Psychometric properties of the Korean version of the Stanford Presenteeism Scale in a nurse population.

Presenteeism, which refers to going to work despite being ill, has been associated with loss of work productivity, decreased quality of care, and an increased risk of health problems. The prevalence of presenteeism is particularly high among nurses; therefore, a reliable and valid tool is needed to assess presenteeism. This study aimed to translate the Stanford Presenteeism Scale (SPS) and to examine its psychometric properties in a Korean nurse population. A methodological study was performed in January 2023. The original SPS-6 (English-language) was translated and adapted to the Korean language using a committee approach translation, cognitive interviews, and content validation with a review panel of experts. An online survey was completed by 608 Korean nurses. The internal consistency, item-to-total correlation, construct validity, concurrent validity, and discriminant validity were examined as psychometric properties of the Korean version of the SPS. The final version of the K-SPS consists of four items shortened from the original six items. Cronbach's alpha of the K-SPS-4 was 0.74, indicating adequate reliability. Confirmatory factor analysis showed a one-factor solution with a good fit. There was a positive correlation between the K-SPS-4 and the Work Limitations Questionnaire. Discriminant validity was evidenced by the positive correlation of the K-SPS-4 with job satisfaction and the negative correlation with job stress. The K-SPS-4 has acceptable psychometric properties, supporting the feasibility of its use in assessing the level of presenteeism among Korean nurses. The validated K-SPS-4 can provide a basis for developing intervention programs to enhance productivity and promote health among nurses in clinical settings.

A patient-centered nurse-supported primary care-based collaborative care program to treat opioid use disorder and depression: Design and protocol for the MI-CARE randomized controlled trial.

BACKGROUND: Opioid use disorder (OUD) contributes to rising morbidity and mortality. Life-saving OUD treatments can be provided in primary care but most patients with OUD don't receive treatment. Comorbid depression and other conditions complicate OUD management, especially in primary care. The MI-CARE trial is a pragmatic randomized encouragement (Zelen) trial testing whether offering collaborative care (CC) to patients with OUD and clinically-significant depressive symptoms increases OUD medication treatment with buprenorphine and improves depression outcomes compared to usual care. METHODS: Adult primary care patients with OUD and depressive symptoms (n ≥ 800) from two statewide health systems: Kaiser Permanente Washington and Indiana University Health are identified with computer algorithms from electronic Health record (EHR) data and automatically enrolled. A random sub-sample (50%) of eligible patients is offered the MI-CARE intervention: a 12-month nurse-driven CC intervention that includes motivational interviewing and behavioral activation. The remaining 50% of the study cohort comprise the usual care comparison group and is never contacted. The primary outcome is days of buprenorphine treatment provided during the intervention period. The powered secondary outcome is change in Patient Health Questionnaire (PHQ)-9 depression scores. Both outcomes are obtained from secondary electronic healthcare sources and compared in "intent-to-treat" analyses. CONCLUSION: MI-CARE addresses the need for rigorous encouragement trials to evaluate benefits of offering CC to generalizable samples of patients with OUD and mental health conditions identified from EHRs, as they would be in practice, and comparing outcomes to usual primary care. We describe the design and implementation of the trial, currently underway. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05122676. Clinical trial registration date: November 17, 2021.

Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment.

AIMS AND OBJECTIVES: This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts. BACKGROUND: Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work. DESIGN: A prospective observational study was employed. The study followed STROBE checklist for observational studies. METHODS: Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness. RESULTS: A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts. CONCLUSIONS: The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty. RELEVANCE TO CLINICAL PRACTICE: Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Effect of sleep on alertness at work among fixed night shift nurses: A prospective observational study.

