short medical research articles

Berkeley Medical Journal

UC Berkeley's Premiere Medical and Health Sciences Undergraduate Publication

Category: Short Articles

59 Years and Counting

By Maia Beaulieu “True peace is not merely the absence of tension; it is the presence of justice.”  -Martin Luther King Jr. After decades of fighting, The Civil Rights Act of 1964 ended segregation and granted rights to African Americans, yet nearly 60 years later, we still see explicit and implicit injustice embedded in our political, […]

Is Chemotherapy Right for Everyone?: Cancer Cell Markers as Predictors of Chemotherapy Efficacy

By Daniel Voronel Chemotherapy is one of the most common ways of treating cancer but is not always a foolproof method to help patients gain remission. Oftentimes, it is difficult to tell if chemotherapy will actually eliminate cancerous cells or fail to take effect. A recent paper written by Hanbing Song and Simon Bucher et […]

Pregnancy Risks in a Post-Roe America

By Harleen Dhillon How free is America when laws regulate and harm the state of healthcare for women? With the overturning of Roe v. Wade, many women with pregnancy-related cancers will be unable to terminate their pregnancies, which can lead to health risks—even death. Jordyn Silverstein and Katherine Van Loon, two researchers at UCSF, discuss […]

Break Out of Jail: COVID-19 Outbreaks within the Prison System

By Derek Hsu A sentence other than death. Many individuals subjugated to the US incarceration system are exposed to gang rivalries, inhumane conditions, and low staffing levels – a sentence some would argue strips the personality and character of an individual. However, the physical layout of prisons, in particular their outdated building design, are causing […]

Epilepsy Research

By: Jacob Yinger Epilepsy is a disease that 50 million people worldwide suffer from, and 80% of those reside in third world countries with minimal access to healthcare. This disease causes irreversible brain damage due to unwarranted electrical activity in the brain, which results in regular seizures. There are many treatments for  epilepsy, mostly consisting […]

‘Tis the Season for Fires: Wildfire Smoke linked to Skin Disease

By Shalini Saravanan Red skies, gray flakes, and the smell of something burnt. This is the reality of the wildfire seasons that come around to California on a yearly basis, although to the average native Californian, wildfire season simply marks the beginning of Fall. Due to decreased rainfall and the persisting drought, California wildfires have […]

The Medical Revolution of Virus Treatment and Diagnostics: CRISPR-Cas

by: Paige McGarry Recent developments in the gene-editing technology CRISPR-Cas have introduced incredible advancements in diagnostic procedures. As of late, the SARS-CoV-2 virus has impacted more than 215 countries around the world, and with no evident cure, the virus is leaving destruction in its wake. The diagnostic abilities of CRISPR-Cas pose potential solutions towards solving […]

A Not-So-New Epidemic: Xenophonic Rhetoric and Anti-Asian Sentiments Within the U.S.

by: Lizzy Trinh On January 28, 2021, an elderly immigrant from Thailand was taking his morning stroll in a San Francisco neighborhood when he was violently shoved to his death in a racially motivated attack. The mourning family of the victim expressed that this hate crime was not simply a random, isolated event, but an […]

by: Amy Wise How does our brain decide between passively processing what we see and integrating the world around us into perception and experience? Numerous psychological studies seek to understand the basis of attention. Attention is the foundation of learning because it allows our brain to process information and begin to develop perception. If we […]

3D Printed Absorber for Capturing Chemotherapy Drugs

by: Jose Avila Imagine a world set in the future where technology has advanced so far that it is capable of carrying out complicated medical procedures with extreme precision. Imagine this world has found the key to better cancer treatments that are much more effective and have few negative after-effects. Well, perhaps that future is […]

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Undiagnosed type 2 diabetes is common – intensified screening of established risk groups is imperative in Sweden: the SDPP cohort

Undiagnosed type 2 diabetes (T2D) is a global problem. Current strategies for diagnosis in Sweden include screening individuals within primary healthcare who are of high risk, such as those with hypertension, ...

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Variability in the prevalence of depression among adults with chronic pain: UK Biobank analysis through clinical prediction models

The prevalence of depression among people with chronic pain remains unclear due to the heterogeneity of study samples and definitions of depression. We aimed to identify sources of variation in the prevalence ...

Prevalence and differences in the co-administration of drugs known to interact: an analysis of three distinct and large populations

The co-administration of drugs known to interact greatly impacts morbidity, mortality, and health economics. This study aims to examine the drug–drug interaction (DDI) phenomenon with a large-scale longitudina...

Anti-PD-1 antibody in combination with radiotherapy as first-line therapy for unresectable intrahepatic cholangiocarcinoma

Unresectable intrahepatic cholangiocarcinoma (iCCA) has a poor prognosis despite treatment with standard combination chemotherapy. We aimed to evaluate the efficacy and safety of radiotherapy in combination wi...

Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England

Tobacco smoking affects women’s fertility and is associated with substantial risks of adverse pregnancy outcomes. This study explored trends by socioeconomic position in patterns of smoking, use of non-combust...

Lipid metabolic reprogramming mediated by circulating Nrg4 alleviates metabolic dysfunction-associated steatotic liver disease during the early recovery phase after sleeve gastrectomy

The metabolic benefits of bariatric surgery that contribute to the alleviation of metabolic dysfunction-associated steatotic liver disease (MASLD) have been reported. However, the processes and mechanisms unde...

Quantifying the impact of hospital catchment area definitions on hospital admissions forecasts: COVID-19 in England, September 2020–April 2021

Defining healthcare facility catchment areas is a key step in predicting future healthcare demand in epidemic settings. Forecasts of hospitalisations can be informed by leading indicators measured at the commu...

COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status

The COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to...

Shared genetic architecture between autoimmune disorders and B-cell acute lymphoblastic leukemia: insights from large-scale genome-wide cross-trait analysis

To study the shared genetic structure between autoimmune diseases and B-cell acute lymphoblastic leukemia (B-ALL) and identify the shared risk loci and genes and genetic mechanisms involved.

Association and biological pathways between lung function and incident depression: a prospective cohort study of 280,032 participants

Lung health is increasingly recognized as an essential factor in mental health. However, prospective evidence on lung function with incident depression remains to be determined. The study aimed to examine the ...

What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography

Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality sta...

Olfactory bulb anomalies in KBG syndrome mouse model and patients

ANKRD11 (ankyrin repeat domain 11) is a chromatin regulator and the only gene associated with KBG syndrome, a rare neurodevelopmental disorder. We have previously shown that Ankrd11 regulates murine embryonic cor...

Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estim...

The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial

Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness ...

Assessing causal links between age at menarche and adolescent mental health: a Mendelian randomisation study

The timing of puberty may have an important impact on adolescent mental health. In particular, earlier age at menarche has been associated with elevated rates of depression in adolescents. Previous research su...

PREX2 contributes to radiation resistance by inhibiting radiotherapy-induced tumor immunogenicity via cGAS/STING/IFNs pathway in colorectal cancer

Colorectal cancer (CRC) lacks established biomarkers or molecular targets for predicting or enhancing radiation response. Phosphatidylinositol-3,4,5-triphosphate-dependent Rac exchange factor 2 (PREX2) exhibit...

Cervical lymph node metastasis prediction from papillary thyroid carcinoma US videos: a prospective multicenter study

Prediction of lymph node metastasis (LNM) is critical for individualized management of papillary thyroid carcinoma (PTC) patients to avoid unnecessary overtreatment as well as undesired under-treatment. Artifi...

Characterizing the polygenic overlap and shared loci between rheumatoid arthritis and cardiovascular diseases

Despite substantial research revealing that patients with rheumatoid arthritis (RA) have excessive morbidity and mortality of cardiovascular disease (CVD), the mechanism underlying this association has not bee...

Patterns of comorbidities in patients with atrial fibrillation and impact on management and long-term prognosis: an analysis from the Prospective Global GLORIA-AF Registry

Clinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidi...

Canadians’ use of cannabis for therapeutic purposes since legalization of recreational cannabis: a cross-sectional analysis by medical authorization status

There has been a precipitous decline in authorizations for medical cannabis since non-medical cannabis was legalized in Canada in 2018. This study examines the demographic and health- and medical cannabis-rela...

Interventions on gender equity in the workplace: a scoping review

Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interve...

Real-world performance of indobufen versus aspirin after percutaneous coronary intervention: insights from the ASPIRATION registry

Indobufen is widely used in patients with aspirin intolerance in East Asia. The OPTION trial launched by our cardiac center examined the performance of indobufen based dual antiplatelet therapy (DAPT) after pe...

Blood leukocytes as a non-invasive diagnostic tool for thyroid nodules: a prospective cohort study

Thyroid nodule (TN) patients in China are subject to overdiagnosis and overtreatment. The implementation of existing technologies such as thyroid ultrasonography has indeed contributed to the improved diagnost...

Childhood urbanicity is associated with emotional episodic memory-related striatal function and common variation in NTRK2

Childhoods in urban or rural environments may differentially affect the risk of neuropsychiatric disorders, possibly through memory processing and neural response to emotional stimuli. Genetic factors may not ...

Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components

Technology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service ...

A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus

Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and glo...

Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England

Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine...

SARS-CoV-2, influenza A/B and respiratory syncytial virus positivity and association with influenza-like illness and self-reported symptoms, over the 2022/23 winter season in the UK: a longitudinal surveillance cohort

Syndromic surveillance often relies on patients presenting to healthcare. Community cohorts, although more challenging to recruit, could provide additional population-wide insights, particularly with SARS-CoV-...

A phase II study of belumosudil for chronic graft-versus-host disease in patients who failed at least one line of systemic therapy in China

Chronic graft-versus-host disease (cGVHD) is an immune-related disorder that is the most common complication post-allogenic hematopoietic stem cell transplant. Corticosteroids with or without calcineurin inhib...

Association between genetic risk and adherence to healthy lifestyle for developing age-related hearing loss

Previous studies have shown that lifestyle/environmental factors could accelerate the development of age-related hearing loss (ARHL). However, there has not yet been a study investigating the joint association...

Associations between maternal pre-pregnancy BMI and infant striatal mean diffusivity

It is well-established that parental obesity is a strong risk factor for offspring obesity. Further, a converging body of evidence now suggests that maternal weight profiles may affect the developing offspring...

Evaluation of a hospital-initiated tobacco dependence treatment service: uptake, smoking cessation, readmission and mortality

The National Health Service in England aims to implement tobacco dependency treatment services in all hospitals by 2024. We aimed to assess the uptake of a new service, adapted from the Ottawa Model of Smoking...

Delivering synaptic protein mRNAs via extracellular vesicles ameliorates cognitive impairment in a mouse model of Alzheimer’s disease

Synaptic dysfunction with reduced synaptic protein levels is a core feature of Alzheimer’s disease (AD). Synaptic proteins play a central role in memory processing, learning, and AD pathogenesis. Evidence sugg...

Association between inflammatory bowel disease and cancer risk: evidence triangulation from genetic correlation, Mendelian randomization, and colocalization analyses across East Asian and European populations

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been associated with several cancer risks in observational studies, but the observed associations have bee...

Medication non-adherence and self-inflicted violence behaviors among 185,800 patients with schizophrenia in the community: a 12-year cohort study

Despite the importance of medication adherence in treatment effectiveness, little is known about the association between medication non-adherence and self-inflicted violence behaviors. We aimed to assess wheth...

