Exploring the potential of meaningful recognition programs in mitigating nursing faculty burnout: A call for further research.

This letter to the editor responds to Godfrey et al.'s study on meaningful recognition (MR) programs in nursing colleges. While the study did not demonstrate significant changes in faculty burnout metrics, it revealed stable levels of compassion satisfaction during the COVID-19 pandemic. This stability, coupled with alarmingly high burnout rates reported in other studies, suggests that MR programs may have a protective effect worth investigating further. The letter proposes future research directions, including longer-term studies and qualitative methods, to better understand the nuanced impact of MR programs on nursing faculty well-being and retention.

Fatigue management: a systematic review of objective measurement techniques for cognitive fatigue.

BACKGROUND: Cognitive fatigue is a complex psychobiological state whereby task performance cannot be maintained. Return-to-work protocols typically rely on self-report measures, therefore the current systematic review aimed to identify "real-time" measures of objective cognitive fatigue to inform return-to-work protocols. METHODS: Studies were included if participants were at least 18 years old, assessed "real-time" objective cognitive fatigue that could be used outside of the lab (neuroimaging measures were, therefore, excluded), used an induction task that was separate to the measurement, were adequately powered, compared objective cognitive fatigue at baseline and post-induction, and included a cognitive fatigue induction task that was at least 30 minutes long.Nine electronic databases were searched until 31 December 2022 (MEDLINE; PsychArticle; PubMED, ProQuest; ProQuest for gray literature; Google Scholar; The Cochrane Library; The Health Technology Assessment Database; and Web of Science), with alerts set up on Google Scholar to notify of new relevant research since this date (reviewed until December 2023). The checklist for quasi-experimental studies (Joanna Briggs Institute, 2014) was used to assess the risk of bias. Whilst a meta-analysis was planned, the data were unsuitable so only a narrative synthesis was conducted. RESULTS: Fifty-seven studies were included, which were conducted within a variety of settings including naturalistic work scenarios, driving, aviation, and artificial computer-based tasks.Whilst the review found a range of potential measurements, there were inconsistencies in findings across studies highlighting the need for more research into the reliable measurement of objective cognitive fatigue in natural settings. DISCUSSION: The findings suggest that eye- and body-related measures may be sensitive measures of objective cognitive fatigue. However, comparisons across measurement types should be cautiously interpreted because eye-related and cognitive measures were far more common. The review highlighted the need for more consistent and transparent reporting across the field to advance our understanding of cognitive fatigue.

Evaluation of validity, reliability and ability to detect change for the Hand Eczema Severity Index (HECSI) and evaluation of HECSI-75 and HECSI-90 as within-patient responder definitions.

BACKGROUND: The Hand Eczema Severity Index (HECSI) is a Clinician-Reported Outcome measure of the severity of hand eczema (HE). OBJECTIVES: This study aimed to evaluate the validity, reliability and ability to detect change of the HECSI, and the HECSI-75 and HECSI-90 as responder definitions. METHODS: Analyses were performed using data from a sample of n = 258 patients with Chronic Hand Eczema (CHE) from a Phase 2b, randomised, double-blind, vehicle-controlled trial of delgocitinib cream, pooled across treatment groups. The measurement properties of the HECSI were assessed and the adequacy of the HECSI-75 and HECSI-90 as responder definitions was explored through cross-tabulation. RESULTS: Inter-item correlations provided support for the scoring, whereby items are grouped by areas of the hand. HECSI demonstrated good test-retest reliability with intra-class correlations >0.70. Construct validity was supported by a logical pattern of correlations with concurrent measures and significant differences in HECSI scores across severity groups (p < 0.001). HECSI was responsive with statistically significant improvements over time and with significant differences (p < 0.001) between improved and stable groups. Data provided support for both HECSI-75 and HECSI-90 as within-patient responder definitions. CONCLUSIONS: HECSI has strong validity, reliability and ability to detect change as a measure of CHE severity. HECSI-75 and HECSI-90 are appropriate responder definitions.

Evaluating anchor variables and variation in meaningful score differences for PROMIS® Pediatric measures in children and adolescents living with a rheumatic disease.

