Weight calibration in the joint modelling of medical cost and mortality.

Joint modelling of longitudinal and time-to-event data is a method that recognizes the dependency between the two data types, and combines the two outcomes into a single model, which leads to more precise estimates. These models are applicable when individuals are followed over a period of time, generally to monitor the progression of a disease or a medical condition, and also when longitudinal covariates are available. Medical cost datasets are often also available in longitudinal scenarios, but these datasets usually arise from a complex sampling design rather than simple random sampling and such complex sampling design needs to be accounted for in the statistical analysis. Ignoring the sampling mechanism can lead to misleading conclusions. This article proposes a novel approach to the joint modelling of complex data by combining survey calibration with standard joint modelling. This is achieved by incorporating a new set of equations to calibrate the sampling weights for the survival model in a joint model setting. The proposed method is applied to data on anti-dementia medication costs and mortality in people with diagnosed dementia in New Zealand.

Falls Risk in Long-Term Care Residents With Cognitive Impairment: Effects of COVID-19 Pandemic.

OBJECTIVES: The aim of this study was to investigate the impact of the COVID-19 pandemic on falls rates in long-term care residents with cognitive impairment. DESIGN: An observational study using routinely collected national interRAI data. SETTING AND PARTICIPANTS: Participants were from long-term care residents (age ≥60 years) who received an interRAI Long Term Care Facility assessment anywhere in New Zealand between August 17, 2018, and August 16, 2022. METHODS: The primary outcome was "At least 1 fall in the last 30 days." Based on the Cognitive Performance Scale (CPS), cognitive impairment was categorized into 3 levels: intact or borderline intact (0-1), mild to moderate impairment (2-3), and moderately to very severe impairment (4-6). The COVID-19 pandemic was divided into 3 periods (First wave: March 21, 2020, to June 8, 2020; Varying level of community outbreaks: June 9, 2020 to August 16, 2021; and Delta-Omicron wave: August 17, 2021, to August 16, 2021) and compared to a pre-COVID-19 period (August 17, 2018, to March 20, 2020). Cox regression modeling was used to study falls and interactions between CPS and COVID-19 pandemic periods, along with other established falls risk factors in the literature. RESULTS: A total of 282,518 interRAI-LTCF assessments from 75,132 unique residents were included. Interactions between CPS and COVID-19 pandemic periods found that cognitive impairment was associated with a higher hazard ratio (ranged from 1.22 to 1.37) in each of the 3 COVID-19 pandemic periods. We also found unstable health, unsteady gait, wandering, and moderate to severe ADL dependency were the strongest risk factors for falls. CONCLUSIONS AND IMPLICATIONS: Cognitively impaired long-term care residents had an increased risk for falls during the COVID-19 pandemic. This risk was influenced by several factors. In future pandemic or infection control related isolation, residents who are most at risk can be identified for targeted falls prevention programs.

Descripcion de las actitudes de las estudiantes de enfermeria ante las respuestas del paciente ante su enfermedad / Description of attitude of nursing students against patient's responses to disease

Para el estudio de las actitudes se hace necesario reconocer su importancia dentro del comportamiento social del ser humano el cual puede ser fisiologico o de intereses o motivos, que se interrelacionan con elementos basicos como la herencia, la maduracion y la socializacion. El estudiante y el profesional de enfermeria deben reconocer la importancia de la relacion enfermera-paciente, dado que ambos son capaces de generar actitudes positivas o negativas, activas o pasivas, que segun Hollender estan incluidas en tres niveles. Siendo esta la clave para la practica de la enfermera y favorecen la continua empatia dada por las actitudes propias o individuales de la enfermera. Para este estudio se escogieron:las actitudes de rechazo, sobreproteccion e indiferencia, por parte de la enfermera; igualmente se tuvieron en cuenta las respuestas del paciente frente a su enfermedad como agresion, no colaboracion y dependencia siendo estas las mas evidentes en la escala de Likert por el impacto que causa en la relacion enfermera-paciente. Es asi como a traves del analisis estadistico se logro establecer que la formacion profesional no ejerce influencia sobre las actitudes de las estudiantes de I-IV_VII semestre de la facultad, que estan dadas por sus convicciones, creencias y educacion. Se observo tambien que el cambio de las actitudes es poco significativo entre las estudiantes que ingresan a primer semestre y las que estan cursando su ultimo ano, indicando que aun cuando se adquiran conocimientos cientificos y practicos el cambio de comportamiento se..