AIMS: To identify patterns of declining alertness at work among fixed night shift nurses using an objective measure and to determine the effect of sleep parameters on the decline in alertness at work. DESIGN: A prospective observational study. METHODS: Data were collected from 65 fixed night shift nurses who provided direct nursing care for patients in Korean hospitals between September 2020 and March 2021. Participants wore an actigraph for 14 days on their non-dominant hand to measure sleep parameters and predict their hourly alertness scores. They completed an online survey to provide their demographic information. Mixed-effect models were employed to determine the association between sleep parameters and the decline in alertness. RESULTS: The alertness scores of fixed night shift nurses constantly dropped every working hour. Scores dropped below 20% after 4 h from the beginning of the shift and below 30% after 6 h. Increased minutes in bed, minutes asleep and sleep efficiency reduced the risk of decreased alertness scores below 70. Increased sleep latency was associated with an increased risk of alertness scores dropping below 70. CONCLUSION: The alertness of fixed night shift nurses drops steeply during regular hours and remains low during overtime. Sleep parameters contribute to the decline in alertness at work among fixed night shift nurses. IMPACT: This study identified patterns of decline in alertness among fixed night shift nurses and the contributing factors for this decline, using an objective measure. The findings have important implications for the development of future interventions to improve the sleep hygiene of fixed night shift nurses to enhance their alertness at work.

Association Between Dementia Development and COVID-19 among Individuals Who Tested Negative for COVID-19 in South Korea: A Nationwide Cohort Study.

We aim to assess whether the number of newly diagnosed dementia increases and whether comorbid psychiatric symptoms of patients with dementia worsen, in people who were tested for COVID-19. We used electronic medical records from a nationwide cohort consisting of people who tested positive (positive group), tested negative (negative group), and those who did not receive the test (control group) for COVID-19. For people with neither a history of dementia nor mild cognitive disorder (MCI), the negative group was more likely to develop dementia than the control group, and less likely to develop MCI than the positive group. For people who already had dementia, the negative group was more likely to develop comorbid psychiatric disorders than the control group, but less likely than the positive group. These findings suggest the necessity of managing mental health not only for patients with COVID-19 but also for people who tested negative for COVID-19.

Alertness during working hours among eight-hour rotating-shift nurses: An observational study.

PURPOSE: The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure. DESIGN: An observational study using ReadiBand wrist actigraphs was conducted. METHODS: Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep-wake cycles and predict their alertness scores hourly. All participants completed a sleep diary. FINDINGS: Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts. CONCLUSIONS: Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses' alertness, promote high-quality care provision, and ensure patient safety. CLINICAL RELEVANCE: The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.

Sleep, fatigue and alertness during working hours among rotating-shift nurses in Korea: An observational study.

AIMS: To determine the effects of sleep parameters and fatigue on the decline in alertness of nurses across shifts. BACKGROUND: Shift work can lead to nurse fatigue owing to insufficient sleep and inadequate recovery time between shifts. Nurse fatigue has adverse effects on alertness and can affect provision of quality care. METHODS: An observational study using wrist actigraphs was conducted from 2019 to 2020. Participants were 82 rotating-shift nurses who provided direct nursing care in acute hospitals in South Korea. They wore actigraphs for 14 days to measure sleep parameters and predict hourly alertness and reported subjective fatigue before and after every shift. RESULTS: Nurses demonstrated shorter sleep hours, lower sleep efficiency and longer sleep latency before night shifts compared with other shifts. Fatigue was the highest before day shifts. Sleep parameters and fatigue significantly affected the steep decline in alertness in participants with alertness scores below 70. CONCLUSIONS: Sleep parameters and fatigue level contributed to the differences in decline in alertness across shifts. IMPLICATION FOR NURSING MANAGEMENT: Findings inform nurse managers, administrators to develop interventions to reduce fatigue, improve sleep quantity and quality and increase alertness among rotating-shift nurses. Management, institutional and individual factors should be considered when developing interventions.

Taste Sensitivity of Elderly People Is Associated with Quality of Life and Inadequate Dietary Intake.