PURPOSE: Meaningful score differences (MSDs), as defined by recent FDA guidance, can improve the interpretation of outcome measure scores and score changes. Well-accepted methods for estimating MSDs typically rely on external anchor variables, but the applications of these methods are limited in children and adolescents with rheumatic diseases. This project explored multiple candidate anchors for the PROMIS® Pediatric measures of Physical Activity, Fatigue, Pain Interference, and Mobility for children with juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). METHODS: Longitudinal data were extracted from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Candidate anchors included patient-reported domain-specific global impressions of change (GIC) along with other parent- and clinician-reported variables. Prior to MSD estimation, the quality of the anchors was assessed using a priori criteria (correlation ≥0.30, n≥10, <10% missing). Anchors meeting criteria were used to calculate MSDs. RESULTS: Among 289 children with JIA and 47 with SLE, the GIC did not meet criteria inhalf of the scenarios. Other candidate anchors performed slightly better. The calculated MSDs varied by external anchor across measures, diagnoses, and direction of change (better vs worse). CONCLUSIONS: Many of the candidate external anchoring variables did not meet pre-specified criteria for calculating MSDs. Even for those that did, the choice of anchoring variable had a strong impact on the estimated MSD value and were different from other published values. As in adults, establishing pediatric MSDs requires selection of high-quality anchors, as changes in the variables used as anchors can impact MSD values and any subsequent score interpretations.

Clinically meaningful outcomes in refractory metastatic colorectal cancer: a decade of defining and raising the bar.

Currently, there is no consensus definition for clinically meaningful outcomes in randomized clinical trials (RCTs) designed to evaluate new treatments for patients with refractory metastatic colorectal cancer (mCRC). Since 2014, recommended targets for improvements in overall survival and progression-free survival have been published by several societies, including those from the American Society of Clinical Oncology (ASCO) Clinically Meaningful Outcomes Working Group in 2014, the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) in 2015, and Colorectal Cancer Canada (CCC) consensus statements in 2019. However, evidence from several systematic reviews suggests that in a substantial proportion of RCTs that led to oncology drug approvals, the recommended thresholds of ASCO and ESMO-MCBS were not met. In addition to efficacy and safety, quality of life (QoL) is important to patients with mCRC, especially for those who are receiving later-line therapy or end-of-life care. As such, both ESMO-MCBS and CCC recommend the inclusion of QoL assessments in the design of mCRC clinical trials. Since the publication of the ASCO recommendations in 2014, there has been significant progress in the development of treatment options for patients with refractory mCRC; these include the approvals of trifluridine/tipiracil (FTD/TPI) as a single agent and in combination with bevacizumab, and the approval of fruquintinib. Among the phase III RCTs in third-line mCRC, only the SUNLIGHT trial of FTD/TPI plus bevacizumab met all recommended thresholds for clinically meaningful improvements, while also demonstrating a manageable safety profile and slower deterioration in multiple measures of QoL compared with FTD/TPI alone. The results from the SUNLIGHT study show that incremental gains in several clinically meaningful endpoints are achievable, thus raising the bar in defining clinically meaningful outcomes for emerging therapies in refractory mCRC.

Older Adults' Acceptance of a Virtual Reality Group Intervention in Nursing Homes: Pre-Post Study Under Naturalistic Conditions.

Background: Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults' individual characteristics on the acceptance of VR group activities in nursing homes is necessary. Objective: This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group's perceptions of VR after participating in a VR intervention. Methods: In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants' perceptions of VR. Results: The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high. Conclusions: This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals.

Intersection between person-centred practice and Montessori for dementia and ageing in residential aged care.

BACKGROUND: Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. METHODS: This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. RESULTS: Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. CONCLUSIONS: Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.

Treating Alzheimer's Disease: Focusing on Neurodegenerative Consequences.

Neurodegenerative disorders involve progressive dysfunction and loss of synapses and neurons and brain atrophy, slowly declining memories and cognitive skills, throughout a long process. Alzheimer's disease (AD), the leading neurodegenerative disorder, suffers from a lack of effective therapeutic drugs. Decades of efforts targeting its pathologic hallmarks, amyloid plaques and neurofibrillary tangles, in clinical trials have produced therapeutics with marginal benefits that lack meaningful clinical improvements in cognition. Delivering meaningful clinical therapeutics to treat or prevent neurodegenerative disorders thus remains a great challenge to scientists and clinicians. Emerging evidence, however, suggests that dysfunction of various synaptogenic signaling pathways participates in the neurodegenerative progression, resulting in deterioration of operation/structure of the synaptic networks involved in cognition. These derailed endogenous signaling pathways and disease processes are potential pharmacological targets for the therapies. Therapeutics with meaningful clinical benefit in cognition may depend on the effectiveness of arresting and reversing the neurodegenerative process through these targets. In essence, promoting neuro-regeneration may represent the only option to recover degenerated synapses and neurons. These potential directions in clinical trials for AD therapeutics with meaningful clinical benefit in cognitive function are summarized and discussed.

