Improving the causal treatment effect estimation with propensity scores by the bootstrap

AbstractWhen observational studies are used to establish the causal effects of treatments, the estimated effect is affected by treatment selection bias. The inverse propensity score weight (IPSW) is often used to deal with such bias. However, IPSW requires strong assumptions whose misspecifications and strategies to correct the misspecifications were rarely studied. We present a bootstrap bias correction of IPSW (BC-IPSW) to improve the performance of propensity score in dealing with treatment selection bias in the presence of failure to the ignorability and overlap assumptions. The approach was motivated by a real observational study to explore the potential of anticoagulant treatment for reducing mortality in patients with end-stage renal disease. The benefit of the treatment to enhance survival was demonstrated; the suggested BC-IPSW method indicated a statistically significant reduction in mortality for patients receiving the treatment. Using extensive simulations, we show that BC-IPSW substantially reduced the bias due to the misspecification of the ignorability and overlap assumptions. Further, we showed that IPSW is still useful to account for the lack of treatment randomization, but its advantages are stringently linked to the satisfaction of ignorability, indicating that the existence of relevant though unmeasured or unused covariates can worsen the selection bias

A Qualitative Approach Using Diaries and Interviews

1. Nadia Rania[1][1][⇑][2] 2. Laura Migliorini[1][1] 3. Stefania Rebora[1][1] 4. Paola Cardinali[1][1] 1. 1DISFOR, Department of Education Science, University of Genoa, Italy 1. Nadia Rania, DISFOR, Department of Education Science, University of Genoa, C.so A. Podesta, 2, 16121 Genoa, Italy. Email: nadia.rania{at}unige.it This study compares Italian mothers' and Ecuadorian immigrant mothers' daily family routines. Thirty mothers took part in this investigation: 15 Italians ( M = 37.5 years, with ages ranging from 30 to 42 years) and 15 Ecuadorians ( M = 36.1 years, with ages ranging from 18 to 46 years and having lived in Italy for an average of 15 years), with children ranging in age from 4 to 8 years. The objective is to highlight the differences and similarities between the daily routines and family relations that characterize the lives of each of the two groups of participants. The instruments employed in service of these aims were in-depth interviews and diaries. The results showed similarities regarding the routines of Italian and Ecuadorian families. However, a relevant difference emerged regarding their perceptions of social support. Specifically, Italians receive more social support from their parents than do Ecuadorians, who are supported more by other relatives or by friends. [1]: #aff-1 [2]: #corresp-

The Effectiveness of a Motivational Interviewing Intervention on Mutuality Between Patients With Heart Failure and Their Caregivers

background mutuality, defined as "the positive quality of the relationship between a caregiver and a care receiver", was found to be associated with self-care and caregiver contribution to self-care in heart failure (HF). however, no studies were conducted to evaluate whether motivational interviewing (MI) can improve mutuality in patients with HF and caregivers. objectives the aim of this study was to evaluate the effectiveness of MI on mutuality in HF patient-caregiver dyads. methodsThis is a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial, the primary aim of which was to evaluate the effect of MI on improving self-care in patients with HF. participants were randomized into 3 arms: (1) MI for patients only, (2) MI for both patients and caregivers, and (3) standard care. to assess the HF patients' and caregivers' mutuality, the mutuality scale was used in its patient and caregiver versions. results patients with HF had a median age of 74 years, and there were more men (58%). most patients were retired (76.2%). caregivers had a median age of 55 years and were mostly women (75.5%). most patients were in new york heart association class II (61.9%) and had an ischemic HF etiology (33.6%). the motivational interviews did not show any impact on changes in the patient and caregiver mutuality during the follow-up time (3, 6, 9, and 12 months from baseline). the condition of living together between the patient and the caregiver was significantly associated with better mutuality between the patient and the caregiver. conclusions motivational interviewing performed by nurses was not effective in improving mutuality in patients with HF and caregivers, but the target variable of the intervention was patient self-care. stronger effects of MI on mutuality were observed in patients with HF and caregivers who live together. future studies should target mutuality to see whether MI is really effective

Clinical and Socio-Demographic Determinants of Self-Care Behaviours in Patients with Heart Failure and Diabetes Mellitus: A Multicentre Cross-Sectional Study

