The International Initiative to Measure Perceived Risk in Arthroplasty: The Results From a Multinational Survey.

BACKGROUND: There is an inherent moral imperative to avoid complications from arthroplasty. Doing so at ideal cost is also associated with surgeon reputation, and, increasingly in health care delivery systems that measure and competitively score outcomes, reimbursement to the surgeons and their hospitals. As a result, patients who are perceived to be in higher risk comorbidity groups, such as the obese and diabetics, as well as those challenged by socioeconomic factors may face barriers to access elective arthroplasty. METHODS: In this initiative, surveys were sent to surgeons in 8 different countries, each adapted for their own unique payment, remuneration, and punitive models. The questions in the surveys pertained to surgeons' perception of risk regarding medical and socioeconomic factors in patients indicated for total hip or knee arthroplasty. This paper primarily reports on the results from Canada, Ireland, and the United Kingdom. RESULTS: The health care systems varied between a universal/state funded health care system (Canada) to those that were almost exclusively private (India). Some health care systems have "bundled" payment with retention of fees for postoperative complications requiring readmission/reoperation and including some with public publication of outcome data (United States and the United Kingdom), whereas others had none (Canada). There were some major discrepancies across different countries regarding the perceived risk of diabetic patients, who have variable Hemoglobin A1c cut-offs, if any used. However, overall the perception of risk for age, body mass index, age, sex, socioeconomic, and social situations remained surprisingly consistent throughout the health care systems. Any limitations set were primarily driven by surgeon decision making and not external demands. CONCLUSION: Surgeons will understandably try and optimize the health status of patients who have reversible risks as shown by best available evidence. The evidence is of variable quality, and, especially for irreversible social risk factors, limited due to concerns over cost and quality outcomes that can be influenced by experience-driven perceptions of risk. The results show that perceptions of risk do have such influence on access across many health care delivery environments. The authors recommend better risk-adjustment models for medical and socioeconomic risk factors with possible stratification/exclusions regarding reimbursement adjustments and reporting to help reverse disparities of access to arthroplasty.

Reflexive Intervention Development: Using Qualitative Research to Inform the Development of an Intervention for Women With Metastatic Breast Cancer.

There is growing consensus around the limited attention given to documenting the process of intervention development, specifically the role of qualitative research. In this article, we seek to describe a missing piece of this process: how qualitative research, and related methodologies and theories, informs intervention development. We use our research as a case study of "reflexive intervention development." We begin by describing our interview study, consisting of 23 in-depth interviews with women diagnosed with metastatic breast cancer, and go on to detail our methodological framework and research team. We then explain how this interview study directly informed our development of the intervention materials, allowing us to attend carefully to language and its potential implications for women. We conclude by inviting researchers to reflect on the knowledge production process that is inherent in intervention development to consider not only their role in this process but also the role of qualitative research.

Developing a music-based digital therapeutic to help manage the neuropsychiatric symptoms of dementia.

The greying of the world is leading to a rapid acceleration in both the healthcare costs and caregiver burden that are associated with dementia. There is an urgent need to develop new, easily scalable modalities of support. This perspective paper presents the theoretical background, rationale, and development plans for a music-based digital therapeutic to manage the neuropsychiatric symptoms of dementia, particularly agitation and anxiety. We begin by presenting the findings of a survey we conducted with key opinion leaders. The findings highlight the value of a music-based digital therapeutic for treating neuropsychiatric symptoms, particularly agitation and anxiety. We then consider the neural substrates of these neuropsychiatric symptoms before going on to evaluate randomized control trials on the efficacy of music-based interventions in their treatment. Finally, we present our development plans for the adaptation of an existing music-based digital therapeutic that was previously shown to be efficacious in the treatment of adult anxiety symptoms.

The dynamics of political and affective polarisation: Datasets for Spain, Portugal, Italy, Argentina, and Chile (2019-2022).

The TRI-POL project explores the triangle of interactive relationships between affective and ideological polarisation, political distrust, and the politics of party competition. In this project there are two complementary groups of datasets with individual-level survey data and digital trace data collected in five countries: Argentina, Chile, Italy, Portugal and Spain. These datasets are comprised of three waves carried out over a six-month period between late September 2021 and April 2022. In addition, the survey datasets include a series of experiments embedded in the different waves that examine social exposure, polarisation framing, and social sorting. The digital trace datasets include variables on individuals' behaviours and exposure to information received via digital media and social media. This data was collected using a combination of tracking technologies that the interviewees installed in their different devices. This digital trace data is matched with the individual-level survey data. These datasets are especially useful for researchers who wish to explore dynamics of polarisation, political attitudes, and political communication.

Weight loss outcomes in premenopausal versus postmenopausal women during behavioral weight loss interventions: a systematic review and meta-analysis.

IMPORTANCE: Weight loss may be difficult for young women with obesity to achieve due to competing priorities (caring for children and/or full-time work), limiting their ability to engage in weight loss interventions. Older or postmenopausal women may also face challenges to weight loss such as caring responsibilities and menopause. Menopausal status may reflect differences in weight loss. OBJECTIVE: This study compared changes in weight, fat mass, and lean mass in premenopausal versus postmenopausal women in dietary weight loss trials. EVIDENCE REVIEW: We reviewed publications from January 2000 to June 2020 evaluating a weight loss intervention with a dietary component, with or without exercise, and reporting weight loss of premenopausal and postmenopausal women. Where available, data on mean change from baseline for weight, fat mass, and lean mass of premenopausal and postmenopausal groups were entered into Review Manger for meta-analyses. Differences between menopausal groups were compared in subgroups of studies for intervention characteristics (diet-only vs diet and exercise; dietary modification vs meal replacement; < 24 wks vs ≥24 wks duration). FINDINGS: Seven publications (10 interventions, n = 791) were included; three single-arm trials, two randomized controlled trials, and two comparative effectiveness trials. In meta-analyses, there were no statistically significant differences between premenopausal and postmenopausal women (shown as premenopausal minus postmenopausal) for change in weight (0.58 [95% confidence interval -0.12 to 1.28] kg, n = 7 interventions), fat mass (0.73 [-0.25 to 1.70] kg, n = 6 interventions), or lean mass (-0.5 6[-1.48 to 0.36] kg, n = 4 interventions). However, a statistically significant subgroup difference was observed for fat mass change between menopausal groups (premenopausal minus postmenopausal) when comparing diet-only (1.28 [0.23 to 2.33] kg, n = 4 interventions) versus diet and exercise interventions (-0.09 [-0.51 to 0.32]kg, n = 2 interventions). No differences were shown in any other subgroups. CONCLUSIONS AND RELEVANCE: This review provides some evidence to suggest weight loss interventions may not need to be tailored to women's menopausal status. However, given the small number of studies, short intervention duration in most publications (≤ 6 mo) and unclear retention rates in premenopausal versus postmenopausal groups of some publications, menopausal group differences should be examined in existing and future trials where the appropriate data have been collected.