Clinical Meaningfulness of an Algorithm-Based Service for Analyzing Treatment Response in Patients with Metastatic Cancer Using FDG PET/CT.

Background/Objectives: Determining how a patient with metastatic cancer is responding to therapy can be difficult for medical oncologists, especially with text-only radiology reports. In this investigation, we assess the clinical usefulness of a new algorithm-based analysis that provides spatial location and quantification for each detected lesion region of interest (ROI) and compare it to information included in radiology reports in the United States. Methods: Treatment response radiology reports for FDG PET/CT scans were retrospectively gathered from 228 patients with metastatic cancers. Each radiology report was assessed for the presence of both qualitative and quantitative information. A subset of patients (N = 103) was further analyzed using an algorithm-based service that provides the clinician with comprehensive quantitative information, including change over time, of all detected ROI with visualization of anatomical location. For each patient, three medical oncologists from different practices independently rated the usefulness of the additional analysis overall and in four subcategories. Results: In the 228 radiology reports, quantitative information of size and uptake was provided for at least one lesion at one time point in 78% (size) and 95% (uptake) of patients. This information was reported for both analyzed time points (current scan and previous comparator) in 52% (size) and 66% (uptake) of patients. Only 7% of reports quantified the total number of lesions, and none of the reports quantified changes in all lesions for patients with more than a few lesions. In the assessment of the augmentative algorithm-based analysis, the majority of oncologists rated it as overall useful for 98% of patients (101/103). Within specific categories of use, the majority of oncologists voted to use it for making decisions regarding systemic therapy in 97% of patients, for targeted therapy decisions in 72% of patients, for spatial location information in 96% of patients, and for patient education purposes in 93% of patients. Conclusions: For patients with metastatic cancer, the algorithm-based analysis of all ROI would allow oncologists to better understand treatment response and support their work to more precisely optimize the patient's therapy.

The relationship between perceived engagement in meaningful activity and behavioral and psychological symptoms of dementia among assisted living residents.

The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) in five AL communities. The Engagement in Meaningful Activities Scale and the Neuropsychiatric Inventory Questionnaire were completed. Logistic regression was used to compare those with and without each BPSD symptom of interest on engagement in meaningful activities while controlling for age, sex, and cognitive impairment. On average, participants were 85 years old, white, females. Perceived engagement in meaningful activities was significantly associated with decreased odds of having agitation (OR=0.94, 95 % CI [.88-0.99]) but not with apathy, depression, or irritability. Engagement in meaningful activities may help reduce agitation among AL residents.

A Tale of 102,726 Messages: Characterizing the Modern Urologist's Portal Message Burden After Common Urologic Surgeries.

INTRODUCTION: We aimed to characterize patient portal messaging use after urologic surgery to identify administrative burden and evaluate postoperative clinical associations. METHODS: Epic was queried for all urologic surgeries performed at the Mayo Clinic enterprise between 2019 and 2022. Data from the highest volume procedures were extracted including patient-generated portal messages to their provider and emergency department (ED) visits within 6 months of surgery. Factors associated with portal users and message volume, as well as the impact of portal use on risk of subsequent ED visit, were evaluated. RESULTS: We analyzed data from 23,621 urologic procedures, which generated 102,726 patient portal messages within 6 months of surgery. We found that 55% of our cohort sent at least 1 message. Stratifying by subspecialty, endourologic surgeries generated the fewest number of messages per surgery (3.83; SD, 8.76), whereas female pelvic medicine and reconstructive surgeries yielded the most (6.05; SD, 10.92). Younger age, female sex, and White race were associated with increased portal utilization. Multivariable time-to-event analysis revealed a 33% reduction in the risk of ED presentation within 90 days after surgery for patients using the patient portal compared with those who did not. CONCLUSIONS: While only half of patients sent portal messages after surgery, active users showed a 33% reduction in ED visits, suggesting its potential to reduce health care utilization. Encouraging broader portal adoption can improve outcomes. However, the message burden for urologists necessitates solutions. Resource allocation should prioritize strategies to help urologists manage messages while preserving the established clinical benefits.