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, ...

Sleep alterations as a function of 88 health indicators

Alterations in sleep have been described in multiple health conditions and as a function of several medication effects. However, evidence generally stems from small univariate studies. Here, we apply a large-s...

Sarcopenic obesity is part of obesity paradox in dementia development: evidence from a population-based cohort study

Sarcopenic obesity, a clinical and functional condition characterized by the coexistence of obesity and sarcopenia, has not been investigated in relation to dementia risk and its onset.

Sex-specific associations between sodium and potassium intake and overall and cause-specific mortality: a large prospective U.S. cohort study, systematic review, and updated meta-analysis of cohort studies

The impact of sodium intake on cardiovascular disease (CVD) health and mortality has been studied for decades, including the well-established association with blood pressure. However, non-linear patterns, dose...

Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems’ responses to pandemics and climate change

Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS...

Regional disparities and risk factors of mortality among patients at high risk of sudden cardiac death in emerging countries: a nonrandomized controlled trial

Comprehensive data on patients at high risk of sudden cardiac death (SCD) in emerging countries are lacking. The aim was to deepen our understanding of the SCD phenotype and identify risk factors for death amo...

Association of in utero HIV exposure with child brain structure and language development: a South African birth cohort study

There is a growing population of children with in utero HIV exposure who are at risk of poor neurodevelopmental outcomes despite avoiding HIV infection. However, the underlying neurobiological pathways are not...

Correction: Transient increased risk of influenza infection following RSV infection in South Africa: findings from the PHIRST study, South Africa, 2016–2018

The original article was published in BMC Medicine 2023 21 :441

Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: a 7-year longitudinal cohort study in a large population

While the augmented incidence of diabetes after COVID-19 has been widely confirmed, controversial results are available on the risk of developing hypertension during the COVID-19 pandemic.

Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review

Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used too...

SARS-CoV-2 infection is detrimental to pregnancy outcomes after embryo transfer in IVF/ICSI: a prospective cohort study

To explore whether SARS-CoV-2 infection affects the pregnancy outcomes of assisted reproductive techniques (ART).

Risk of encephalitis and meningitis after COVID-19 vaccination in South Korea: a self-controlled case series analysis

Several neurological manifestations shortly after a receipt of coronavirus infectious disease 2019 (COVID-19) vaccine have been described in the recent case reports. Among those, we sought to evaluate the risk...

Autotaxin inhibition attenuates the aortic valve calcification by suppressing inflammation-driven fibro-calcific remodeling of valvular interstitial cells

Patients with fibro-calcific aortic valve disease (FCAVD) have lipid depositions in their aortic valve that engender a proinflammatory impetus toward fibrosis and calcification and ultimately valve leaflet ste...

Improved emotion differentiation under reduced acoustic variability of speech in autism

Socio-emotional impairments are among the diagnostic criteria for autism spectrum disorder (ASD), but the actual knowledge has substantiated both altered and intact emotional prosodies recognition. Here, a Bay...

Polygenic risk score-based phenome-wide association study of head and neck cancer across two large biobanks

Numerous observational studies have highlighted associations of genetic predisposition of head and neck squamous cell carcinoma (HNSCC) with diverse risk factors, but these findings are constrained by design l...

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Research articles

Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022, antipsychotic use in people with dementia, predicting the risks of kidney failure and death in adults with moderate to severe chronic kidney disease, impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse, esketamine after childbirth for mothers with prenatal depression, glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer, use of progestogens and the risk of intracranial meningioma, delirium and incident dementia in hospital patients, derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin, quality and safety of artificial intelligence generated health information, large language models and the generation of health disinformation, 25 year trends in cancer incidence and mortality among adults in the uk, cervical pessary versus vaginal progesterone in women with a singleton pregnancy, comparison of prior authorization across insurers, diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis, ultra-processed food exposure and adverse health outcomes, added benefit and revenues of oncology drugs approved by the ema, exposure to air pollution and hospital admission for cardiovascular diseases, short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity, optimal timing of influenza vaccination in young children, effect of exercise for depression, association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes, duration of cpr and outcomes for adults with in-hospital cardiac arrest, clinical effectiveness of an online physical and mental health rehabilitation programme for post-covid-19 condition, atypia detected during breast screening and subsequent development of cancer, publishers’ and journals’ instructions to authors on use of generative ai in academic and scientific publishing, effectiveness of glp-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes, neurological development in children born moderately or late preterm, invasive breast cancer and breast cancer death after non-screen detected ductal carcinoma in situ, all cause and cause specific mortality in obsessive-compulsive disorder, acute rehabilitation following traumatic anterior shoulder dislocation, perinatal depression and risk of mortality, undisclosed financial conflicts of interest in dsm-5-tr, effect of risk mitigation guidance opioid and stimulant dispensations on mortality and acute care visits, update to living systematic review on sars-cov-2 positivity in offspring and timing of mother-to-child transmission, perinatal depression and its health impact, christmas 2023: common healthcare related instruments subjected to magnetic attraction study, using autoregressive integrated moving average models for time series analysis of observational data, demand for morning after pill following new year holiday, christmas 2023: christmas recipes from the great british bake off, effect of a doctor working during the festive period on population health: experiment using doctor who episodes, christmas 2023: analysis of barbie medical and science career dolls, christmas 2023: effect of chair placement on physicians’ behavior and patients’ satisfaction, management of chronic pain secondary to temporomandibular disorders, christmas 2023: projecting complete redaction of clinical trial protocols, christmas 2023: a drug target for erectile dysfunction to help improve fertility, sexual activity, and wellbeing, christmas 2023: efficacy of cola ingestion for oesophageal food bolus impaction, conservative management versus laparoscopic cholecystectomy in adults with gallstone disease, social media use and health risk behaviours in young people, untreated cervical intraepithelial neoplasia grade 2 and cervical cancer, air pollution deaths attributable to fossil fuels, implementation of a high sensitivity cardiac troponin i assay and risk of myocardial infarction or death at five years, covid-19 vaccine effectiveness against post-covid-19 condition, association between patient-surgeon gender concordance and mortality after surgery, intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention, treatment of lower urinary tract symptoms in men in primary care using a conservative intervention, autism intervention meta-analysis of early childhood studies, effectiveness of the live zoster vaccine during the 10 years following vaccination, effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women, pyrotinib versus placebo in combination with trastuzumab and docetaxel in patients with her2 positive metastatic breast cancer, association of dcis size and margin status with risk of developing breast cancer post-treatment, racial differences in low value care among older patients in the us, pharmaceutical industry payments and delivery of low value cancer drugs, rosuvastatin versus atorvastatin in adults with coronary artery disease, clinical effectiveness of septoplasty versus medical management for nasal airways obstruction, ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder, early versus delayed antihypertensive treatment in patients with acute ischaemic stroke, mortality risks associated with floods in 761 communities worldwide, interactive effects of ambient fine particulate matter and ozone on daily mortality in 372 cities, association between changes in carbohydrate intake and long term weight changes, future-case control crossover analysis for adjusting bias in case crossover studies, association between recently raised anticholinergic burden and risk of acute cardiovascular events, suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis, efficacy and safety of an inactivated virus-particle vaccine for sars-cov-2, effect of invitation letter in language of origin on screening attendance: randomised controlled trial in breastscreen norway, visits by nurse practitioners and physician assistants in the usa, non-erosive gastro-oesophageal reflux disease and oesophageal adenocarcinoma, venous thromboembolism with use of hormonal contraception and nsaids, food additive emulsifiers and risk of cardiovascular disease, balancing risks and benefits of cannabis use, promoting activity, independence, and stability in early dementia and mild cognitive impairment, effect of home cook interventions for salt reduction in china, cancer mortality after low dose exposure to ionising radiation, effect of a smartphone intervention among university students with unhealthy alcohol use, long term risk of death and readmission after hospital admission with covid-19 among older adults, mortality rates among patients successfully treated for hepatitis c, association between antenatal corticosteroids and risk of serious infection in children, the proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes, safety of ba.4-5 or ba.1 bivalent mrna booster vaccines, comparative effectiveness of booster vaccines among adults aged ≥50 years, third dose vaccine schedules against severe covid-19 during omicron predominance in nordic countries, private equity ownership and impacts on health outcomes, costs, and quality, healthcare disruption due to covid-19 and avoidable hospital admission, educational inequalities in mortality and their mediators among generations across four decades, prevalence and predictors of data and code sharing in the medical and health sciences, medicare eligibility and in-hospital treatment patterns and health outcomes for patients with trauma, therapeutic value of first versus supplemental indications of drugs in us and europe, hospital admissions linked to sars-cov-2 infection in children and adolescents, vitamin d supplementation and major cardiovascular events, follow us on, content links.

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Short Paper

Years in this theme:   All years 2024   2023   2018   2016   2010   2006   2002   2001   2000   1999  

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Articles published in this theme: 17 (scroll down to load remaining articles)

Limitations of the Cough Sound-Based COVID-19 Diagnosis Artificial Intelligence Model and its Future Direction: Longitudinal Observation Study

Jina Kim , Yong Sung Choi , Young Joo Lee , Seung Geun Yeo , Kyung Won Kim , Min Seo Kim , Masoud Rahmati , Dong Keon Yon , Jinseok Lee

Download Citation: END BibTex RIS

Identifying Rare Circumstances Preceding Female Firearm Suicides: Validating A Large Language Model Approach

Weipeng Zhou , Laura C Prater , Evan V Goldstein , Stephen J Mooney

Advanced Messaging Intervention for Medication Adherence and Clinical Outcomes Among Patients With Cancer: Randomized Controlled Trial

Chen-Xu Ni , Wen-Jie Lu , Min Ni , Fang Huang , Dong-Jie Li , Fu-Ming Shen

Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study

Laura Churchill , Mary Morrow , Jacob J Capin , Sarah E Jolley , Kristine Hare , Samantha MaWhinney , Jennifer E Stevens-Lapsley , Kristine M Erlandson

Evaluating the Ability of Open-Source Artificial Intelligence to Predict Accepting-Journal Impact Factor and Eigenfactor Score Using Academic Article Abstracts: Cross-sectional Machine Learning Analysis

Carmelo Macri , Stephen Bacchi , Sheng Chieh Teoh , Wan Yin Lim , Lydia Lam , Sandy Patel , Mark Slee , Robert Casson , WengOnn Chan

Using a Virtual Reality Social Network During Awake Craniotomy to Map Social Cognition: Prospective Trial

Florian Bernard , Jean-Michel Lemée , Ghislaine Aubin , Aram Ter Minassian , Philippe Menei

The Sydney West Knowledge Portal: Evaluating the Growth of a Knowledge Portal to Support Translational Research

Anna Janssen , Tracy Elizabeth Robinson , Pamela Provan , Tim Shaw

Photoaging Mobile Apps in School-Based Tobacco Prevention: The Mirroring Approach

Titus Josef Brinker , Werner Seeger , Fabian Buslaff

Developing a Disease Outbreak Event Corpus

Mike Conway , Ai Kawazoe , Hutchatai Chanlekha , Nigel Collier

Utilization Patterns and User Characteristics of an Ad Libitum Internet Weight Loss Program

Martin Binks , Trevor van Mierlo

Responding Rapidly to FDA Drug Withdrawals: Design and Application of a New Approach for a Consumer Health Website

Peter J Embi , Prasad Acharya , Mark McCuistion , Charles P Kishman , Doris Haag , Stephen Marine

