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Goals Of Work: Treatments for early-stage prostate cancer (PCa) are highly effective; therefore, research studies that explore quality of life (QOL) issues associated with different treatments are important. The purposes of this study were to (a) examine differences among treatment groups of men treated with either radiation therapies or radical prostatectomy for PCa and (b) examine quality of life outcomes over time.Patients and Methods: We report outcomes 6 and 12 months after 159 men began treatment for PCa with either one of two types of radiation treatment (intensity-modulated radiation therapy plus high dose rate or intensity-modulated radiation therapy plus seed implantation) or radical prostatectomy.Main Results: Significant differences among groups are described. Significant predictors of QOL at 6 months included urinary, bowel, and sexual symptoms, anxiety, depression, problem-focused coping, and physiological self-efficacy. Significant predictors of QOL at 12 months were urinary and bowel symptoms, stress, depression, problem-focused coping, and physiological self-efficacy. Demographic variables, race, and living status were significant predictors of quality of life at 12 months.Conclusions: Physiological symptoms and psychological symptoms were both significant predictors of QOL. The psychological factors that predicted quality of life in this study have potential for intervention and point to the next stage of the research. [ABSTRACT FROM AUTHOR]

Deals with a study which examined C-reactive protein and serum amyloid A levels in a diverse group of patients with documented influenza A infection. Details on the influenza epidemics; Patients and methods; Results of the study.

We propose a non-parametric approach to reduce the overestimation of the Kaplan-Meier (KM) estimator when the event and censoring times are independent. We adjust the KM estimator based on the interval-specific censoring set, a collection of intervals where censored data are observed between two adjacent event times. The proposed interval-specific censoring set adjusted KM estimator reduces to the KM estimator if there are no censored observations or the sample size tends to infinity and the proposed estimator is consistent, as is the case for the KM estimator. We prove theoretically that the proposed estimator reduces the overestimation compared to the KM estimator and provide a mathematical formula to estimate the variance of the proposed estimator based on Greenwood's approach. We also provide a modified log-rank test based on the proposed estimator. We perform four simulation studies to compare the proposed estimator with the KM estimator when the failure rate is constant, decreasing, increasing, and based on the flexible hazard method. The bias reduction in median survival time and survival rate using the proposed estimator is considerably large, especially when the censoring rate is high. The standard deviations are comparable between the two estimators. We implement the proposed and KM estimator for the Nonalcoholic Fatty Liver Disease patients from a population study. The results show the proposed estimator substantially reduce the overestimation in the presence of high observed censoring rate., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2023 Informa UK Limited, trading as Taylor & Francis Group.)

A fundamental problem in the regulatory evaluation of a therapy is assessing whether the benefit outweighs the associated risks. This work proposes designing a trial that assesses a composite endpoint consisting of benefit and risk, hence, making the core of the design of the study, to assess benefit and risk. The proposed benefit risk measure consists of efficacy measure(s) and a risk measure that is based on a composite score obtained from pre-defined adverse events of interest (AEI). This composite score incorporates full aspects of adverse events of interest (i.e. the incidence, severity, and duration of the events). We call this newly proposed score the AEI composite score. After specifying the priorities between the components of the composite endpoint, a win-statistic (i.e. win ratio, win odds, or net benefit) is used to assess the difference between treatments in this composite endpoint. The power and sample size requirements of such a trial design are explored via simulation. Finally, using Dupixent published adult study results, we show how we can design a paediatric trial where the primary outcome is a composite of prioritized outcomes consisting of efficacy endpoints and the AEI composite score endpoint. The resulting trial design can potentially substantially reduce sample size compared to a trial designed to assess the co-primary efficacy endpoints, therefore it may address the challenge of slow enrollment and patient availability for paediatric studies.

The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO. Veterans had a visit from a therapy dog and the dog's handler, a clinical psychologist (experimental condition) and an unstructured visit with the clinical psychologist alone (control condition). Blood pressure, heart rate, and the salivary biomarkers cortisol, alpha-amylase, and immunoglobulin A were collected before, after, and 30-minutes after both the experimental and control conditions. Significant decreases in cortisol were found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.007) and control condition ( p = 0.036). A significant decrease in HR was also found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.0046) and control ( p = 0.0119) condition. Results of this study supported that a VA facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and HR in veterans.