Conceptualizing meaningful between-group difference in change over time: a demonstration of possible viewpoints.

PURPOSE: Determining if group-level differences in health outcomes are meaningful has recently been neglected in favour of determining if individuals have experienced a meaningful change. We explore interpretation of a meaningful between-group difference (MBGD) in clinical outcome assessment scores, primarily in the context of randomized clinical trials. METHODS: We constructed a series of possible 'viewpoints' on how to conceptualize MBGD thresholds. Each viewpoint is discussed critically in terms of potential advantages and disadvantages, with simulated data to facilitate their consideration. RESULTS: Five viewpoints are presented and discussed. The first considers whether thresholds for meaningful within-individual change over time can be equally applied at the group-level, which is shown to be untenable. Viewpoints 2-4 consider what would have to be observed in treatment groups to conclude a meaningful between-group difference has occurred, framed in terms of the proportion of patients perceiving that they had meaningfully improved. The final viewpoint considers an alternative framework where stakeholders are directly questioned on the meaningfulness of varying magnitudes of between-group differences. The choice of a single threshold versus general interpretative guidelines is discussed. CONCLUSION: There does not appear to be a single method with clear face validity for determining MBGD thresholds. Additionally, the notion that such thresholds can be purely data-driven is challenged, where a degree of subjective stakeholder judgement is likely required. Areas for future research are proposed, to move towards robust method development.

A Cross-Sectional Study Exploring the Impact of Violence on Healthcare Employees' Work Engagement and Meaningful Work.

AIM: This study aims to determine the prevalence of workplace violence against healthcare professionals and its effects on work engagement and meaningful work in healthcare settings. DESIGN: This study is designed as an analytical cross-sectional study. METHODS: This study surveyed 676 healthcare professionals in Turkiye between June and December 2022, using face-to-face and online methods. Scales measured exposure to and witnessing violence, work engagement, and meaningful work. The study has adhered to STROBE guidelines. Statistical analyses included descriptive, correlation, and linear regression. RESULTS: According to the results, shouting and cursing by patients and their companions were determined as the most common type of violence encountered by healthcare professionals. The effect of healthcare professionals' exposure to violence from patients' companion on work engagement and witnessing to violence from colleagues on meaningful work were found to be negative and significant. DISCUSSION: The findings emphasise the urgent need for interventions addressing workplace violence against healthcare professionals. Since workplace violence significantly reduces work engagement and the sense of meaningful work in healthcare setting. IMPACT: By highlighting the prevalence of workplace violence and its negative impact on both work engagement and meaningful work in healthcare setting, this study provides critical evidence for policymakers and healthcare administrators. PATIENT OR PUBLIC CONTRIBUTION: The participants in this study were healthcare professionals who had direct contact with patients and their relatives.

Significant individual change should be used as a lower bound for anchor based estimates of meaningful change on patient-reported outcome scores.

Interpretation of patient-reported outcome (PRO) scores has been supported by identifying score thresholds or ranges that indicate clinical importance. There has been a recent focus on the estimation of meaningful within patient change (MWPC). While much attention has been focused on anchor-based methods, some researchers prefer that a lower bound to these estimates should exceed a change score that could be observed due to measurement error alone as a safeguard against misclassifying individual patients as changed when they have not. The standard error of measurement (SEM) is often used as the lower bound of anchor estimates. Here, we argue that the SEM is not an the best lower bound for MWPCs. Instead, statistically significant individual change as calculated by the reliable change index (RCI) should be used as the lower bound. Our argument is based on two points. First, conceptually, the SEM does not provide specific enough information to serve as a lower bound for MWPCs, which should be based on the level of observed score change that is unlikely to be due to chance alone. Second, the SEM is not appropriate for direct application to observed scores, and requires a multiplier when examining observed change instead of true change. We conclude with recommendations for using the RCI with a thoughtful range of p-values in combination with anchor estimates.

Identity work of public hospital nurses during the COVID-19 pandemic in South Africa.