Where Are They Now? A Case Study of Health-related Web Site Attrition

Michael A Veronin

Factors Associated with Intended Use of a Web Site Among Family Practice Patients

Peggy A Smith-Barbaro , John C Licciardone , Howard F Clarke , Samuel T Coleridge

Thoughts concerning the BMJ editorial "Kitemarking the west wind" and the WHO dot-health proposal

Gunther Eysenbach

Rating the Raters: Legal Exposure of Trustmark Authorities in the Context of Consumer Health Informatics

Nicolas P Terry

Online Prescribing of Sildanefil (Viagra) on the World Wide Web

Medical pioneers in cyberspace: German practice owners advertising on the WWW

Claudia Schuh

Editor's Choice: AI Tools to Improve Access to Reliable Health Information

• Antibiotic Stewardship Trials April 19, 2024 Original Investigation Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial Shruti K. Gohil, MD, MPH; Edward Septimus, MD; Ken Kleinman, ScD; et al
• Original Investigation Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial Shruti K. Gohil, MD, MPH; Edward Septimus, MD; Ken Kleinman, ScD; et al
• Editorial Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing Anurag N. Malani, MD; Preeti N. Malani, MD, MSJ
• Audio Stewardship Prompts to Improve Antibiotic Selection for Pneumonia and Urinary Tract Infection Shruti K. Gohil, MD, MPH, with host JAMA Deputy Editor Preeti Malani, MD, MSJ

Just Published

• Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection Shruti K. Gohil, MD, MPH; et al. Original Investigation online first free access has multimedia Shruti K. Gohil, MD, MPH; et al. Editorial
• Stewardship Prompts to Improve Antibiotic Selection for Pneumonia Shruti K. Gohil, MD, MPH; et al. Original Investigation online first free access has multimedia Shruti K. Gohil, MD, MPH; et al. Editorial
• Main Residency Match for Applicants With Disability Mytien Nguyen, MS; et al. Research Letter online first Mytien Nguyen, MS; et al.
• Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban Wayne A. Ray, PhD; et al. Original Investigation online first has active quiz Wayne A. Ray, PhD; et al.
• Leave of Absence and Medical Student GME Placement by Race and Ethnicity Mytien Nguyen, MS; et al. Research Letter online first Mytien Nguyen, MS; et al.
• Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing Anurag N. Malani, MD; et al. Editorial online first has multimedia Anurag N. Malani, MD; et al.
• “The Patient” Katie A. Thure, MPH A Piece of My Mind online first free access Katie A. Thure, MPH
• Accelerating Climate Action Through Academic Health Systems A. Eugene Washington, MD, MSc; et al. Viewpoint online first free access has multimedia A. Eugene Washington, MD, MSc; et al.
• Understatement in Poetry (Quieter Than an MRI) Rafael Campo, MD, MA Editor's Note online first free access Rafael Campo, MD, MA
• Protecting Privacy of Pregnant and LGBTQ+ Research Participants Ellen Wright Clayton, MD, JD; et al. Viewpoint online first free access Ellen Wright Clayton, MD, JD; et al.
• A Patient with Diabetes Mellitus and Acute Rhinosinusitis Francisco J. Machiavello Roman, MD; et al. JAMA Clinical Challenge online first has active quiz Francisco J. Machiavello Roman, MD; et al.
• Does This Infant Have a Dislocated Hip? Abhinav Singh, BMBS, MSc; et al. The Rational Clinical Examination online first has active quiz has multimedia Abhinav Singh, BMBS, MSc; et al.
• Tilt Table Testing William P. Cheshire, MD; et al. JAMA Diagnostic Test Interpretation online first has active quiz William P. Cheshire, MD; et al.
• Does This Patient Have Alcohol Use Disorder? Evan Wood, MD, PhD; et al. The Rational Clinical Examination has active quiz Evan Wood, MD, PhD; et al.
• Systemic Lupus Erythematosus Caroline H. Siegel, MD, MS; et al. Review online first has active quiz has multimedia Caroline H. Siegel, MD, MS; et al.

Latest from the USPSTF

• USPSTF Recommendation: Primary Care Interventions to Prevent Child Maltreatment
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Displaying 1 - 20 of 1003 articles.

Graduation rates for low-income students lag while their student loan debt soars

Robert Samuels , University of California, Santa Barbara

The tragedy of sudden unexpected infant deaths – and how bedsharing, maternal smoking and stomach sleeping all contribute

Fern R. Hauck , University of Virginia

Cities with Black women police chiefs had less street violence during 2020’s Black Lives Matter protests

Kayla Stajkovic , University of California, Davis and Alex Stajkovic , University of Wisconsin-Madison

‘The former guy’ versus ‘Sleepy Joe’ – why Biden and Trump are loath to utter each other’s name

Roger J. Kreuz , University of Memphis

Deepfake detection improves when using algorithms that are more aware of demographic diversity

Siwei Lyu , University at Buffalo and Yan Ju , University at Buffalo

Human brains and fruit fly brains are built similarly – visualizing how helps researchers better understand how both work

Kristin Scaplen , Bryant University

How to battle boredom at work

Casher Belinda , University of Notre Dame

Tiny crystals capture millions of years of mountain range history – a geologist excavates the Himalayas with a microscope

Matthew J. Kohn , Boise State University

Loneliness can kill, and new research shows middle-aged Americans are particularly vulnerable

Frank J. Infurna , Arizona State University

Rural students’ access to Wi-Fi is in jeopardy as pandemic-era resources recede

Gabriel E. Hales , Michigan State University and Keith N. Hampton , Michigan State University

In 1877, a stained-glass window depicted Jesus as Black for the first time − a scholar of visual images unpacks its history and significance

Virginia Raguin , College of the Holy Cross

Could sharing a bedroom with your pets be keeping you from getting a good night’s sleep?

Brian N. Chin , Trinity College

Affordable stroke-risk screening could save the lives of many children in sub-Saharan Africa with sickle cell disease

Paul (Seung Yup) Lee , Kennesaw State University

‘Fake news’ legislation risks doing more harm than good amid a record number of elections in 2024

Samuel Jens , Stony Brook University (The State University of New York)

What is Volt Typhoon? A cybersecurity expert explains the Chinese hackers targeting US critical infrastructure

Richard Forno , University of Maryland, Baltimore County

Competitive workplaces don’t work for gender equality

Amalia Rebecca Miller , University of Virginia and Carmit Segal , University of Zurich

Many travel nurses opt for temporary assignments because of the autonomy and opportunities − not just the big boost in pay

Ivan Gan , University of Houston-Downtown

Tweaking US trade policy could hold the key to reducing migration from Central America

Raymond Robertson , Texas A&M University and Kaleb Girma Abreha , Texas A&M University

69% of US Muslims always give to charities during Ramadan, fulfilling a religious obligation

Shariq Siddiqui , Indiana University

Not having job flexibility or security can leave workers feeling depressed, anxious and hopeless

Monica Wang , Boston University

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Page 1 of 496

Diet and lifestyle behaviours simultaneously act on frailty: it is time to move the threshold of frailty prevention and control forward

To analyse the association among the simultaneous effects of dietary intake, daily life behavioural factors, and frailty outcomes in older Chinese women, we predicted the probability of maintaining physical ro...

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Factors affecting safe pesticide-use behaviors among farm plant agriculturists in northeastern Thailand

Pesticide poisoning is a major public health problem in Thailand and is the result of intensive inappropriate and unsafe use of pesticides. This analytical cross-sectional study aimed to determine the factors ...

“It’s about how you take in things with your brain” - young people’s perspectives on mental health and help seeking: an interview study

Poor mental health in young people has become a growing problem globally over the past decades. However, young people have also been shown to underutilize available healthcare resources. The World Health Organ...

Racial and ethnic disparities in access to community-based perinatal mental health programs: results from a cross-sectional survey

Perinatal mental health is a major public health problem that disproportionately affects people from racial and ethnic minority groups. Community-based perinatal mental health programs, such as peer support gr...

Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey

The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania.

Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD)

Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment....

Trends in parkinson’s disease mortality in China from 2004 to 2021: a joinpoint analysis

This study aimed to analyze the trends of Parkinson’s disease (PD) mortality rates among Chinese residents from 2004 to 2021, provide evidence for the formulation of PD prevention and control strategies to imp...

Associations between Life’s Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study

Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life’s Essential...

Factors associated with the use of antibiotics for children presenting with illnesses with fever and cough obtained from prescription and non-prescription sources: a cross-sectional study of data for 37 sub-Saharan African countries

Fever and cough in under-five children are common and predominately self-limiting illnesses. Inappropriate prescribing of antibiotics in sub-Saharan Africa is a significant public health concern. However, pres...

A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021

Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures....

‘We get to learn as we move’: effects and feasibility of lesson-integrated physical activity in a Swedish primary school

Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are n...

Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003–2018

Currently, it is still largely unknown whether the proportion of calcium intake at breakfast and dinner is associated with cardiovascular disease (CVD) in the general population.

Retraction Note: Children’s physical activity level and sedentary behaviour in Norwegian early childhood education and care: effects of a staff-led cluster-randomised controlled trial

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12889-024-18629-0.

Racial/ethnic differences in the associations between trust in the U.S. healthcare system and willingness to test for and vaccinate against COVID-19

Trust in the healthcare system may impact adherence to recommended healthcare practices, including willingness to test for and vaccinate against COVID-19. This study examined racial/ethnic differences in the a...

Engaging with immigrant students’ voices in the school environment: an analysis of policy documents through school websites

For students to feel happy and supported in school, it is important that their views are taken seriously and integrated into school policies. However, limited information is available how the voices of immigra...

Effectiveness of implementing evidence-based approaches to promote physical activity in a Midwestern micropolitan area using a quasi-experimental hybrid type I study design

Much evidence-based physical activity (PA) interventions have been tested and implemented in urban contexts. However, studies that adapt, implement, and evaluate the effectiveness of these interventions in mic...

Prevalence of tobacco use among cancer patients in Iran: a systematic review and meta-analysis

The prevalence of tobacco use among various cancer types in Iran remains a significant concern, necessitating a comprehensive analysis to understand the extent and patterns of consumption. This study aimed to ...

Clusters of 24-hour movement behavior and diet and their relationship with health indicators among youth: a systematic review

Movement-related behaviors (physical activity [PA], sedentary behavior [SB], and sleep) and diet interact with each other and play important roles in health indicators in youth. This systematic review aimed to...

Associations between 47 anthropometric markers derived from a body scanner and relative fat-free mass in a population-based study

Low relative fat free mass (FFM) is associated with a greater risk of chronic diseases and mortality. Unfortunately, FFM is currently not being measured regularly to allow for individuals therapy.

Correction: Sodium, potassium intake, and all-cause mortality: confusion and new findings

The original article was published in BMC Public Health 2024 24 :180

Relationship between resilience at work, work engagement and job satisfaction among engineers: a cross-sectional study

Workplace challenges can negatively affect employees and the organization. Resilience improves work-related outcomes like engagement, satisfaction, and performance. Gaps exist in studying resilience at work, p...

Demographic disparities in the limited awareness of alcohol use as a breast cancer risk factor: empirical findings from a cross-sectional study of U.S. women

Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast canc...

