Order effects: a randomised study of three major cancer-specific quality of life instruments

BACKGROUND: In methodological studies and outcomes research, questionnaires often comprise several health-related quality of life (HRQoL) measures. Previous psychological studies have suggested that changing the sequential order of measurement scales within a questionnaire could alter the pattern of responses. Yet, information on the presence or absence of order effects on the assessment of HRQoL in cancer patients is limited. METHODS: An incomplete block design was used in this study of 1277 cancer patients. Each patient filled out a questionnaire package that contained two of the three major cancer-specific HRQoL instruments, namely the Functional Assessment of Cancer Therapy – General, the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire and the Functional Living Index – Cancer. Within a questionnaire package the sequential order of the instruments contained were randomised. Measurement properties of the instruments, including the number of missing values, mean HRQoL scores, known-groups validity and internal consistency were compared between samples of different presentation orders. RESULTS: No effect of presentation order on the four properties aforementioned was found. CONCLUSION: Presentation order is unlikely to alter the responses to these HRQoL instruments administered in cancer patients when any two of them are used together

Frailty Screening and Detection of Geriatric Syndromes in Acute Inpatient Care: Impact on Hospital Length of Stay and 30-Day Readmissions

Background Frailty is prevalent in acute care and is associated with negative outcomes. While a comprehensive geriatric assessment to identify geriatric syndromes is recommended after identifying frailty, more evidence is needed to support this approach in the inpatient setting. This study examined the association between frailty and geriatric syndromes and their impact on outcomes in acutely admitted older adults. Methods A total of 733 individuals aged ≥65 years admitted to the General Surgery Service of a tertiary hospital were assessed for frailty using the Clinical Frailty Scale (CFS) and for geriatric syndromes using routine nursing admission assessments, including cognitive impairment, falls, incontinence, malnutrition, and poor oral health. Multinomial logistic regression and Cox regression were used to evaluate the associations between frailty and geriatric syndromes and their concomitant impact on hospital length of stay (LOS) and 30-day readmissions. Results Greater frailty severity was associated with an increased likelihood of geriatric syndromes. Individuals categorized as CFS 4–6 and CFS 7–8 with concomitant geriatric syndromes had 29% and 35% increased risks of a longer LOS, respectively. CFS 4–6 was significantly associated with functional decline (relative risk ratio =1.46; 95% confidence interval [CI], 1.03–2.07) and 30-day readmission (hazare ratio=1.78; 95% CI, 1.04–3.04), whereas these associations were not significant for CFS 7–8. Conclusions Geriatric syndromes in frail individuals can be identified from routine nursing assessments and represent a potential approach for targeted interventions following frailty identification. Tailored interventions may be necessary to achieve optimal outcomes at different stages of frailty. Further research is required to evaluate interventions for older adults with frailty in a wider hospital context

Economic analysis of border control policies during COVID-19 pandemic : a modelling study to inform cross-border travel policy between Singapore and Thailand

With countries progressing towards high COVID-19 vaccination rates, strategies for border reopening are required. This study focuses on Thailand and Singapore, two countries that share significant tourism visitation, to illustrate a framework for optimizing COVID-19 testing and quarantine policies for bilateral travel with a focus on economic recovery. The timeframe is the month of October 2021, when Thailand and Singapore were preparing to reopen borders for bilateral travel. This study was conducted to provide evidence for the border reopening policy decisions. Incremental net benefit (INB) compared to the pre-opening period was quantified through a willingness-to-travel model, a micro-simulation COVID-19 transmission model and an economic model accounting for medical and non-medical costs/benefits. Multiple testing and quarantine policies were examined, and Pareto optimal (PO) policies and the most influential components were identified. The highest possible INB for Thailand is US $125.94 million, under a PO policy with no quarantine but with antigen rapid tests (ARTs) pre-departure and upon arrival to enter both countries. The highest possible INB for Singapore is US$29.78 million, under another PO policy with no quarantine on both sides, no testing to enter Thailand, and ARTs pre-departure and upon arrival to enter Singapore. Tourism receipts and costs/profits of testing and quarantine have greater economic impacts than that from COVID-19 transmission. Provided healthcare systems have sufficient capacity, great economic benefits can be gained for both countries by relaxing border control measures

