Development and preliminary psychometric characteristics of the PODIUM questionnaire for recreational marathon runners

The purpose of this research was to develop a comprehensive and psychometrically adequate measure of recreational marathon runner’s psychological state during the few days and hours prior to the race. The questionnaire was developed in Spanish. In Study 1, Participants were 1060 recreational runners aged 18-67 years. Exploratory factor analysis revealed five dimensions reflective of motivation, self-confidence, anxiety, perceived physical fitness, and perceived social support. In two subsequent studies, the psychometric properties of a refined version of this measure were examined. In study 2, an independent sample of 801 recreational runners (aged 17-63 years) completed the questionnaire. Confirmatory factor analysis and alternative model testing supported a six-factor model. Internal consistency was .72 to .90. In support of construct validity, the self-confidence scale correlated positively with perceived physical fitness, motivation scalecorrelated positively with social support and self-confidence, and anxiety correlated negatively with motivation and self-confidence factors. In study 3, an independent sample of 22 recreational marathon runners (aged 28-47 years) responded to the PODIUM and MOMS. Additionally, another independent sample of 36 recreational runners (23-57 years) responded the to PODIUM and CSAI-2 scales. In support of concurrent validity of PODIUM, the motivation scale correlated with MOMS, and the anxiety and the self-confidence scales correlated with CSAI-2

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Desenvolvimento e propriedades psicométricas preliminares do questionário PODIUM para os corredores amadores de maratona

ABSTRACT: The purpose of this research was to develop a comprehensive and psychometrically adequate measure of recreational marathon runner’s psychological state during the few days and hours prior to the race. The questionnaire was developed in Spanish. In Study 1, Participants were 1060 recreational runners aged 18-67 years. Exploratory factor analysis revealed five dimensions reflective of motivation, self-confidence, anxiety, perceived physical fitness, and perceived social support. In two subsequent studies, the psychometric properties of a refined version of this measure were examined. In study 2, an independent sample of 801 recreational runners (aged 17-63 years) completed the questionnaire. Confirmatory factor analysis and alternative model testing supported a six-factor model. Internal consistency was .72 to .90. In support of construct validity, the self-confidence scale correlated positively with perceived physical fitness, motivation scale correlated positively with social support and self-confidence, and anxiety correlated negatively with motivation and self-confidence factors. In study 3, an independent sample of 22 recreational marathon runners (aged 28- 47 years) responded to the PODIUM and MOMS. Additionally, another independent sample of 36 recreational runners (23-57 years) responded the to PODIUM and CSAI-2 scales. In support of concurrent validity of PODIUM, the motivation scale correlated with MOMS, and the anxiety and the self-confidence scales correlated with CSAI-2.RESUMEN: El objetivo de esta investigación era desarrollar un instrumento en español, que fuera completo y adecuado psicométricamente, para la medida del estado psicológico de los corredores de maratón durante los días y horas previos a la carrera. En el estudio 1 participaron 1060 corredores aficionados de 18 a 57 años. El análisis factorial exploratorio mostró cinco dimensiones que reflejaban motivación, autoconfianza, ansiedad, percepción del estado físico y apoyo social percibido. En dos estudios posteriores se examinaron las propiedades psicométricas de una versión depurada de esta medida. En el estudio 2 completaron el cuestionario 801 corredores aficionados (17-63 años) de una muestra independiente. El análisis factorial confirmatorio con modelos alternativos apoyó un modelo de seis factores. La consistencia interna fue de .72 a .90. En apoyo de la validez de constructo, la escala de auto-confianza correlacionó positivamente con la percepción del estado físico, la escala de motivación correlacionó positivamente con el apoyo social y la auto-confianza, y la ansiedad correlacionó negativamente con los factores motivación y auto-confianza. En el estudio 3, una muestra independiente de 22 corredores aficionados (28-47 años) cumplimentaron los cuestionarios PODIUM y MOMS. Adicionalmente, otra muestra independiente de 36 corredores aficionados (23-57 años) cumplimentaron el PODIUM y el CSAI-2. En apoyo de la validez concurrente del PODIUM, la escala de motivación correlacionaba con el MOMS, y las escalas de ansiedad y auto-confianza correlacionaban con el CSAI-2.RESUMO: O objectivo deste estudo foi o desenvolvimento de um instrumento em espanhol, que fosse completo e psicometricamente adequado para medir o estado psicológico dos corredores de maratona durante os dias e horas prévias à corrida. No Estudo 1 participaram 1060 corredores amadores de 18-57 anos. A análise fatorial exploratória mostrou cinco dimensões que reflectem motivação, autoconfiança, ansiedade, percepção do estado físico e apoio social percebido. Em dois estudos posteriores foram examinadas as propriedades psicométricas de uma versão refinada desta medida. No Estudo 2 responderam ao questionário 801 corredores amadores (17-63 anos) de uma amostra independente. A análise fatorial confirmatória com modelos alternativos apoiou um modelo de seis factores. A consistência interna foi de .72-.90. Para apoio da validade do constructo, a escala de autoconfiança correlacionou-se positivamente com a escala de percepção de estado físico, a escala de motivação correlacionou-se positivamente com a escala de apoio social e autoconfiança, e os fatores de ansiedade correlacionaram-se negativamente com as escalas de motivação e autoconfiança. No Estudo 3, uma amostra independente de 22 corredores amadores (28-47 anos) completou os questionários PODIUM e MOMS. Complementarmente, uma amostra independente de 36 corredores amadores (23-57 anos) completou o PODIUM e CSAI-2. Em apoio à validade concorrente do PODIUM, a escala de motivação correlacionou-se com o MOMS, e as escalas de ansiedade e autoconfiança correlacionaram-se com o CSAI-2

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research