Design of a bilingual (FR-UR) website on the sensitive topic of sexual and mental health with Urdu speakers in a Parisian suburb: a qualitative study

This article is a continuation of the Musafir study published in 2020. Following the results of this study, we designed an educational website with Urdu-speaking volunteers, using a participatory approach. Thi...

Assessment of the correlation between KAP scores regarding sugar-sweetened beverage consumption and hyperuricemia amongst Chinese young adults

The prevalence of hyperuricemia in China has been consistently increasing, particularly among the younger generation. The excessive consumption of sugar-sweetened beverages is associated with hyperuricemia. Th...

Problematic usage of the internet among Hungarian elementary school children: a cross-sectional study

Problematic usage of the internet (PUI) is perhaps one of the most frequently studied phenomena of the 21st century receiving increasing attention in both scientific literature and the media. Despite intensive...

Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139)

Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational...

Inter-leg systolic blood pressure difference has been associated with all-cause and cardiovascular mortality: analysis of NHANES 1999–2004

Inter-leg systolic blood pressure difference (ILSBPD) has emerged as a novel cardiovascular risk factor. This study aims to investigate the predictive value of ILSBPD on all-cause and cardiovascular mortality ...

Sex-related inequalities in crude and age-standardized suicide rates: trends in Ghana from 2000 to 2019

Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefo...

Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults

Sedentary behavior has been demonstrated to be a modifiable factor for several chronic diseases, while coffee consumption is believed to be beneficial for health. However, the joint associations of daily sitti...

Association of hypertension and depression with mortality: an exploratory study with interaction and mediation models

The association of hypertension and depression with mortality has not been fully understood. We aimed to explore the possible independent or joint association of hypertension and depression with mortality. The...

Knowledge and trust of mothers regarding childhood vaccination in Rwanda

Knowledge and trust are some of the contributing factors to vaccine acceptance(VA) and Vaccine hesitancy (VH) is one of the top threats to global health. A significant drop in childhood vaccination has been ob...

Associations between COVID-19 incidence, weight status, and social participation restrictions in the U.S.: evidence from the national population, cross-sectional study

To explore the associations between coronavirus infection incidence and weight status and social participation restrictions among community-dwelling adults in the United States.

The impact of internet use on health among older adults in China: a nationally representative study

Aging poses a significant challenge worldwide, with China’s aging status becoming particularly severe. What is the impact of Internet use on the health of the elderly? Existing studies have drawn conflicting c...

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model

Understanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its p...

Relationship between 24-h activity behavior and body fat percentage in preschool children: based on compositional data and isotemporal substitution analysis

This study aims to elucidate the dose‒response relationship between 24-h activity behaviors and body fat percentage (BFP) in Chinese preschool children using a compositional isotemporal substitution model (ISM).

Evaluating compliance with local and International Food Labelling Standards in urban Tanzania: a cross-sectional study of pre-packaged snacks in Dar Es Salaam

Urbanization influences food culture, particularly in low- and middle-income countries where there is an increasing consumption of processed and pre-packaged foods. This shift is contributing to a rise in non-...

Association between the circulating very long-chain saturated fatty acid and cognitive function in older adults: findings from the NHANES

Age-related cognitive decline has a significant impact on the health and longevity of older adults. Circulating very long-chain saturated fatty acids (VLSFAs) may actively contribute to the improvement of cogn...

The association between psychological distress, abusive experiences, and help-seeking among people with intimate partner violence

Intimate partner violence (IPV) is a serious public health problem associated with countless adverse physical and mental health outcomes. It places an enormous economic and public health burden on communities....

Experiences of support for people who access voluntary, community and social enterprise (VCSE) organisations for self-harm: a qualitative study with stakeholder feedback

Prevalence of self-harm In England is rising, however contact with statutory services remains relatively low. There is growing recognition of the potential role voluntary, community and social enterprise secto...

Subnational estimates of life expectancy at birth in India: evidence from NFHS and SRS data

Mortality estimates at the subnational level are of urgent need in India for the formulation of policies and programmes at the district level. This is the first-ever study which used survey data for the estima...

The association between social connectedness and euthanasia and assisted suicide and related constructs: systematic review

Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common...

Health effects of holistic housing renovation in a disadvantaged neighbourhood in the Netherlands: a qualitative exploration among residents and professionals

Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting soc...

Archetype analysis and the PHATE algorithm as methods to describe and visualize pregnant women’s levels of physical activity knowledge

The knowledge of physical activity (PA) recommended for pregnant women and practical application of it has positive impact on the outcome. Nevertheless, it is estimated that in high-income countries over 40% o...

Correlation of pre-existing comorbidities with disease severity in individuals infected with SARS-COV-2 virus

Shortly after the first publication on the new disease called Coronavirus Disease 2019 (Covid-19), studies on the causal consequences of this disease began to emerge, initially focusing only on transmission me...

Associations between cardiovascular diseases and cancer mortality: insights from a retrospective cohort analysis of NHANES data

This study explored the association of cardiovascular disease (CVD) with cancer mortality risk in individuals with or without a history of cancer, to better understand the interplay between CVD and cancer outc...

Inflammation mediates the association between furan exposure and the prevalence and mortality of chronic obstructive pulmonary disease: National Health and Nutrition Examination Survey 2013–2018

Although extensive research has established associations between chronic obstructive pulmonary disease (COPD) and environmental pollutants, the connection between furan and COPD remains unclear. This study aim...

Correction: Racial discrimination is associated with food insecurity, stress, and worse physical health among college students

The original article was published in BMC Public Health 2024 24 :883

Longitudinal association of grip strength with cardiovascular and all-cause mortality in older urban Lithuanian population

Ageing populations experience greater risks associated with health and survival. It increases the relevance of identifying variables associated with mortality. Grip strength (GS) has been identified as an impo...

The 5 C model and Mpox vaccination behavior in Germany: a cross-sectional survey

Due to the authorization of the Mpox vaccines, we aimed to identify determinants of the intention to get vaccinated, actively trying to receive vaccination, and for successfully receiving a vaccination in Germ...

Pregnancy period and early-life risk factors for inflammatory bowel disease: a Northern Finland birth cohort 1966 study

The pathogenesis of inflammatory bowel disease (IBD) has not been fully elucidated. The aim of this study was to analyze the pregnancy period, perinatal period, and infancy period risk factors for IBD in a wel...

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• v.104(7); Jul 2014

Short-Term Medical Service Trips: A Systematic Review of the Evidence

Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern.

Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips.

Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.

With globalization, there has been significant growth in short-term medical service trips (MSTs) from high-income countries (HICs) to low- and middle-income countries (LMICs). Although MSTs deliver significant amounts of care, relatively little attention is given in the medical and public health literature to the impact of these interventions on the populations being served. The following review offers a step forward by addressing this gap with a systematic analysis of the existing empirical work and suggestions for further study.

According to the World Health Organization, the highest proportions of the global burden of disease fall on the regions that also suffer significantly from physician shortages. 1 A growing group from HICs aims to address both medical and surgical unmet needs in LMICs through MSTs, sometimes referred to as medical missions.

For purposes of this review, MSTs are defined as trips in which volunteer medical providers from HICs travel to LMICs to provide health care over periods ranging from 1 day to 8 weeks. Both faith-based organizations and non–faith-based organizations facilitate these trips, a feature that will be discussed in more detail later. Team composition can range from members of academic departments from a single institution to collections of individuals affiliated only by friendship, geography, or the organization facilitating the trip.

Authors of several published articles have noted that MSTs as a form of aid do not address the primary sources of the health care problems in the developing world: poverty and overstretched health care infrastructure. 2–4 There are, however, significant resources, financial and human, dedicated to MSTs annually. Although there is no central monitoring group or agency for MSTs, conservative estimates that do not take into account opportunity costs for the volunteers place the annual expenditures at $250 million. 5 With expenditures of this magnitude, questions naturally arise about the return on investment. If noteworthy returns exist and organizations are simply not measuring or reporting them, then this can be remedied. If the returns do not exist and the missions continue, an ethical dilemma may be emerging.

Over the past 20 years, publications describing MSTs have largely aimed to promote models of health care delivery in these settings. The pressure to develop practice guidelines has created some standardization in care, but the lack of critically reviewed empirical data continues to be a concern. Assumptions that the safety and acceptable risk or rates of complications from HICs are automatically transferable to MSTs are unwarranted and could be dangerous. 6

The lack of evidence is particularly concerning when one considers the vulnerable nature of patients living in LMICs. 2 Under the best circumstances, MSTs address an unmet medical need with high-quality care. Under the worst circumstances, they serve, as one author states, as an opportunity for physicians to practice techniques for the treatment of conditions that are less common in the developed world. 7 This example is extreme and is unlikely to play a role in the justification for most contemporary MSTs, but the possibility is concerning. One report in the faith-based literature (of an evangelical short-term mission trip in this case) suggested that some trips may benefit the volunteer as much as or more than the recipient of aid as well as potentially costing the hosts valuable time and resources. 8

Martiniuk et al. recently provided a starting point in the review of MST evidence; however, they included articles with mixed goals and did little to assess the quality of the articles presenting empirical data from MSTs or their participants. 9 The authors described benefits associated with MSTs, including personal gains for the volunteers and an increased sense of solidarity between the recipients and volunteers. They went on to identify common criticisms of MSTs, namely questions about efficacy or impact and unintended consequences.

The present review differs in several ways. First, it specifically targets publications with empirical results based on intentional data collection regarding activities associated with MSTs. These empirical results include work discussing treatment interventions, cost-effectiveness, quality assessment and assurance, or the perspectives of MST participants and target communities. Second, it addresses the assessment of quality. Third, the final section of this article suggests a framework drawn from the existing literature and its remaining gaps for the minimum data collection requirements necessary to expand the evidence base for MSTs.

Investments in MSTs continue to grow while their impact remains largely unmeasured. This demands a critical review and illustrates the need to measure the quality and impact of MSTs. 2,5,10–13 Analyzing the status of existing empirical evidence will help to establish some basic guidelines and a research agenda for future work in this area. Scholarship in the fields of social psychology and tourism also addresses aspects of MSTs; however, this review focuses solely on the medical literature.

This review follows the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for constructing the review methodology. 14 The aim is to standardize the reporting of reviews. PubMed and ISI Web of Knowledge were the primary sources for identifying relevant publications ( Figure 1 ), using queries for the medical subject headings “medical missions, official” and a “medical missions” topical search for each engine, respectively. After adding limitations for English-language publications, I limited the pool further to those articles with a date of publication between January 1, 1993, and May 15, 2013. Exclusionary terms (e.g., “not dental” and “not disaster response”) narrowed the data set. Finally, I used the terms “study” or “analysis” to identify publications with the empirical level of analysis to establish evidence for MSTs.

Literature search for research on short-term medical service trips (STMSTs): January 1, 1993–May 15, 2013.

To be included in this review, publications had to report on work performed in association with a short-term MST. I defined short-term as trips with a duration of less than or equal to 2 months. Because the intent for this work was to focus on the available evidence produced by these publications, it includes only publications with intentional data collection regarding procedures, patients, volunteers, or the MST literature.

A review of the full-text versions of each publication determined inclusion. In some cases, the abstracts did not reveal enough information to accurately characterize the publication; therefore, a subsequent review of the full-text article was necessary to assess for exclusionary characteristics. Finally, I reviewed the bibliographies of the included articles to identify additional publications missed by the previously described methods. I then subjected these to the same process of inclusion and exclusion analysis.