Background Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. Objectives (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. Design Secondary analysis of data from a multicentre cross-sectional study. Setting Outpatient clinics from 29 Italian provinces. Participants 1192 adults with confirmed diagnosis of heart failure. Methods Socio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score \u3c70 indicates inadequate self-care. Multiple linear regression analyses were performed. Results Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p = 0.12), self-care management (p = 0.21) or self-care confidence (p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p \u3c 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p \u3c 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p \u3c 0.001) were determinants of self-care confidence. Conclusions Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care

MOTIVATional intErviewing to Improve Self-Care in Heart Failure Patients (MOTIVATE-HF): Study Protocol of a Three-Arm Multicenter Randomized Controlled Trial

Aims Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support. Methods A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3 months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12 months after enrollment. Conclusion This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease

The Impact of an Intervention to Improve Caregiver Contribution to Heart Failure Self-care on Caregiver Anxiety, Depression, Quality of Life, and Sleep

backgroundBetter caregiver contribution to self-care in heart failure is associated with better patient outcomes. however, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep.objectivethe aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. methods this is a secondary outcome analysis of the MOTIVATE-HF trial. patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). data were collected between June 2014 and october 2018. the article has been prepared following the consolidated standards of reporting Trials checklist. results a sample of 510 patient-caregiver dyads was enrolled. over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. conclusions motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings

Glutathione S-transferase homozygous deletions and relapse in childhood acute lymphoblastic leukemia: a novel study design in a large Italian AIEOP cohort

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Delirium symptoms duration and mortality in SARS-COV2 elderly: results of a multicenter retrospective cohort study

BACKGROUND: Since the occurrence of the SARS-COV2 pandemic, there has been an increasing interest in investigating the epidemiology of delirium. Delirium is frequent in SARS-COV2 patients and it is associated with increased mortality; however, no information is available on the association between delirium duration in SARS-COV2 patients and related outcomes. AIMS: The aim of this study is to investigate the association between the duration of delirium symptoms and in-hospital mortality in older patients with SARS-COV2 infection. METHODS: Retrospective cohort study of patients 65 years of age and older with SARS-CoV 2 infection admitted to two acute geriatric wards and one rehabilitation ward. Delirium symptoms duration was assessed retrospectively with a chart-based validated method. In-hospital mortality was ascertained via medical records. RESULTS: A total of 241 patients were included. The prevalence of delirium on admission was 16%. The median number of days with delirium symptoms was 4 (IQR 2–6.5) vs. 0 (IQR 0–2) in patients with and without delirium on admission. In the multivariable Cox regression model, each day with a delirium symptom in a patient with the same length of stay was associated with a 10% increase in in-hospital mortality (Hazard ratio 1.1, 95% Confidence interval 1.01–1.2; p = 0.03). Other variables associated with increased risk of in-hospital death were age, comorbidity, CPAP, CRP levels and total number of drugs on admission. CONCLUSIONS: The study supports the necessity to establish protocols for the monitoring and management of delirium during emergency conditions to allow an appropriate care for older patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-021-01899-8

Crude incidence in two-phase designs in the presence of competing risks.

BackgroundIn many studies, some information might not be available for the whole cohort, some covariates, or even the outcome, might be ascertained in selected subsamples. These studies are part of a broad category termed two-phase studies. Common examples include the nested case-control and the case-cohort designs. For two-phase studies, appropriate weighted survival estimates have been derived; however, no estimator of cumulative incidence accounting for competing events has been proposed. This is relevant in the presence of multiple types of events, where estimation of event type specific quantities are needed for evaluating outcome.MethodsWe develop a non parametric estimator of the cumulative incidence function of events accounting for possible competing events. It handles a general sampling design by weights derived from the sampling probabilities. The variance is derived from the influence function of the subdistribution hazard.ResultsThe proposed method shows good performance in simulations. It is applied to estimate the crude incidence of relapse in childhood acute lymphoblastic leukemia in groups defined by a genotype not available for everyone in a cohort of nearly 2000 patients, where death due to toxicity acted as a competing event. In a second example the aim was to estimate engagement in care of a cohort of HIV patients in resource limited setting, where for some patients the outcome itself was missing due to lost to follow-up. A sampling based approach was used to identify outcome in a subsample of lost patients and to obtain a valid estimate of connection to care.ConclusionsA valid estimator for cumulative incidence of events accounting for competing risks under a general sampling design from an infinite target population is derived