Aging has been implicated in the alteration of taste acuity. Diet can affect taste sensitivity. We aimed to investigate the types of tastes altered in elderly Korean people and factors associated with taste alteration in relation to dietary intake and other factors. Elderly participants (≥65 years) and young adults were assessed to determine their recognition thresholds (RT) for sweet, salty, bitter, sour, and umami tastes. Elderly participants were further surveyed for dietary intake and non-nutritional factors. Five taste RTs were correlated with age, but only four taste RTs, except sweetness, differed between the elderly participants and young adults. Inadequate intake of iron, thiamin, folic acid, zinc, and phosphorus among the elderly participants was related to elevated taste RT levels, except for bitter taste. In both correlation and regression analyses, only salty and sour RTs were associated with energy, iron, thiamin, fiber, vitamin C, and riboflavin levels in the elderly participants. The elderly participants' taste RTs exhibited strong associations with quality of life (QOL) but showed partial relationships with physical activity, number of medicine intakes, social gatherings, and education. Taste sensitivity may decrease with age, which is further influenced by insufficient dietary intake, especially iron and thiamin, and QOL.

Some thoughts on the QR method for analytical similarity evaluation.

As indicated in a recent published draft guidance on comparative analytical assessment, the United States (US) Food and Drug Administration (FDA) seems to suggest the use of quality range (QR) method for analytical similarity evaluation. It is a concern that the use of QR method for analytical similarity evaluation could potentially approve biological products which are not deemed biosimilar to the reference biological products. In this article, the limitations and potential risk for the use of the QR method for analytical similarity evaluation are discussed. Alternatively, two modified versions of the QR method, which are referred to as effect size (ES) mQR and plausibility interval (PI) mQR methods are suggested. The performance and statistical properties of the mQR methods are evaluated via extensive clinical trial simulation under various scenarios. The results indicate that the modified versions of the QR method not only overcome the limitations of the QR method for analytical similarity evaluation, but also can potentially help in detecting reference product changes during manufacturing process.

Sparse graphical models via calibrated concave convex procedure with application to fMRI data.

This paper proposes a calibrated concave convex procedure (calibrated CCCP) for high-dimensional graphical model selection. The calibrated CCCP approach for the smoothly clipped absolute deviation (SCAD) penalty is known to be path-consistent with probability converging to one in linear regression models. We implement the calibrated CCCP method with the SCAD penalty for the graphical model selection. We use a quadratic objective function for undirected Gaussian graphical models and adopt the SCAD penalty for sparse estimation. For the tuning procedure, we propose to use columnwise tuning on the quadratic objective function adjusted for test data. In a simulation study, we compare the performance of the proposed method with two existing graphical model estimators for high-dimensional data in terms of matrix error norms and support recovery rate. We also compare the bias and the variance of the estimated matrices. Then, we apply the method to functional magnetic resonance imaging (fMRI) data of an attention deficit hyperactivity disorders (ADHD) patient.

Changes in taste and food preferences in breast cancer patients receiving chemotherapy: a pilot study.

PURPOSE: Cancer treatment may relate to appetite reduction and malnutrition. We investigated taste alterations and dish-type preferences during chemo- and/or radiation therapy in breast cancer patients. METHODS: Breast cancer patients (BC, n = 59) scheduled to receive cancer therapy and healthy subjects (control group or CTRL, n = 49) were voluntarily recruited. Taste detection thresholds (DTs) and recognition thresholds (RT) were compared between pre-treatment BC patients and CTRL for sweet (sucrose), salty (NaCl), bitter (caffeine), and sour (citric acid) solutions. Changes in taste thresholds and dish preferences during treatment were monitored in the BC group. Blood chemistry and anthropometric data were collected. RESULTS: At baseline, BC patients demonstrated lower sweet and salty DTs and RTs and a higher sour RT compared to CTRL. Bitter DT and RT were similar in both groups. Mild/soft dishes were preferred over fried/oily dishes by BC patients. Throughout treatment in BC patients, sweet thresholds significantly declined, while salty, bitter, and sour DTs and RTs were not affected, and there was no increase in preference for a dish. However, preference towards mild/soft dishes remained. While sweet-sour fruits and sweetened nuts were not favored during therapy. CONCLUSIONS: Sensitivities to sweet, salty, and sour but not bitter tastes differed between BC patients and CTRL. During treatment, sweet taste sensitivity increased while other tastes were unaffected. BC patients preferred mild/soft dishes over fried and sweetened dishes compared to CTRL. Our findings may contribute to developing dishes for breast cancer patients to increase food intake and thereby lower the risk of malnutrition.