I collected authors and the date and journal of publication from the final list of studies. This was followed by the collection of study-specific data including focus (literature, patients, participants, equipment, community, or cost-effectiveness), medical specialty or subspecialty, nature of the trip (surgical, medical, or both), study design, sample size, location, duration of the trip, affiliated organizations, and the terms used to refer to MSTs.

The search process identified 1164 unique publications. Abstract reviews reduced the number to 112 for full-text review. As noted by other authors, one significant limitation on searches for this literature base is the diversity of terms used to refer to seemingly the same activity. 15 I identified more than 45 terms used to refer to MSTs ( Table 1 ). The final group of publications included 67 studies for the quantitative and qualitative analysis.

TABLE 1—

Terms Used in Publications to Refer to Medical Service Trips From Literature Search: January 1, 1993–May 15, 2013

Note . DENCAP = dental civilian aid/assistance projects; MCMO = medical civilian–military operation; MEDCAP = medical civilian aid/assistance projects; MEDRETE = medical readiness training exercise; MOOTW = military operations other than war; OHDACA = overseas humanitarian disaster and civic aid.

When one considers the entire eligible group of publications on the topic of MSTs, these studies represent a mere 5.7% of the more than 1100 publications on the topic in the past 20 years. Figure 2 illustrates the increase in annual publications on this topic in recent years. The peak of 15 publications per year occurred in 2012. The most common journal for these reports was the World Journal of Surgery with 15% of the publications (10 of 67).

Medical service trip publications by year (included and excluded), from literature search: January 1, 1993–May 15, 2013.

The results presented here synthesize the emerging and diverse nature of the MST literature. Results are organized around a series of questions that this literature attempts to answer. There are obvious gaps in the scope of the questions posed here. Moreover, much of the data generated by these publications lacks adequate support to answer fully these questions. Thus, the review closes with a proposal for the basic data points that participants in MSTs could collect during their efforts to answer the bigger yet still unanswered questions.

In spite of a diverse group of study designs, nearly all of the publications (98%) represent low-level evidence when judged against standard research design evaluation tools. Nearly two thirds of the publications can be classified in 3 groups on the basis of their study design. The largest proportion of the studies (49%) employed a retrospective study design or simple descriptive statistics to report their findings. Quality improvement or quality assurance projects represent the second most common among the published reports, with 9 studies (13%). Surveys of individuals that volunteer on MSTs and organizations that operate MSTs represent 10% of the publications.

Although the included articles all contained empirical results based on the use of systematic data collection, approximately one third of the studies did not describe their data collection process and 70% failed to describe approval from institutional review boards or their equivalents, leaving it unclear whether the organizations affiliated with these publications had their efforts overseen by an institutional review board. Most organizations freely reported the frequency of the procedures or visits that occurred during an MST (essentially outputs), but the data fail to include demographic characteristics such as socioeconomic status of patients or even gender and age distributions. 16 These are the most basic elements required to describe patient populations for the majority of scholarly literature.

Characteristics of MSTs That Publish Empirical Findings

This group of publications represents the broad scope of activities and locations in which MSTs are performed. With the exception of Antarctica, every continent is represented as either a provider or a recipient of care, with the majority of the recipients being distributed across regions of Africa, Central and South America, and Southeast Asia. Some publications (24%) describe individual trips to a single location. 17–32 Others (34%) describe multiple trips to single countries. 3,9,33–53 Finally, the last group (42%) describes multiple trips to multiple countries that in some cases are completely unrelated to one another. 5,6,15,54–78

The fields of optometry, medicine, pharmacy, and surgery were represented. Nearly 81% (54 of 67) of the studies reported on surgical trips, with 17 of the 54 referring specifically to cleft lip and palate interventions. Thirty-one percent (n = 21) of the publications included pediatric care. Trip duration ranged from 1 day to 8 weeks. Patient sample sizes varied considerably ranging from a single case to up to 8151 patients. Thirty-six (56%) of the 64 studies included reported a sample size of 200 or smaller.

Reported Magnitude of MST Efforts

Magnitude can be defined as both the financial expenditures and the volume of procedures associated with MSTs. According to 2 publications, respondents indicated that the total costs of MSTs ranged from $12 600 to $84 000 per trip (mean ranging from $22 650 59 to $34 400 5 ), and conservative estimates for annual expenditures from teams departing from the United States totaled $250 million. 5

McQueen et al. published the results of their survey of medical service organizations and reported that the organizations perform 223 425 surgical cases per year. 70 Many of these organizations and others may be focusing on maximizing the number operations in a short-term setting at the potential expense of quality of care. 78 Approximately 13% of the organizations surveyed provided more than 1000 cases per year. 70 Again, with estimates of expenditures from the United States alone reaching one quarter of a million dollars and with hundreds of thousands of patients treated annually, questions naturally arise about the return on investment.

Cost-Effectiveness in Low- and Middle-Income Countries

An increased focus on the publication of projects that measure the cost-effectiveness of their interventions is a promising and emerging trend in the development of the evidence base for MST activities. 17,45,67 Three publications used cost-effectiveness analysis as a mechanism for evaluating the efforts of MSTs. Two of the 3 cost-effectiveness studies reviewed cleft lip and palate surgeries performed by 2 organizations. 45,67 As noted in the article by Moon et al., both their study 45 and the previous study by Magee et al. 67 concluded that intervening surgically for cleft lip and palate patients represents a cost-effective intervention with a cost per disability-adjusted life year (DALY) of $68 and $34, respectively.

The third cost-effectiveness study evaluated orthopedic surgical trips to Nicaragua and comparably defined the interventions as cost-effective, but at a much higher investment level of $352.15 per DALY averted. 45

Factors That May Limit the Evaluation of MSTs

The contributions of some of the included publications are limited because of the lack of priority for research among medical service organizations and the absence of standardized evaluation tools. Medical service organizations do not regularly include research as a part of their goals.

A survey of 10 international volunteer organizations revealed specifically that they see it as a luxury or side project that yields limited benefits to their mission. 78 Maki et al. contributed a tool for use with MSTs 5 ; however, only 1 of the 21 publications subsequently citing this article described using the proposed tool in any form. 60 Current evaluative measures fail to assess any unintentional harm resulting from MSTs. 2

Reasons Why People Participate in MSTs

Numerous publications, including those from scholars in business, economics, sociology, and tourism, have explored the motivations of volunteers participating in MSTs. Some have claimed that participation in an MST provides an opportunity for personal development, and others have reported an opportunity to promote diplomatic relations. 60 Beyond the article by Chiu et al., 60 only the literature discussing the work of military MSTs explicitly addresses the concept of diplomacy.

Withers et al. reported emotional benefits, as well as career and professional benefits derived from participation in MSTs. 53 Panosian and Coates asserted that the global perspective emerging in students that have matured in the era of globalization materializes in the form of MSTs throughout the US medical education, from aspiring medical students to the postgraduate level. 79 Although they may get these same emotional benefits, they also hope to gain exposure to medical care, show a compassion for the less fortunate on their medical school application, and gain connections in the field. 53

Personal connections to the mission of an organization play a role in a volunteer’s interest, and the emotional experiences draw volunteers together creating relationships that extend beyond the trips. 53 Relationships and the volunteer’s ability to feel valuable and useful are reportedly among the most important factors in motivating volunteers to return for future MSTs. 53 Withers et al. also reported that only 1 of the 30 interviewees discussed a religious or spiritual reason for volunteering. 53

Role of Religion or Faith-Based Organizations

From the 19th century through the early 20th century, MST efforts appear to have been predominantly faith-based. Current efforts, however, are increasingly secular. 80

Among the reviewed literature, Internet searches of the organizations described revealed that only 18% (12 of 67) of the publications refer to activities performed in conjunction with a faith-based organization. This is lower than the 33% of faith-based organizations represented in a survey of 40 medical service organizations from 2010 59 ; thus, the proportion of faith-based organizations reported in this review may slightly underrepresent the proportion performing these activities overall. 53

Role of Education in MST Activities

Medical service organizations often tout reciprocity for their public image in the form of bilateral education—that is, providers from HICs learning from providers in LMICs and vice versa. Therefore, education has 3 forms on these trips: (1) education of students from HICs by providers from HICs and LMICs, (2) education of providers in LMICs by providers from HICs, and (3) education of providers from HICs by providers from LMICs.

Two studies from this review focused solely on the education of pharmacy students or surgical trainees resulting from MSTs. 57,58 Both studies reported a strongly positive experience and the second claimed to be the first to demonstrate the ability of an MST to provide positive training in cultural competency. The concept of cultural competency is a key training item for the Accreditation Council for Graduate Medical Education. Campbell et al. argued that some residency training programs in the United States could use MSTs as a mechanism for meeting that training competency. 58

Almost half (48%) of the included studies indicated that their trip included an educational component or exchange aimed at increasing the medical knowledge of local providers or community members. Several of these publications discussed the third educational form loosely, but they fail to formally evaluate or measure this practice. Compiling results from 3 studies that included surveys of medical service organizations reveals that respondents reported an educational or training component in 43%, 59 60%, 5 and 89% 70 of trips.

Publications associated with various international partnerships between providers in HICs and LMICs included the term “independence” when referring to local provider achievements. 36,41,44,46,52,61,73,74 Independence seems to mean that the providers achieve a level of competence that reflects the observable ability to safely manage patients and treat them in a manner equivalent to the quality achieved in HICs. All of these partnerships began as MSTs, or MSTs continually support and augment the care provided by local providers. All but 1 evaluated their ability to establish independence among the local providers (although they failed to include descriptions of methods for evaluating it). The publications reported on relationships that ranged in length from 2 to 15 years. Although there is not a clear timeline to independence, publications describing partnerships lasting 10 years or less at least showed independence in postoperative management. The 2 publications reporting relationships of greater than 10 years showed a mixed level of independence. 52,73 One reported complete independence at 15 years and one reported independence at 75% of their sites 14 years into the relationships. 44

Patient Outcomes From MSTs

When asked about patient outcomes and the processes in place for the collection of patient outcomes, volunteers or the organizations that facilitate MSTs reported 1 to 3 days of follow-up and surgical trips included follow-up ranging from 1 day to 1 week. 5 Surveys by Maki et al. and others revealed that 60% to 80% of organizations tracked morbidity and mortality data. 5,70,78 This is in stark contrast to the standards in HICs that track this information and in some cases pay providers according to performance on these measures.

In this review, 13 of the 67 publications (19%) reported mortality in a total of 59 patients. Nearly half of these (n = 30) were likely the result of progression of the disease being treated or a comorbidity. Five died from unknown causes. Four deaths were attributable to sepsis, allergic reactions, or a blood transfusion reaction. Two deaths reportedly resulted from complications associated with pre-existing conditions that patients failed to report preoperatively. 6 One case of malignant hyperthermia was reported in this group of publications. The remaining deaths related largely to cardiopulmonary complications in operative cases for various cardiac conditions.

For our purposes, outcomes are classified in 2 ways: early and late. I defined early outcomes as the immediate postintervention or perioperative periods ranging from zero to 7 days. I defined late outcomes at minimum as 8 days after treatment or as the period after the trip on which the patient received initial treatment.

Among the 50 publications (75%) focusing on the patients of MSTs, only 26% (n = 13) reported late outcomes. The length of follow-up included in these publications ranged from approximately 3 months to 7.6 years. The proportion of patients included in those follow-up statistics ranged from 14% to 84%. The remaining 74% (n = 37) of publications excluded any documentation of outcomes or they were limited to early outcomes.