Pet therapy can be therapeutic for older adults living in the community. A crossover design was used to examine changes in blood pressure and heart rate before and after a pet therapy visit versus a volunteer-only visit in 28 community dwelling older adults. Relationships among stress, pet attitude, social support, and health status were also examined. Study findings supported that pet therapy significantly decreased blood pressure and heart rate. Ultimately, the findings supported the notion that community health nurses should consider developing and implementing pet therapy programs in the communities they serve. Further implications for community health nurses are discussed.

Rationale and Objectives: Consider a study evaluating the prognostic value of prostate-specific antigen (PSA), in the presence of Gleason score, in differentiating between early and advanced prostate cancer. This data set features subjects divided into two groups (early versus advanced cancer), with one manifest variable (PSA), one covariate (Gleason score), and one stratification variable (hospital, taking three values). We present a nonparametric method for estimating a shift in median PSA score between the two groups, after adjusting for differences in Gleason score and stratifying on hospital. This method can also be extended to cases involving multivariate manifest variable., Materials and Methods: Our method uses estimating equations derived from an existing rank-based estimator of the area under the receiver operating characteristic curve (AUC). This existing AUC estimator is adjusted for stratification and for covariates. We use the adjusted AUC estimator to construct a family of tests by shifting manifest variables in one of the treatment groups by an arbitrary constant. The null hypothesis for these tests is that the AUC is half. We report the set of shift values for which the null hypothesis is not rejected as the resulting confidence region., Results: Simulated data show performance consistent with the distributional approximations used by the proposed methodology. This methodology is applied to two examples. In the first example, the mean difference in PSA levels between advanced and nonadvanced prostate cancer patients is estimated, controlling for Gleason score. In the second example, to assess the degree to which age and baseline tumor size are prognostic factors for breast cancer recurrence, differences in age and tumor size between subjects with recurrent and nonrecurrent breast cancer, stratified on Tamoxifen treatment and adjusting for tumor grade, are estimated., Conclusions: The proposed methodology provides a nonparametric method for a statistic measuring adjusted AUC to be used to estimate shift between two manifest variables., (Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.)

Mentoring in nursing is an important process for socializing nurse researchers, developing a body of professional knowledge, and influencing career choices of students. Self-efficacy (Bandura, 1997) is concerned with one's perceived ability to perform tasks within a specific domain. The purpose of this study was to compare undergraduate and graduate student's perceptions of their abilities to pursue research (research self-efficacy) with their mentors' perceptions. A cross-sectional design was used to study mentors in any academic discipline who received external funding and worked with an undergraduate or graduate student on the research study. Recruitment and data collection were completed using the Internet and included 21 faculty mentors and student dyads. The Clinical Research Appraisal Inventory was used to measure research self-efficacy. Differences between the faculty mentor's perception of the student's confidence in research and students' perception were significant at p=<0.001. Misjudgment of efficacy appraisals can result in opportunities forsaken and careers not pursued. Assisting mentors to guide students' skill perfection may increase students' choice of research careers, promote the effectiveness of mentorship, aid in the development of a body of professional knowledge and benefit careers of both mentors and students., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the accuracy and precision of random sampling in identifying healthcare system outliers in diabetes performance measures., Study Design: Cross-sectional analysis of 79 Veterans Health Administration facilities serving 250 317 patients with diabetes mellitus between October 1, 1999, and September 30, 2000., Methods: Primary outcome measures were poor glycosylated hemoglobin (A1C) control and good low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) control. Facility performance for each measure was calculated using 150 separate random samples and was compared with results using the bootstrap method as the criterion standard for determining outlier status (defined as a >/=5% difference from the mean, within the 10th or 90th percentile, or >/=2 SDs from the mean)., Results: The study population was largely male (97.4%), with 54.0% of subjects being 65 years or older. The facility-level mean performances were 22.8% for poor A1C control, 53.1% for good LDL-C control, and 55.3% for good BP control. Comparing the random sampling method with the bootstrap method, the sensitivity ranged between 0.64 and 0.83 for the 3 outcome measures, positive predictive values ranged between 0.55 and 0.88, and specificity and negative predictive values ranged between 0.88 and 0.99., Conclusions: The specificity and negative predictive value of the random sampling method in identifying nonoutliers in performance were generally high, while its sensitivity and positive predictive value were moderate. The use of random sampling to determine performance for individual outcome measures may be most appropriate for internal quality improvement rather than for public reporting.