BACKGROUND:  Nurses play a remarkable role in our healthcare system and contribute to the wellbeing of communities at large. During the coronavirus disease 2019 (COVID-19) pandemic, nurses faced various challenges to provide adequate patient healthcare. OBJECTIVES:  This study aimed to explore the identity work of public hospital nurses during the COVID-19 pandemic. METHOD:  The study followed a phenomenological qualitative approach with an interpretive view, employing two sampling methods: purposive and snowball sampling. The sample comprised 11 nurses from a public hospital in the Gauteng province. The data were collected using semi-structured interviews and analysed using thematic analysis. RESULTS:  The findings revealed that the nurses faced identity demands, which resulted in them experiencing identity tensions. There was also a need for recognition and support; their work served a greater purpose and was meaningful to them. The nurses used different identity work strategies, such as family support, spiritual upliftment and meaningful work to deal with the identity tensions and demands they experienced. CONCLUSION:  Strategies such as counselling and wellbeing programmes should be implemented to assist nurses in dealing with the physical and psychological effects of working in the health sector during pandemics and epidemics. Hospitals and governments should create healthier working environments by conducting workshops, training and upskilling initiatives, encouraging nurses' inclusion in policymaking and implementation.Contribution: The study provided insight into the challenges nurses encountered during the COVID-19 pandemic, how these challenges affected their nursing identity and roles, and the strategies they used to maintain their sense of self in their work.

Averting older adults' memory function decline via meaningful activities: a follow-up longitudinal study.

PURPOSE: The purpose of the study was to investigate the effects of satisfaction with meaningful activities and their performance on the memory function among community-dwelling older adults 3 years later. METHODS: A longitudinal analysis was conducted on 288 community-dwelling older adults aged 65 years and more who had completed the survey in 2019 and 2022 as participants in the Tarumizu Study. Meaningful activities were assessed in 2019 using the Aid for Decision-Making in Occupation Choice for activities. Satisfaction with and performance of meaningful activities were assessed, and the bottom 25% were classified into two groups: low satisfaction and low performance. Memory function was assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool in 2019 and 2022. Changes in memory function over 3 years were analyzed by satisfaction and performance of meaningful activities. RESULTS: Two-way analysis of variance with group (satisfaction with and performance of meaningful activities) and time (2019 and 2022) as factors showed no statistically significant group-time interaction for memory in the satisfaction with meaningful activities group (F = 1.4, p = 0.24). Meanwhile, a statistically significant group-time interaction was observed for memory in the meaningful activity performance group, indicating that high performance of meaningful activities may play a protective role against memory decline (F = 7.4, p = 0.007). CONCLUSION: Higher performance of meaningful activities may protect against age-related changes in memory. A careful assessment of meaningful activities, and engagement that enhances performance may be useful in designing health support against memory decline.

Early Improvements with Guselkumab Associate with Sustained Control of Psoriatic Arthritis: Post hoc Analyses of Two Phase 3 Trials.

INTRODUCTION: Patterns of treatment response can inform clinical decision-making. This study assessed the course and impact of achieving minimal clinically important improvement (MCII) in clinical measures and patient-reported outcomes (PROs) with guselkumab in patients with active psoriatic arthritis (PsA). METHODS: Post hoc analyses evaluated 1120 patients with PsA receiving guselkumab every 4 or 8 weeks (Q4W/Q8W) or placebo from DISCOVER-1 (31% tumor necrosis factor inhibitor-experienced) and DISCOVER-2 (biologic-naïve). Achievement of MCII in clinical Disease Activity Index for PsA (cDAPSA), patient global assessment (PtGA) of arthritis, PtGA of psoriasis, patient-reported pain, Functional Assessment of Chronic Illness Therapy-Fatigue, Health Assessment Questionnaire-Disability Index, 36-item Short-Form Health Survey Physical Component Summary score, PtGA Arthritis + Psoriasis, and PsA Disease Activity Score (PASDAS) was compared between the guselkumab and placebo groups using Cox regression. Logistic regression adjusting for baseline factors evaluated associations between early (W4/W8) MCII achievement and stringent response (≥%50/%70 improvement in American College of Rheumatology response criteria, cDAPSA low disease activity [LDA], PASDAS LDA, and minimal disease activity) at W24/W52 among guselkumab-randomized patients. RESULTS: Among patients with highly active PsA (baseline cDAPSA = 44.1-45.0, PASDAS = 6.4-6.5), times to MCII were significantly faster for guselkumab vs. placebo (hazard ratios 1.3-2.5; P < 0.05). Across measures, at first timepoint assessed, MCII rates were significantly higher with guselkumab (Q4W/Q8W 28-68%/29-65%) vs. placebo (19-47%; both P < 0.05). Early (W4/W8) MCII with guselkumab associated with higher odds of achieving stringent responses at W24/W52 (odds ratios 1.4-17.2/1.4-5.4). CONCLUSIONS: In a mixed PsA population, significant proportions of patients treated with guselkumab achieved early (W4/W8) MCII across clinical and PRO measures, which associated with a higher likelihood of attaining clinically relevant improvements and low levels of disease activity at W24/W52. TRIAL REGISTRATION: DISCOVER-1 (NCT03162796). DISCOVER-2 (NCT03158285).