One qualitative study aimed to establish the feasibility of collecting late outcomes in cleft palate patients. 49 This study presents a unique view into the world of these patients in some cases years after their surgeries. These patients received care from numerous groups and the results do not represent outcomes for one specific intervention. 49 Most notably this publication revealed that patients and their families attribute multiple benefits to surgical intervention despite the absence of the HIC standard level of follow-up care for speech and swallow therapy.

Noma describes an often fatal rapidly spreading and invasive gangrene with edema of the face originating from an ulcer of the mucous membrane and extending outwardly to destroy bone and soft tissue in surrounding regions. 81 In HICs, interventions for noma may have failure rates as high as 73%. 56 Bouman et al. reported complications in 64% of patients and outcomes that were classified as “bad” in 41%. 56 This article presented data regarding early outcomes alone.

How Those Affected by MSTs Perceive Teams and Activities

Green et al. provided the first empirical evidence regarding the perception of people directly and indirectly connected to the work of MSTs in Guatemala. 3 This interview group (n = 72) was composed of health care providers, family members of patients, government officials, foreign medical providers, and nonmedical personnel that work with or around MSTs. One Guatemalan physician indicated that medical service volunteers inaccurately perceive that everyone is poor, thus relieving them from the need to assess the socioeconomic status of patients. 3 The authors covered a few benefits that Guatemalans attribute to MSTs including providing necessary specialty services to patients, education for local providers, and donations of supplies, but even the benefits they described came with strong caveats about problems that may result from improperly distributing services and materials. The authors also explored unintended consequences of the actions of MSTs and attributed causality largely to a lack of knowledge of the surrounding medical and sociological environment.

Reeve et al. used open-ended survey questions to explore the beliefs and expectations of patients and families receiving care from MSTs for cleft lip or palate. 29 The patients expressed that they believed that the surgery would make a dramatic difference in their lives and that their primary goal for the surgery was improving their speech. According to the authors, most informants inaccurately perceived the origins of the developmental disorder. Finally, the primary concern for patients’ parents going into surgery was pain management.

Deonandan et al. described an MST aiming to improve health literacy among tribal people in Guyana awaiting care from their team. 40 The MST identified a basic disconnect between some of the ideas expressed in public health messaging and the knowledge base of the community. Although many describe the presumed benefits of repeat trips to an area, only Jewell described the phenomenon of gender empowerment as a benefit. 21 The observation of female involvement in the MST prompted women to express feelings of a new ability to move toward gender equity. 21 This empowerment differs from the standard definitions employed in the United States, but nonetheless the presence of the MST and the distribution of authority on the team across both genders promoted female empowerment in this setting.

Outputs vs Outcomes of MSTs

Because of their study design and isolated data that may be difficult to reproduce, one group of publications (n = 18) has extremely limited generalizability and benefit for the MST knowledge base. These studies did not include any assessment of the outcomes of interventions. In some cases, they reported on early clinical outcomes associated with morbidity and mortality that occurs during the stay of the team, but intervention efficacy remained absent from their discussions. In the Methods section for some of these publications, there was little or no information about the data collection process or any analysis plan. The focus of the Methods section in these articles was the model of delivery or the intricacies of the setting of the MST.

Among the medical interventions (n = 2) in this group of publications, one described the utilization of a needs assessment in the planning process for their MST, but there was no description of the tool. 25 This represents the only publication in the entire group of 67 that explicitly mentioned employing this practice. This group also elected to focus on only 2 conditions (hypertension and parasite infection). Outcomes related to these goals are not available. One publication focusing on nonsurgical patients described the conditions observed and the interventions performed for these patients. 9 There are no outcomes associated with this publication. None of the publications relating to surgical care (n = 16) from this subgroup included outcomes beyond the perioperative period, and they failed to provide much information beyond descriptive statistics for specific MSTs.

Reporting outputs rather than outcomes appears to be the default approach for quantifying the value added to the communities and individuals served by MSTs. This criterion, however, falls short of the measures used to identify high-quality evidence-based medicine. In some cases, the included publications relied on personal judgments or anecdotes to support their conclusions. This weak form of evidence has the potential to overshadow some of the more promising work in this field. Most of the questions raised in the Results section are unanswered by the included publications, and more research is necessary to strengthen the evidence available. The assessment of process output data, without assessing the short-term or long-term impacts of MSTs, 82 precludes the ability to measure efficacy of interventions performed.

Aiming to assess the quality of the evidence in some cases justifies the use of a standardized hierarchical evaluation tool. For instance, the tool developed by the US Preventive Services Task Force classifies evidence on the basis of the employed study design, with randomized controlled trials representing the highest level of evidence. However, because of the emerging nature of this body of literature, distinctions based on study design have limited benefits. The assumption with that form of evaluation is that authors have unified research questions and are aiming to move up the hierarchy with their work. In the case of the wide-open nature of the MST literature, authors are not united in their research questions nor study designs to advance the scientific rigor of their efforts.

Students and Trainees as Volunteers

The motivations and expectations of MST volunteers may be as diverse as the trips in which they participate. The enormous number of available MSTs, their short-term nature, and the relatively low cost associated with travel makes MSTs a common choice to fulfill the desire for international experience among students and nonstudents alike.

Some disparities research argues that cultural competence plays a role in the quality of care provided to minority populations. 58 That assertion prompted academic medicine to encourage training in cultural competence. Some institutions utilize MSTs as a mechanism for cross-cultural training and integrate these programs into their medical education curriculum. The sample sizes and limited scope of the work regarding the relationship between MSTs and educational benefits limit conclusions at this point.

The answers and conclusions from a limited survey of pharmacy students participating in MSTs are largely unrevealing about the motivations and expectations of the students. They note that experiences on the trips have a positive impact on participants, but the brevity and close-ended form of the survey does not allow for an exploration into specifics about how they will put those positive experiences into action beyond possibly traveling on another trip. 57 The overwhelmingly positive responses among surveyed surgical trainees raises concerns about bias, particularly social desirability. 58

Students and trainees may elect to participate in MSTs for reasons similar to those of nonstudents, but their motivations also may include the desire to receive career and professional benefits. 53 There is a limited number of studies assessing the impact these trips have on the life trajectory of students, their participation in future mission-related activities, or the actual benefits of the social capital on their academic pursuits. Another gap exists in the literature regarding MST organizations and their view of the role they play in medical education process.

Education Through Partnerships

The term partnership should not imply reciprocity between providers from HICs and those from LMICs. The intention behind every partnership appears to be the education or training of surgeons and other providers in communities with limited access to specialty care. In some cases, these partnerships bring patients that local providers refer to HICs for treatment. One organization that sends children to the United States for care cites this as a far more expensive model, increasing costs 10-fold. 74 That contrast prompts most organizations to opt for traveling to countries to train local providers in operative techniques utilized in HICs. Evaluations of the outcomes of that training yield mixed results and seem to require an extended, possibly 15 years or more, presence and partnership to ensure quality.

Many partnerships also include the donation of materials and durable medical equipment. One publication notably reports the inclusion of biomedical engineers in their traveling teams as a way of managing donated equipment that often falls out of repair. 74 This addition is often absent from MSTs and has been the source of published concerns historically. 83

Faith Communities and MSTs

In the mid-1880s, to pursue their mission of caring for the soul, the mind, and the body, the Catholic Church began sending missionaries throughout the world, establishing churches, schools, and hospitals. 80 Such origins may lead to the assumption that faith is motivational for volunteers. Although the assumption may have validity, there is limited evidence for it in the published literature reviewed here. Surveys of medical service organizations reveal a higher proportion of faith-based activities than the 18% of publications included in this review. This is almost certainly a publication bias related to the absence of organizational motivation to publish findings in the medical literature.

The absence of informants describing religious reasons for participation raises some interesting questions about whether the majority culture of medical service is outside the faith-based community, if there is change in the comfort with discussing religion, or if this simply an anomaly among the groups that are participating in research. There is no known work comparing outcomes or the impact of faith-based MSTs versus secular efforts.

Creating and Implementing Evidence in MSTs

There is no shortage of opinions about the ideal framework for an MST, but there is a significant shortage of evidence to support any particular framework. 10 By developing or planning MSTs that include data collection in the mission, practitioners can begin to address some of the concerns and validate the practice or provide information about areas that need improvement.

Maki et al. attempted to address this gap by creating a tool for use by MSTs 5 ; however, for unknown reasons, this tool has not been widely implemented or its use has not been subsequently published. One possible explanation for the apparent lack of adoption of this tool could be that the dissemination of the instrument failed to reach the organizations that could put it into action. Another explanation could be that the organizations faced challenges with its implementation that reduced the return on investment for the process to an unfavorable level. Regardless of the reason, tools for organizations to evaluate their work remain a need.

Critics argue that because of the lack of research on structure, process, or outcomes, a fraction of the care provided as a part of MSTs in the developing world has any evidence base at all. 84 Implementing evidence faces significant challenges in this health care delivery model. First, it assumes that providers are aware of evidence-based practices and only treat patients that fall under the spectrum of populations covered by guidelines. Second, it assumes that providers will deliver medical care in a standardized manner including the provision of continuous or follow-up care by either the group or a local provider. Finally, it assumes that they will perform outcome analyses. By definition, MSTs do not typically deliver care under this model.

The primary goal for medical service organizations is health care delivery and these organizations do not commonly prioritize the collection and subsequent evaluation of data. 71 Delivering care without understanding the impact or the outcome of that care presents ethical challenges. 2 Long-term outcome measurement is difficult, but necessary. 49 The consensus for the ethical challenges of MSTs is that there should be no assumed ethical immunity solely based on the altruistic nature of these efforts. 2

Guidelines and Unintended Consequences in MSTs

In some cases, experts and workgroups are establishing guidelines and standards for humanitarian health care delivery. The dissemination and implementation of these standards again faces challenges related to the unregulated and uncoordinated nature of these activities. Chapin and Doocy expressed a concern about their finding that only 25% of respondents were aware of the World Health Organization Guidelines for Drug Donations. 59 Reflecting that absence of knowledge, 20% of the respondents reported that they did not leave their donations with qualified medical professionals or health organizations. Drug accountability may be tightening globally and the practice of leaving behind medications is receiving a growing level of scrutiny.

The ethical concerns raised by critics, such as Crump, DeCamp, and others, suggest a need for ethical standards that will guide the work toward measurable benefits in light of the inherent risks. 85–90 There is a need for objectives and long-term plans developed in coordination with recipient communities. 78

Outcomes Associated With MSTs

Bureaucrats, consumers, and researchers commonly measure the quality of health care on the basis of patient outcomes, defined according to recovery, restoration of function, and survival. 91 Morbidity and mortality associated with treatments are standard; however, changes in the quality of life resulting from medical interventions are rarely measured in this literature.

Although it is not safe to assume that health care providers are solely responsible for these outcomes, their actions play a role in the process and represent an opportunity for inquiry. Patient outcomes are the most concrete measure of quality, but they are among the least commonly described concepts in the MST literature. Outcomes in this literature may also refer to the impact on the volunteer, on the patient relative to the cost, and on the local health care providers.