A bis(germyliumylidene)silver(I) complex dication

The reaction of the 2,6-bis(imino)phenylchlorogermylene [LGeCl] (1, L = C6H3-2,6-(HC=NtBu)2) with silver(I) trifluoromethanesulfonate (AgOTf) in a molar ratio of 2:3 in toluene afforded a mixture of the bis(germylene)silver(I) complex [{L(TfO)Ge}2Ag(OTf)] (2) and AgCl. Compound 2 was then reacted with 2 equiv of 1,3-dimethyl-4,5-dimethylimidazol-2-ylidene (IMe,:C{N(Me)C(Me)}2) in toluene to afford 3, which comprises the bis(germyliumylidene)silver(I) complex dication [{L(IMe)Ge}2Ag(OTf)]2+. Compounds 2 and 3 were characterized by NMR spectroscopy and X-ray crystallography. [{L(IMe)Ge}2Ag(OTf)]2+ in compound 3 was further elucidated by DFT studies.ASTAR (Agency for Sci., Tech. and Research, S’pore)MOE (Min. of Education, S’pore)Accepted versio

A Bis(germyliumylidene)silver(I) Complex Dication

The reaction of the 2,6-bis­(imino)­phenylchlorogermylene [LGeCl] (<b>1</b>, L = C₆H₃-2,6-(HC​N<i>t</i>Bu)₂) with silver­(I) trifluoromethanesulfonate (AgOTf) in a molar ratio of 2:3 in toluene afforded a mixture of the bis­(germylene)­silver­(I) complex [{L­(TfO)­Ge}₂­Ag­(OTf)] (<b>2</b>) and AgCl. Compound <b>2</b> was then reacted with 2 equiv of 1,3-dimethyl-4,5-dimethylimidazol-2-ylidene (I_Me, :C­{N­(Me)­C­(Me)}₂) in toluene to afford <b>3</b>, which comprises the bis­(germyliumylidene)­silver­(I) complex dication [{L­(I_Me)­Ge}₂­Ag­(OTf)]²⁺. Compounds <b>2</b> and <b>3</b> were characterized by NMR spectroscopy and X-ray crystallography. [{L­(I_Me)­Ge}₂­Ag­(OTf)]²⁺ in compound <b>3</b> was further elucidated by DFT studies

Epstein–Barr Virus Epithelial Cancers—A Comprehensive Understanding to Drive Novel Therapies

10.3389/fimmu.2021.734293Frontiers in Immunology1273429

A Bis(germyliumylidene)silver(I) Complex Dication

The reaction of the 2,6-bis­(imino)­phenylchlorogermylene [LGeCl] (<b>1</b>, L = C₆H₃-2,6-(HC​N<i>t</i>Bu)₂) with silver­(I) trifluoromethanesulfonate (AgOTf) in a molar ratio of 2:3 in toluene afforded a mixture of the bis­(germylene)­silver­(I) complex [{L­(TfO)­Ge}₂­Ag­(OTf)] (<b>2</b>) and AgCl. Compound <b>2</b> was then reacted with 2 equiv of 1,3-dimethyl-4,5-dimethylimidazol-2-ylidene (I_Me, :C­{N­(Me)­C­(Me)}₂) in toluene to afford <b>3</b>, which comprises the bis­(germyliumylidene)­silver­(I) complex dication [{L­(I_Me)­Ge}₂­Ag­(OTf)]²⁺. Compounds <b>2</b> and <b>3</b> were characterized by NMR spectroscopy and X-ray crystallography. [{L­(I_Me)­Ge}₂­Ag­(OTf)]²⁺ in compound <b>3</b> was further elucidated by DFT studies

Enhancing self-care education amongst medical students: a systematic scoping review

Abstract Background Reports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, “what is known about self-care education interventions amongst medical students?”. Methods We adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion. Results A total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula. Conclusion Greater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required. </jats:sec