Separation of Traits and Extreme Response Style in IRTree Models: The Role of Mimicry Effects for the Meaningful Interpretation of Estimates.

Item response tree (IRTree) models are a flexible framework to control self-reported trait measurements for response styles. To this end, IRTree models decompose the responses to rating items into sub-decisions, which are assumed to be made on the basis of either the trait being measured or a response style, whereby the effects of such person parameters can be separated from each other. Here we investigate conditions under which the substantive meanings of estimated extreme response style parameters are potentially invalid and do not correspond to the meanings attributed to them, that is, content-unrelated category preferences. Rather, the response style factor may mimic the trait and capture part of the trait-induced variance in item responding, thus impairing the meaningful separation of the person parameters. Such a mimicry effect is manifested in a biased estimation of the covariance of response style and trait, as well as in an overestimation of the response style variance. Both can lead to severely misleading conclusions drawn from IRTree analyses. A series of simulation studies reveals that mimicry effects depend on the distribution of observed responses and that the estimation biases are stronger the more asymmetrically the responses are distributed across the rating scale. It is further demonstrated that extending the commonly used IRTree model with unidimensional sub-decisions by multidimensional parameterizations counteracts mimicry effects and facilitates the meaningful separation of parameters. An empirical example of the Program for International Student Assessment (PISA) background questionnaire illustrates the threat of mimicry effects in real data. The implications of applying IRTree models for empirical research questions are discussed.

Development of a suite of short planetary health learning resources by students for students as future health professionals.

Planetary health recognizes the interdependencies between human health and the well-being of the Earth's ecosystems. Human activities have led to the disruption and transformation of natural systems and a range of global environmental changes such as climate change, air pollution, and biodiversity loss. Health professionals must be equipped to deal with the health impacts of global environmental changes. This article describes the development and usage of a suite of 14 short online learning resources ('bricks') on Planetary Health on the ScholarRx platform. There are several principles that inform the development of these bricks, including learner-centric, peer learning, diversity, equity and inclusion, and authentic learning. The content is developed using a student-educator collaboration model, supported by an editorial team. The suite of 14 modules was published in June 2023, with the initial usage data promising with 1,990 views in the first 10 months. These digital, modular resources allow for easy dissemination and can be incorporated in different programs depending on context and need.

Characterizing cancer-related cognitive impairments and impact on quality of life in women with metastatic breast cancer.

PURPOSE: Little is known about cancer-related cognitive impairments (CRCI) in women with metastatic breast cancer (MBC). The purpose of this study is to (1) comprehensively describe CRCI and any associated psychosocial and behavioral symptoms, (2) determine observable sociodemographic and clinical risk factors for CRCI, and (3) explore cognitive and psychosocial predictors of quality of life and social functioning in women living with MBC. METHODS: Using a cross-sectional design, women with MBC completed assessments (objective and subjective measures of CRCI including 3 open-ended questions, measures of psychosocial and behavioral factors, and assessments of quality of life and social function), and data were analyzed using descriptive statistics, qualitative content analysis, correlation analyses, t tests, analysis of variance, and linear regression models. RESULTS: Data from 52 women were analyzed. 69.2% of the sample reported clinically significant CRCI and 46% of the sample scored < 1 standard deviation below the standardized mean on one or more cognitive tests. Those with triple-negative MBC (compared to HER2+), recurrent MBC (compared to de novo), and no history of chemotherapy had worse subjective CRCI, and those without history of surgery and older age had worse objective CRCI. Subjective CRCI, but not objective CRCI, was significantly associated with quality of life and social functioning. CONCLUSION: Subjective and objective CRCI are likely a common problem for those with MBC. Subjective CRCI is associated with poorer quality of life and lower social functioning. Healthcare providers should acknowledge cognitive symptoms, continually assess cognitive function, and address associated unmet needs across the MBC trajectory.