Determining Outcomes and Success

The challenges of medical resource shortages come to bear in discussions of patient outcomes. Following patients or obtaining reports regarding the outcome of the interventions performed by MSTs after a team departs remains uncommon and requires intentional effort and resource allocation. 49 The challenges are inherent with the transient nature of the patient population and the distances traveled to seek care from service teams. Most teams do not have the ability or data to attest to their psychological, financial, or sociological impact.

The 13 studies that included a measurement of late outcomes all related to surgical interventions, and there seems to be no data regarding the late outcome of any intervention performed by a strictly medical team. In some cases, the best follow-up available is the vital status of patients, but a few of these publications do attempt to evaluate the efficacy of the intervention.

Focusing largely on fistulas and cleft palates, the bulk of the outcomes literature falls under the auspices of general or plastic surgery. A few of these reported outcomes are bad enough to raise serious concerns. Preconceived ideas about the risks and benefits of surgery have a sociocultural component, particularly in the context of plastic or reconstructive surgery. Patients and their families have beliefs about the origins of congenital conditions, concerns about the reconstructive procedures, and expectations for the outcomes of the intervention. Understanding the role of the MST to address the perceived origins of conditions in a culturally sensitive way may provide another opportunity to reduce the marginalization of the affected.

Cultural awareness is one of the most important parts of defining successful patient interactions and surgical interventions. Learning that parents fear the pain for their children more than other factors allows providers to concentrate on that aspect of the consultation to alleviate their fears. 29 Realizing that speech outcomes were the primary interest for patients allows surgeons to manage the expectations for each individual procedure. 29

Although the aesthetic changes resulting from this type of surgery may provide a dramatic background for fund-raising efforts, aesthetic outcomes, though important to the patients, were less significant than speech outcomes in their definition of success. 29 Speech assessments after cleft lip and palate surgeries were seldom completed and, when they are completed, may reveal unsatisfactory results. 49,63 Operative success in HICs does not stop with satisfactory aesthetics and MSTs should find creative ways to match that standard.

Although organizations aim to provide high-quality care, evaluating outcomes should be universally included in their activities. 70 Yeow et al. summarized the aims of surveyed organizations, and conducting research was considered by most to be a luxury only. 78 The combined results from publications included in the present systematic review report a total of 59 deaths in association with the care provided during MSTs. Simply assuming the care provided is safe and has minimal risks is no longer adequate for these activities.

Comparing Outcomes in Light of Expenses

Recent trends in global health evaluation employ cost-effectiveness analysis to compare interventions and their ability to address the United Nations Millennium Development Goals. These goals aim to increase access to high-quality cost-effective care in LMICs. Comparing the cost-effectiveness of interventions associated with MSTs assists with resource allocation decisions. Disability-adjusted life years serve as the unit of analysis for comparative purposes by accounting for the years of life lost because of disease or injury. These calculations have been widely utilized in public health and health economics.

Interpreting the cost per DALY of interventions introduces subjectivity when determining their cost-effectiveness, especially as they relate to MSTs. The World Bank established guidelines for these determinations in 1993, approximating $150 per DALY as the cutoff for determining cost-effectiveness. 45 Although the costs vary substantially, 3 publications in this review reported their interventions to be cost-effective even though one nearly doubles the World Bank cutoff. 18,45,67 There are limitations to this type of work, but it does represent a promising area for comparative evaluation of MSTs. The basic data necessary for these calculations should include diagnoses and treatments (already collected by most teams), costs for the hosts and volunteers for all treatment and follow-up activities, and a measure of the costs for patients including opportunity costs associated with missed income from work. Decisions about cost-effectiveness may translate to comparisons between trips within organizations or they could relate to comparisons of the costs to employee local providers rather than the standard MSTs. Both raise questions about sustainability, and the limited cost-effectiveness data for MSTs leaves these issues open for debate.

The diversity of terms associated with MST activities in the published literature increases the likelihood of underestimating the number of eligible articles. This review was limited to English-language publications, which may have created a selection bias if we consider the global nature of these activities. This review is also limited to the medical literature, which may exclude notable work in other fields of study.

Conclusions

The popularity of MSTs is increasing along with publications on the topic; however, nearly 95% of all publications lack any significant data collection and the outcomes from the interventions that do exist are not well understood. The MSTs that travel to LMICs are largely unregulated and often lack evaluative procedures. Unfortunately, because of the largely disorganized and diverse nature of these efforts, health care providers choosing to participate in these activities are largely left to their own impetus to participate in evaluative data collection and critical process or activity reviews. The vulnerable nature of the patient populations served by MSTs raises frequently discussed ethical concerns including the provision of care within the regular scope of practice of the provider 92 and the adoption of standards comparable to those of routine research with human participants. 2 The self-imposed standards for MSTs should also include basic critical reviews powered by data collection and evaluation.

Collecting data about the quality of care from patients served by MSTs is a challenge and only a few organizations have shown the initiative to publish the data they collect. Organizations may be evaluating their efforts for internal quality improvement, but the volunteer nature of these efforts and the absence of incentives for publication may mean that these results are not widely disseminated. If these reports do exist, their dissemination could benefit MST efforts in general by allowing others to learn from successes and failures of similar groups.

Evaluation of cost-effectiveness is relatively new to the MST arena. Relative comparisons to United Nations standards may be problematic and the value of these assessments may be limited to internal comparisons between trips for medical service organizations. The educational benefits and impact on cultural competency from these trips for students may represent a relatively easy area for objective evaluation in the future.

An emphasis on evaluation is warranted to improve the planning, implementation, and outcomes of MST investments. Furthermore, the limited number of publications describing rigorously evaluated MSTs may lead to the conclusion that the data do not exist and further support the historical criticisms of these activities.

Suggested Data Elements

There is a need for comprehensive data collection and outcome assessment to justify, quantify, and verify the impact of MSTs. Organizations and volunteers participating in MSTs should at minimum collect data related to patient demographics, the socioeconomic status of the patients including their household income and liabilities, the availability of regular care in the community, and the cost of delivering the care provided by the MST. Information regarding the outcome of the intervention performed by the MST is pivotal for decision-making and quality improvement.

Future research in the area of MSTs needs to focus on the development or implementation of materials or instruments capable of measuring the psychological, financial, and sociological benefits or costs of interventions in this setting. At this point, I am not aware of any validated and reliable instruments capable of this assessment.

Acknowledgments

I would like to thank Mary K. Zimmerman, PhD, Sarah Finocchario-Kessler, PhD, MPH, and Robert H. Lee, PhD, for reviewing the draft of the article and making helpful suggestions.

Human Participant Protection

No protocol approval was needed for this study as it is a review of previously published research.

• Open access
• Published: 20 April 2024

Development and validation of the hospice professional coping scale among Chinese nurses

• Yanting Zhang 1   na1 ,
• Li Zheng 2   na1 ,
• Yanling He 3 ,
• Min Han 3 ,
• Yu Wang 3 ,
• Jinyu Xv 3 ,
• Hui Qiu 3   na2 &
• Liu Yang 3   na2  

BMC Health Services Research volume  24 , Article number:  491 ( 2024 ) Cite this article

Metrics details

Hospice care professionals often experience trauma patient deaths and multiple patient deaths in a short period of time (more so than other nurses). This repeated exposure to the death process and the death of patients leads to greater psychological pressure on hospice care professionals. But at present, people pay more attention to the feelings and care burden of the family members of dying patients but pay less attention to medical staff. Thus, this study aimed to develop a scale on the burden of care for hospice care providers and assess the coping capacity of hospice professionals. Raising awareness of the psychological burden of hospice professionals.

Through a literature review, research group discussion, Delphi method and a pre-survey of professional coping skills among nurses, 200 hospice professionals who had received training in hospice care from pilot institutions engaged in or providing hospice care were selected for investigation. Cronbach’s α coefficient and split-half reliability were used to test the internal consistency of the scale, and content validity and explore factor analysis (EFA) were used to test the construct validity of the scale.

Two rounds of Delphi methods were carried out, and the effective recovery rate was 100%. The expert authority coefficients of the two rounds were 0.838 and 0.833, respectively. The Kendall’s W coefficient of experts in the first round was 0.121 ~ 0.200 ( P  < 0.05), and the Kendall’s W coefficient of the second round was 0.115–0.136 ( P  < 0.05), indicating a good level of expert coordination. The final survey scale for the care burden of hospice professionals included four dimensions—working environment (9 items), professional roles (8 items), clinical nursing (9 items) and psychological burden (7 items)—with a total of 33 items. The total Cronbach’s α coefficient of the scale was 0.963, and the Cronbach’s α coefficients of the working environment, professional roles, clinical nursing and psychological burden dimensions were 0.920, 0.889, 0.936 and 0.910, respectively. The total split-half reliability of the scale was 0.927, and the split-half reliability of each dimension was 0.846, 0.817, 0.891, and 0.832. The content validity of the scale items ranged from 0.90 to 1.00. Exploratory factor analysis revealed 5 common factors, with a total cumulative contribution rate of 68.878%. The common degree of each item in the scale was > 0.4, and the factor loading of each item was also > 0.4.

The scale is an open-access, short, easy-to-administer scale. And which for assessing hospice care burden among hospice professionals developed in this study demonstrated strong reliability and validity. This tool can serve as a dependable instrument for evaluating the burden of hospice care for terminally ill patients by professionals in the hospice setting.

Peer Review reports

Hospice care refers to providing patients with terminal diseases with physical, psychological, and spiritual care, as well as humanistic care, by controlling the symptoms of pain and discomfort to improve their quality of life and help them die comfortably, calmly, and with dignity [ 1 ]. In June 2020, hospice care was incorporated into Chinese law for the first time. Article 36 of the Law on the Promotion of Basic Medicine and Health clearly stipulates that medical institutions provide hospice care and other medical and health services to citizens [ 2 ]. As early as 2016, the National Health and Family Planning Commission issued the National Nursing Development Plan (2016–2020) [ 3 ], noting the need to strengthen capacity-building for hospice care and improve relevant mechanisms. While the state vigorously promoted the development of hospice care, it also exposed many problems. These problems include the relatively traditional concept of death for our citizens, uneven development in the field of hospice care, and a lack of human resources and teams. The legal provisions on hospice care are relatively broad, and a lack of understanding of hospice care services can easily lead to medical disputes [ 4 , 5 ]. This not only poses numerous obstacles to the practical development of hospice care but also exposes hospice nursing staff to complex clinical situations [ 6 ].

According to previous studies, hospice care professionals often experience traumatic patient deaths and multiple patient deaths in a short period of time (more so than other nurses) [ 7 , 8 ]. This repeated exposure to the death process and the death of patients leads to greater psychological pressure on hospice care professionals [ 9 , 10 ]. In different groups, social support alleviates many adverse outcomes of hospice care professionals, such as high psychological stress and high emotional burnout [ 11 , 12 ]. In addition, nurses in oncology departments and palliative care departments need to continue to provide empathy and care for patients, not only to bear psychological pressure but also to undertake the emotional work of patients’ families, which easily results in empathy fatigue [ 13 , 14 ]. The psychological stress caused by empathy fatigue seriously affects the mental health and nurse‒patient relationships of nurses and may even lead to their resignation [ 15 ]. The assessment of the care burden of hospice care professionals can provide a reference for the formulation of relevant policies, provide guidance for terminally ill patients and their families to implement better hospice care services, provide comfort and respect for people in the final stages of life, and promote the development of hospice care [ 16 ].

