Risk Prediction Models for Barrett's Esophagus Discriminate Well and Are Generalizable in an External Validation Study.

BACKGROUND: Barrett's esophagus is the precursor to the highly lethal esophageal adenocarcinoma. Risk prediction models have been developed to assist in its detection, potentially improving early identification and treatment of esophageal adenocarcinoma. Six models have been developed. AIMS: To externally validate three models (Rubenstein, Thrift, and Baldwin-Hunter models) and compare them to a fourth risk prediction model (Ireland model) for Barrett's esophagus. METHODS: Data from 120 Barrett's cases and 235 population controls were available to externally validate the three models. Discriminatory ability of these models was assessed by the area under the receiver operating characteristic curve. Calibration was assessed with the calibration slope, Hosmer-Lemeshow test, and Lowess smoother calibration plot. Following external validation, diagnostic accuracy of the three models was compared to that of the Ireland model. RESULTS: On external validation, the Rubenstein model had an area under the receiver operating characteristic curve of 0.71 and was well calibrated (Hosmer-Lemeshow test, p = 0.67). Likewise, the Thrift and Baldwin-Hunter models had similar discrimination (0.71 and 0.70, respectively) and were also well calibrated (p = 0.69 and p = 0.28). Our previous external validation of the Ireland model provided an area under the receiver operating characteristic curve of 0.83 and was well calibrated (p = 0.14). The Ireland model demonstrated a statistically significantly greater area under the receiver operating characteristic curve than the Rubenstein (p = 0.02), Thrift (p = 0.001), and Baldwin-Hunter (p = 0.002) models. CONCLUSION: We externally validated the Rubenstein, Thrift, and Baldwin-Hunter risk prediction models and compared them to the Ireland model. The Ireland model demonstrated improved accuracy, albeit with slightly poorer calibration.

Risk factors for Barrett's esophagus: a scoping review.

INTRODUCTION: Cancer of the esophagus is a highly lethal disease with many patients presenting with metastatic spread of their tumor at diagnosis; a consequence of this late presentation is the 5-year survival rate of <20 %. Barrett's esophagus (BE), a premalignant condition of the distal esophagus, is the main risk factor for adenocarcinoma of the esophagus. The development of a risk prediction tool that could assist healthcare professionals in identifying people at increased risk of developing BE would be advantageous. Understanding the factors that influence the risk of developing BE is the first stage of developing a risk prediction tool. METHODS: A scoping review was undertaken to address the following question 'what factors influence the risk of developing Barrett's esophagus?' Forty-six articles were included in this review. RESULTS: The majority of articles reviewed were case-control or cohort studies. Samples sizes ranged from 68 to 84,606. Risk factors reported to be statistically significant were divided into three categories: demographic, lifestyle and clinical factors. Strongest risk factors identified include: male gender, increasing age, white race, smoking, obesity and gastro-esophageal reflux disease symptoms, while some aspects of a person's diet appear to act as a protective measure. CONCLUSION: Risk factors for BE are complex and need to be considered by healthcare professionals when identifying patients that could benefit from endoscopic eradication. These results provide a stepping stone for the future development of a risk prediction model.

Development and psychometric testing of the gender misconceptions of men in nursing (GEMINI) scale among nursing students.

BACKGROUND: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. OBJECTIVE: To develop and evaluate the psychometric properties of the 'Gender Misconceptions of meN in nursIng (GEMINI) Scale. DESIGN: Cross-sectional survey. METHODS: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The 17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. RESULTS: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%) were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach's alpha of 0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. CONCLUSION: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. IMPACT STATEMENT: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society.

Acquiring and maintaining competence in the application of extrication cervical collars by a group of first responders.

INTRODUCTION: Research on skill acquisition and retention in the prehospital setting has focused primarily on resuscitation and defibrillation. Investigation into other first aid skills is required in order to validate practices and support training regimes. No studies have investigated competency using an extrication cervical collar for cervical spine immobilization. OBJECTIVE: This study was conducted to confirm that a group of first responders could acquire and maintain competency in the application of an extrication cervical collar over a 12-month period. METHODS: Participants attended a standardized training session that addressed the theory of application of an extrication cervical collar followed by hands-on practice. The training was presented by the same instructor and covered the nine key elements necessary in order to be deemed competent in extraction cervical collar application. Following the practical session, the competency of the participants was assessed. Participants were requested not to practice the skill during the 12-month period. Following the 12-month period, their skills were re-assessed by the same assessor. RESULTS: Of the 64 subjects who participated in the study, 100% were competent after the initial first assessment. Forty-one participants (64%) were available for the second assessment (12 months later); of these, 25 (61%) maintained competence. CONCLUSIONS: Although the sample size was small, this research demonstrates that first responders are able to acquire competence in applying an extrication cervical collar. However, skill retention in the absence of usage or re-training is poor. Larger studies should be conducted to validate these results. In addition, there is a need for research on the clinical practice and outcomes associated with spinal immobilization in the prehospital setting.

Validation of a risk prediction model for Barrett's esophagus in an Australian population.

BACKGROUND: Esophageal adenocarcinoma is a disease that has a high mortality rate, the only known precursor being Barrett's esophagus (BE). While screening for BE is not cost-effective at the population level, targeted screening might be beneficial. We have developed a risk prediction model to identify people with BE, and here we present the external validation of this model. MATERIALS AND METHODS: A cohort study was undertaken to validate a risk prediction model for BE. Individuals with endoscopy and histopathology proven BE completed a questionnaire containing variables previously identified as risk factors for this condition. Their responses were combined with data from a population sample for analysis. Risk scores were derived for each participant. Overall performance of the risk prediction model in terms of calibration and discrimination was assessed. RESULTS: Scores from 95 individuals with BE and 636 individuals from the general population were analyzed. The Brier score was 0.118, suggesting reasonable overall performance. The area under the receiver operating characteristic was 0.83 (95% CI 0.78-0.87). The Hosmer-Lemeshow statistic was p=0.14. Minimizing false positives and false negatives, the model achieved a sensitivity of 74% and a specificity of 73%. CONCLUSION: This study has validated a risk prediction model for BE that has a higher sensitivity than previous models.