Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial.

INTRODUCTION: Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. METHODS AND ANALYSIS: This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. ETHICS AND DISSEMINATION: This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. TRIAL REGISTRATION NUMBER: NCT03632343

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

User-centered Design Approach to the Development and Pilot Testing of a Smartphone App To Support Real-time Pain Management for Adolescents with Cancer

It is estimated that 49-96% of adolescents with cancer will experience pain related to the disease and/or associated invasive procedures and treatments. Pain negatively impacts adolescent health-related quality of life (HRQL) and is associated with long-term morbidity. In response, a smartphone-based pain app, called Pain Squad+, capable of providing adolescents with real-time pain management support was developed and evaluated. Using user-centered methods, research aims were to utilize iterative cycles of usability testing with adolescents with cancer to refine the app (Study 1), to evaluate the ability to implement the Pain Squad+ app in a hypothesis-testing trial (Study 2), and to obtain estimates of treatment effects on adolescent health outcomes (Study 2). In Study 1, iterative cycles of usability testing with 16 adolescents were used to refine the Pain Squad+ app to ensure it was easy to use, easy to understand, efficient, and acceptable to adolescents. In Study 2, 33 adolescents used the app for 28-days, receiving real-time self-management advice and clinical support from a nurse dependent on self-reported pain. Acceptability of the intervention assessed quantitatively and qualitatively was high. The study accrual percent was 75% and the withdrawal percentwas 3%. Technical malfunctioning of the app was rare. The nurse received pain-related emails from 39% adolescents with a mean time to follow-up of 62.5 hours (SD=55.5). Outcome assessment piloting was successful with a mean of 94.9% (SD=4.3) of baseline and 84.3% (SD=31.0) of post-study questions completed. Adherence to pain reporting was 69.0Âą40.8%. Significant trends in improvement in pain intensity and HRQL were observed (pPh.D

The role of AMP-activated protein kinase in the coordination of metabolic suppression in the common goldfish

Cell survival in conditions of severe oxygen deprivation depends on a wide variety of biochemical modifications, which result in a large-scale suppression of metabolism, preventing [ATP] from falling to fatally low levels. We investigated whether AMP-activated protein kinase (AMPK) has a role in the coordination of cellular modification during hypoxia, which leads to a regulated state of metabolic suppression in the goldfish (Carassius auratus). Energy charge, AMPK activity, protein and gene expression, as well as the translational capacity and phosphorylation state of a downstream target were measured in goldfish tissues during exposure to hypoxia (-0.3 mg 02/L) for up to 12 h. AMPK activity in the goldfish liver increased by 4-fold at 0.5 h hypoxia and was temporally associated with a —11-fold increase in calculated AMPfree/ATP. No change was observed in total AMPK protein or relative gene expression of identified AMPK isoforms. Changes in AMPK activity were also associated with a decreased rate of protein synthesis and an increase in the phosphorylated form of eukaryotic elongation factor-2 (eEF2; relative to total eEF2). Increases in AMPK activity were not seen in hypoxic goldfish muscle, brain, heart or gill, nor was a significant alteration in cellular energy charge seen in muscle. Still, the present study is the first to show that AMPK activity increases in liver in response to short-term severe hypoxia exposure in a hypoxia-tolerant fish. The decreased rates of protein synthesis, a well known component of metabolic suppression, combined with increased phosphorylation of eEF2, a downstream target of AMPK, potentially implicate the kinase in the cellular effort to suppress metabolism in hypoxia-tolerant species during oxygen deprivation.Science, Faculty ofZoology, Department ofGraduat

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness. Pain is the most common and distressing symptom of JIA. Pain has been found to negatively impact all aspects of functioning, including physical, social, emotional and role functions. Children with arthritis continue to experience clinically significant pain despite adequate doses of disease-modifying antirheumatic drugs and anti-inflammatory agents. The present article reviews the prevalence and nature of pain in JIA, the biopsychosocial factors that contribute to the pain experience, current approaches to assessing pain in this population, and ways of managing both acute and persistent pain using pharmacological, physical and psychological therapies. Finally, new approaches to delivering disease self-management treatment for youth with JIA using the Internet will be outlined

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness. Pain is the most common and distressing symptom of JIA. Pain has been found to negatively impact all aspects of functioning, including physical, social, emotional and role functions. Children with arthritis continue to experience clinically significant pain despite adequate doses of disease-modifying antirheumatic drugs and anti-inflammatory agents. The present article reviews the prevalence and nature of pain in JIA, the biopsychosocial factors that contribute to the pain experience, current approaches to assessing pain in this population, and ways of managing both acute and persistent pain using pharmacological, physical and psychological therapies. Finally, new approaches to delivering disease self-management treatment for youth with JIA using the Internet will be outlined.Peer Reviewe

The impact of digital technologies, data analytics and AL on nursing informatics: The new skills and knowledge nurses need for the 21st century

We first outline how digital technologies, data analytics and artificial intelligence (AI) impact the rapid advancement of nursing informatics and on nursing care delivery. The individual-, contextual- and structural-level complexities that these new technologies introduce for nurses and the new knowledge and skill sets that they demand are highlighted. Then we encourage readers to think critically about their current practices and describe reconceptualized aspects of nursing practice as advocate, explainer, implementer, creator and analyst. We feature a case study of machine learning for prediction in the clinical practice setting to illustrate the analyst role. The new digital technologies hold promise to support nurses in providing safe and effective care at multiple levels. The nursing profession can be at the forefront for the design and adoption of these technologies as well as ensuring that there is careful consideration of the ethical and social implications of implementing digital technologies into practice

Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology

Background: This study aimed to test the inter-rater reliability, construct validity, and feasibility of the modified “Which Health Approaches and Treatments Are You Using?” (WHAT) questionnaires in pediatric oncology; Methods: Parent–child dyads were invited to complete self- and proxy-report-modified WHAT, Pediatric Quality of Life Inventory, demographics, a diary of the child’s recent use of CHA, and a questionnaire assessing the aspects of feasibility. Parents were asked to complete a satisfaction of their children’s use of the CHA survey; Results: Twenty-four dyads completed the study. The mean weighted kappa showed strong inter-rater reliability (k = 0.77, SE = 0.056), and strong agreements between the modified WHAT and the diary (self-report [k = 0.806, SE = 0.046] and proxy-report [k = 0.894, SE = 0.057]). Significant relationships were found only between recent and non-recent CHA users in relation to the easy access to CHA (self-report [p = 0.02], proxy-report [p < 0.001]). The mean scores of the feasibility scale (out of 7.0) for the self- and proxy-report were 5.64 (SD = 0.23) and 5.81 (SD = 0.22), respectively, indicating the feasibility of the modified WHAT; Conclusions: The findings provide initial evidence of the reliability and validity of the modified WHAT and their feasibility. Further research is needed to test the theoretical relationships and further explore the validity and reliability of the modified WHAT