A50%-A70%) resulted in underestimation of tumor volumes, and use of lower thresholds (e.g., SUV30% or SUV40% and A30%) resulted in overestimation of tumor volumes relative to TV-Histo and TPR. Manual segmentation overestimated the tumor volume, with a median difference of +2.49 (IQR, 0.42-4.11) and a median relative difference of +130%. Conclusion: Segmentation of intraprostatic tumor volume and TPR with an adaptive segmentation approach most closely approximates TV-Histo. This information might be used to guide the primary treatment of men with clinically localized, high-risk prostate cancer.

Can family members reliably assess mood and suicidal ideation in individuals with epilepsy?

BackgroundRoutine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms. MethodsFrom October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson’s correlation analysis. ResultsThe study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) – spouses, 15 (10.7 %) – partners, 11 (7.9 %) – children and 6 (4.3 %) – siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = − 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE − proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen’s Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation. ConclusionCompanions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.

Immune Contexture Changes Following Blue Light Cystoscopy with Hexaminolevulinate in Bladder Cancer

BackgroundTransurethral resection of bladder tumor (TURBT) is a central component in the diagnosis of non–muscle-invasive bladder cancer (NMIBC) and can be guided by several optical imaging techniques for better visualization of lesions. ObjectiveTo investigate if a change in tumor microenvironment (TME) composition could be observed as an effect of hexaminolevulinate (HAL)-assisted blue light cystoscopy (BLC) in TURBT samples from patients with bladder cancer. Design, setting, and participantsThis was a retrospective study of 40 patients with bladder cancer who underwent either BLC-guided TURBT (n = 20) or white light cystoscopy (WLC)-guided TURBT (n = 20) before radical cystectomy (RC). Tissue samples (n = 80) were collected from paired TURBT and RC specimens for all 40 patients. Tumor tissue was stained using multiplex immunofluorescence and immunohistochemistry. Outcome measurements and statistical analysisImmune cell infiltration was assessed according to the proportions of each immune cell or immune evasion marker and the relative change from TURBT as baseline was calculated. Statistical comparisons between groups were performed using the Wilcoxon rank-sum test or the paired-sample Wilcoxon test. Results and limitationsComparison of relative changes in the TME revealed a significant decrease in stromal infiltration of cytotoxic T cells (p = 0.024), B cells (p = 0.041), and stromal cells expressing PD-1 (p = 0.011) in patients treated with BLC-guided TURBT compared to WLC-guided TURBT. ConclusionsOur pilot study showed that HAL-BLC during TURBT in bladder cancer may influence the immune cell composition and TME. Patient summaryWe investigated the potential therapeutic effect of blue light versus white light for guidance in removing bladder tumors via the urethra in patients with bladder cancer. For blue light guidance, a compound called hexaminolevulinate is used to visualize tumor tissue. We found changes in immune cell composition that may have been influenced by the blue light guidance.

SIMPEDVR: using VR in teaching pediatric emergencies to undergraduate students—a pilot study

The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6–100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9–88.9). The perceived level of competence increased from 2 (IQR 1–3) to 4 (IQR 3–4) on a 5-point Likert scale, for both scenarios (p < 0.001, Wilcoxon test for paired samples). Conclusions: The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula.What is Known:• Virtual reality (VR) is a rising simulation training methodology in Pediatric Emergency Medicine (PEM), however little experience is reported about its use for undergraduate studentsWhat is New:• VR PEM trainiing was found useful by undergraduate students and its use increased their perceived level of competence, although ease-of-use received lower ratings.• Despite the young age, an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made

Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study

BackgroundResearch highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students.MethodsEducational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis.Results96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss.ConclusionsThe educational intervention increased student nurses’ perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.

Association between problematic Internet use and specific Internet activities and COVID-19- and earthquake-related stress, anxiety, and depression symptoms among Croatian young adults.

During the COVID-19 pandemic and concomitant earthquakes in Croatia in 2020, increased Internet use (IU) and Internet-based addictive behaviors were associated with decreasing mental well-being. We determined the changes in IU, problematic IU (PIU), and problematic specific Internet activities in young adults during the prolonged stress caused by the pandemic and earthquakes, age differences in PIU and differences in perceived source of stress (pandemic or earthquakes), and association between PIU and increase in specific Internet activities and stress, anxiety, and depression symptoms in young adults. A cross-sectional online survey conducted from September 30, 2021 to October 17, 2021 included 353 young adults aged 22.6 ± 2.1 years, 382 early adults aged 32.1 ± 4.4 years, and 371 middle-aged adults aged 49.0 ± 6.5 years. Data on sociodemographic characteristics, stressors (without perceived stressors, only pandemic-related stressor, only earthquake-related stressor, and both pandemic and earthquake-related stressors), PIU and IU were collected with a self-report questionnaire. The Impact of Event Scale and the Hospital Anxiety Depression Scale were used to evaluate mental symptoms. PIU and problematic specific Internet activities were assessed using Tao et al.'s criteria. Data were anaylzed with paired-sample Wilcoxon test, McNemar's and Pearson's chi-square tests, and structural equation modeling. In 17% of young adults, we found increased PIU (OR = 5.15, 95% CI [2.82, 10.18]), problematic social media use (OR = 2.77, 95% CI [1.56, 5.14]), and uncontrolled online shopping (OR = 5.75, 95% CI [1.97, 22.87]) (p < 0.001 for all). PIU and problematic social media use were more common among young adults (60.8%), as well as problematic online gaming (25.9%). Problematic social media use was more frequent among young adults reporting pandemic stress than among those without perceived stress (69.9% vs. 43.2%). Increased online gaming predicted more severe avoidance symptoms (p = 0.041), increased social media use predicted more severe depression symptoms (p = 0.017), increased online shopping predicted more severe intrusion (p = 0.013) and anxiety symptoms (p = 0.001). PIU predicted more severe intrusion (p = 0.008), avoidance (p = 0.01), anxiety (p < 0.001), and depression (p = 0.012) symptoms. Different effects of the pandemic and earthquakes on IU could reflect a different effect of various stressors on Internet behavior of young adults. Type of problematic Internet behavior may predict for the type of mental health problem.