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BackgroundTo describe the ethical issues and experiences of scientists conducting mixed methods health services research and to advance empirical and conceptual discussion on ethical integrity in mixed methods health research.MethodsThe study was conducted with 64 scholars, faculty and consultants from the NIH-funded Mixed Methods Research Training Program (MMRTP) for the Health Sciences. This was a cross-sectional study. Survey results were analyzed using descriptive statistics to characterize responses and open coding to summarize strategies about eight ethical mixed methods research issues. Respondents completed an online survey to elicit experiences related to eight ethical issues (informed consent, confidentiality, data management, burden, safety, equitable recruitment, communication, and dissemination) and strategies for addressing them.ResultsOnly about one-third of respondents thought their research ethics training helped them plan, conduct, or report mixed methods research. The most frequently occurring ethical issues were participant burden, dissemination and equitable recruitment (> 70% endorsement). Despite occurring frequently,

Background: Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low‐income older adults are particularly vulnerable to these challenges compared with their higher‐income counterparts due to their limited access to resources and social networks. Many low‐income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low‐income older adults significantly influences how they navigate crises. Methods: We conducted semi‐structured interviews with 24 older adults aged 63–86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach. Results: Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation. Conclusions: Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well‐being. Additionally, the role of technology in maintaining connections proved to be crucial. [ABSTRACT FROM AUTHOR]

BackgroundIn the context of prostate cancer (PCa) characterized by the multiple alternative treatment strategies, comparative effectiveness analysis is essential for informed decision-making. We analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly diagnosed localized PCa patients.MethodsWe performed a systematic review of literature published in English from 1995 to October 2016. A search strategy was employed using terms "prostate cancer," "localized," "outcomes," "mortality," "health related quality of life," and "complications" to identify relevant randomized controlled trials (RCTs), prospective, and retrospective studies. For observational studies, only those adjusting for selection bias using propensity-score or instrumental-variables approaches were included. Multivariable adjusted hazard ratio was used to assess all-cause and disease-specific mortality. Funnel plots were used to assess the level of bias.ResultsOur search strategy yielded 58 articles, of which 29 were RCTs, 6 were prospective studies, and 23 were retrospective studies. The studies provided moderate data for the patient-centered outcome of mortality. Radical prostatectomy demonstrated mortality benefit compared to watchful waiting (all-cause HR = 0.63 CI = 0.45, 0.87; disease-specific HR = 0.48 CI = 0.40, 0.58), and radiation therapy (all-cause HR = 0.65 CI = 0.57, 0.74; disease-specific HR = 0.51 CI = 0.40, 0.65). However, we had minimal comparative information about tradeoffs between and within treatment for other patient-centered outcomes in the short and long-term.ConclusionLack of patient-centered outcomes in comparative effectiveness research in localized PCa is a major hurdle to informed and shared decision-making. More rigorous studies that can integrate patient-centered and intermediate outcomes in addition to mortality are needed.

The Mixed Methods Research Training Program for the Health Sciences aims to enlarge the national pool of trained investigators in mixed methods and improve the quality of grant applications to the National Institutes of Health. Selected scholars are assigned a consulting team, participate in webinars, and attend an annual "retreat" focused on learning mixed methods through application to their research. Our article summarizes the process evaluation of the retreat. Scholars identified strengths in small interactive groups to discuss individual projects and the opportunity to apply learning. Scholars wanted further opportunity to discuss individual projects, understanding interventions and mixed methods, and finding collaborators. Our findings will be useful to leaders developing workshops or similar programs at the faculty level.

Background Depressive symptoms are common in knee osteoarthritis (OA), exacerbate knee pain severity and may influence outcomes of oral analgesic treatments. The aim was to assess whether oral analgesic effectiveness in knee OA varies by fluctuations in depressive symptoms. Methods The sample included Osteoarthritis Initiative (OAI) participants not treated with oral analgesics at enrolment (n  = 1477), with radiographic disease at the first follow-up visit (defined as the index date). Oral analgesic treatment and depressive symptoms, assessed with the Center for Epidemiological Studies Depression [(CES-D) score ≥16] Scale, were measured over three annual visits. Knee pain severity was measured at visits adjacent to treatment and modifier using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (rescaled range = 0–100). Structural nested mean models (SNMMs) estimated causal mean differences in knee pain severity comparing treatment versus no treatment. Results The average causal effects of treated versus not treated for observations without depressive symptoms showed negligible differences in knee pain severity. However, causal mean differences in knee pain severity comparing treatment versus no treatment among observations with depressive symptoms increased over time from −0.10 [95% confidence interval (CI): −9.94, 9.74] to −16.67 (95% CI: −26.33, −7.01). Accordingly, the difference in average causal effects regarding oral analgesic treatment for knee pain severity between person-time with and without depressive symptoms was largest (−16.53; 95% CI: −26.75, −6.31) at the last time point. Cumulative treatment for 2 or 3 years did not yield larger causal mean differences. Conclusions Knee OA patients with persistent depressive symptoms and chronic pain may derive more analgesic treatment benefit than those without depressive symptoms and less pain. [ABSTRACT FROM AUTHOR]