At present, people pay more attention to the feelings and care burden of the family members of dying patients but pay less attention to medical staff. In addition, the related assessment tools in China are mainly aimed at assessing nurses’ knowledge, attitudes and behaviors related to hospice care. For example, the assessment tool used by Zheng is the self-developed hospice care attitude scale [ 17 , 18 ], and few studies have assessed the psychological stress of medical staff. However, due to cultural differences, assessment tools such as the Zarit Nursing Burden Scale (ZBI) [ 19 ] are not applicable in other countries. In recent years, some scholars have developed and verified self-care ability assessment tools for hospice care practitioners, but there is still a lack of assessments of care burden [ 20 , 21 ]. Therefore, this study provides a tool for assessing the care burden level of hospice care professionals by developing a scale for hospice care professionals and testing its reliability and validity. In addition, this study provides a clearer understanding of the current situation and influencing factors of hospice care burden in China and evaluates the effectiveness of interventions to reduce hospice care burden.

Development and procedure

Constructing a scale item pool.

Under the guidance of the Zarit Nursing Burden Scale (ZBI) [ 19 ], which uses hospice care/hospice care/health care personnel/nurses care/stress/empathy/psychological burden/fatigue as the key words, a large number of related studies were consulted through Pubmed/Web of Science/CINAL/China Knowledge Network/Wan Fang and other databases. To form a pool of items in the nursing burden scale for hospice care staff. The scale pool consists of 32 items, including working environment, professional role, clinical nursing and psychological burden. All the items were scored on a 5-point Likert scale, and they were all positive.

Delphi method

Expert inclusion criteria.

Bachelor’s degree or above; intermediate or above professional title; engaged in clinical work ≥ 5 years; were familiar with hospice care treatment and highly enthusiastic about this study; and voluntarily participated in and completed multiple rounds of inquiries.

Delphi method expert consultation form

The expert consultation form consisted of four parts: an introduction, basic information from the experts, a nursing burden scale for hospice care professionals, and an expert authority scale. The preface introduces the purpose, significance, and instructions of this survey. The basic expert information table includes age, sex, educational background, professional title, clinical working years, research field, and whether he or she is a graduate tutor. The nursing burden scale of hospice care professionals includes four dimensions: working environment, professional role, clinical nursing, and psychological burden. The importance and relevance of the scale items were evaluated by experts. For items that need to be modified, deleted, or added, experts can write down their comments in the corresponding “modified comments” column. Importance is divided into 5 levels: level 5 is highly important, level 1 is highly unimportant, relevance is divided into 4 levels, level 4 is highly relevant, and level 1 is highly irrelevant.

The expert authority scale includes the degree of experts’ familiarity with hospice care (very familiar = 1, relatively familiar = 0.8, generally familiar = 0.6, unfamiliar = 0.4, very unfamiliar = 0.2) and the influence of judgment basis (work experience judgment/theoretical knowledge analysis/domestic and foreign relevant data) on expert judgment.

Distribution and recycling of scales

During the first round of Delphi, the items of the scale were made into an expert consultation form and sent to all the experts by email. The experts were invited to provide responses within a week and to integrate, analyse and discuss their views. After an interval of 2 weeks, the second round of the credit scale is sent to all the experts via the same process as the first round. The selection criteria for the items were as follows: mean importance ≥ 4, coefficient of variation (CV) ≤ 0.25, and full score ratio > 0.20. Items that met all three criteria were retained. If only 1–2 criteria are met, further confirmation or panel discussion with the expert is required to decide whether to retain the criterion, and if none of the three criteria are met, the criterion is deleted [ 22 ].

Item modification content

After the first round of Delphi method, the items were added or modified according to the experts’ scores on the importance and relevance of the items as well as the expert’s advice. Three items with a coefficient of variation > 0.25 and a full score ratio < 0.2 were excluded (see supplement 1: Tables  1 and 2 for specific results). In the clinical nursing dimension, there is an item that does not meet the above criteria: “Do you think the terminally ill patients or their families you care for will require too much care for you?” After discussion with the working group, this item was retained because of its importance. The languages of 10 items had to be revised. One new item was added to each of the three dimensions of working environment, professional role and clinical nursing, and the new item was “Do you think that hospice care currently lacks the support of social recognition and other social forces?”, “Do you think it is more difficult for hospice workers to gain a sense of professional achievement?”, “Do you think that family members’ recognition and compatibility with hospice care is an important factor in carrying out work?”

After the second round of Delphi method, only one of the items in the clinical nursing dimension was modified: “strong death identity” was replaced by “patients who are pessimistic about death”. Finally, the nursing burden survey scale of hospice care professionals was developed, which included working environment (9 items), professional role (8 items), clinical nursing (9 items) and psychological burden (7 items), for a total of 33 items.

Pre-investigation

Using a convenience sampling method, 50 hospice care professionals who were engaged in or who received hospice care training in pilot hospice care institutions were selected as the research subjects in October 2022. In the course of the survey, the participants were closely observed for difficulty in understanding the scale and their opinions. After the last 2 rounds of Delphi method, all the entries were retained for formal investigation.

Sample size

According to the rough estimation method of sample size proposed by clinical epidemiology, the sample size is 5  ∼  10 times the number of items in the scale [ 23 ], and the final number of items in this scale is 33, so the sample size is 165  ∼  330.

Characteristics of participants

Using a convenience sampling method, 200 hospice care professionals who were engaged in or who received hospice care training in several hospitals or hospice pilot institutions were selected in December 2022, of which 150 were used for supplementary investigation. It should be noted that the supplementary survey objects here are the sample sizes collected after the presurvey. The inclusion criteria for participants were medical staff who participated in hospice care and who had received training, were aged ≥ 18 years, were clearly conscious, had good expression, provided informed consent, and had more than 2 years of work experience. The exclusion criteria were working for ≤ 2 years; not providing informed consent; only professionals who understood but did not participate in the hospice care system; and who had received training in the hospice care system.

Survey tools

① The general and basic conditions of hospice care and nursing staff. ② The scale of care burden of hospice nurses included four dimensions: working environment (9 items), professional role (8 items), clinical nursing (9 items) and psychological burden (7 items). On a 5-point Likert scale, 1 indicates complete lack (very disagree), and 5 indicates proficiency (very much agree).

Investigation procedure

The scale survey method was as follows: To ensure the smooth progress of the study, informed consent was obtained from the respondents before the scale survey, and the purpose and significance of this study were explained to the respondents to obtain cooperation. All the scales distributed in this study were distributed and completed through the scale stars. It can only be submitted after answering the set questions. It can only answer each time to ensure the rigor, authenticity and completeness of the scale. The scale collected must be reviewed by the research team, and if all the answers are the same, it will be determined to be invalid. A total of 250 copies were distributed in this study, and 200 copies were recovered.

Statistical methods

The data were inputted by two people using EpiData 3.0 software, and SPSS 23.0 statistical software was used for descriptive analysis, project analysis, exploratory factor analysis [ 24 ], correlation analysis, reliability and validity testing. The specific contents of the analysis were as follows: the items of the scale were screened by the differentiation method, and the items were sorted according to their scores. The first 27% of the scores are high, and the remaining 27% are low. Then, the average score of each item was calculated for the high score and low score groups. Using the independent sample t test, if the average score of an item has no significant difference between the high score and the low score (0.05), the importance and differentiation of the item are not significant, and the entry is excluded [ 22 ]. Cronbach’s α coefficient and the Spearman Brown method were used to test the reliability. Content validity and construct validity were used to test the validity of the scale, item-level content validity (I-CVI) and average scale-level content validity (S-CVI/Ave) were used as content validity indicators, and exploratory factor analysis was used to determine the number of common factors, cumulative contribution rate and eigenvalues of the scale. The screening criteria for each item were cumulative contribution rate > 60%, eigenvalue > 1, common variance > 0.4, and factor load > 0.4 for each entry.

Ethical considerations

All participants provided signed informed consent when reliability and validity tests were conducted. This study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University [2,022,119 K].

Basic characteristics of the experts

A total of 20 experts were selected for this study, and the details are shown in Table  1 .

Basic characteristics of the study subjects

Table  2 shows the general characteristics of the hospice care professionals.

Delphi results

A total of 2 rounds of Delphi method were conducted, 20 scales were distributed in each round, and the effective recovery rate was 100%. In the first round, 10 experts put forward their opinions, and in the second round, two experts put forward their opinions, and the experts were highly motivated. The authority coefficients of the two rounds of experts are 0.838 and 0.833 respectively. The expert authority coefficient of Delphi method is 0.75  ∼  1. It is generally believed that an expert authority coefficient greater than 0.7 indicates the degree of expert authority [ 22 ], so the degree of expert authority in this study is greater. The Kendall consistency of the experts in the first round was 0.121  ∼  0.200, and the reliability of the experts in the second round ranged from 0.115 to 0.136 ( P  < 0.05).

Analysis of scale entries

The t values of each item in the high-score group and the low-score group ranged from 5.442 to 10.170 ( P  < 0.05), and there was no item that could be deleted.

Scale reliability

The reliability of the scale is based on Cronbach’s α coefficient and the half-and-half reliability coefficient, which are commonly used to determine the reliability of the index. It is generally believed that Cronbach’s α coefficient and half-and-half reliability coefficient are greater than 0.7, indicating that the scale has good reliability. (Table  3 ).

The Cronbach’s α coefficients of each dimension of the scale were 0.920, 0.889, 0.938 and 0.910 respectively, and the half-and-half reliability coefficients were 0.846, 0.817, 0.891 and 0.832, respectively, while the Cronbach’s α coefficient and half-and-half reliability coefficient of the total scale were 0.963 and 0.927, respectively, all ≥ 0.7, indicating that the scale had good reliability, internal consistency and stability.

Content validity (correlation score 1–4)

The validity of the scale was expressed by the content validity index (CVI), including the content validity index of the item level (I-CVI) and the average content validity index of the scale level (S-CVI) [ 25 ]. When the I-CVI > 0.78, the content validity at the item level is better [ 26 ]. S-CVI/Ave is the average I-CVI for all projects. When the S-CVI/Ave > 0.9, the scale has good content validity at the average level [ 27 ].

The I-CVI was 0.90-1 > 0.78, and the content validity at the item level was good. The S-CVI/Ave was 0.967, and the S-CVI/Ave of each dimension was > 0.90, ranging from 0.964 to 0.980. The content validity of the average scale was good.

Structural validity - exploratory factor analysis

Kmo and bartlett tests (table  4 ).

Table  4 shows that the KMO values are all greater than 0.7, the validity is good, and P  < 0.001. There is a correlation between variables, so exploratory factor analysis can be carried out.

Using principal component maximum variance rotation factor analysis

According to the analysis of the overall structural validity of the scale, the scale has five common factors, and the total cumulative contribution rate is 68.878%. After principal component analysis and maximum orthogonal rotation of variance, the common variance (commensurate) of the scale was more than 0.4, and the factor load of each item was also more than 0.4. Factor 1 is the clinical nursing dimension, factor 2 is the psychological burden dimension, factor 3 and factor 5 are the working environment dimension, and factor 4 is the professional role dimension. It should be noted that the B1 entry in factor 3 is slightly different from the structure of the original scale. However, considering that B1 reflects the content related to professional roles, after expert discussion, the entry remains in the professional role dimension. The specific analysis is shown in Table  5 below. (A is the working environment dimension, B is the professional role dimension, C is the clinical nursing dimension, and D is the psychological burden dimension).

Quality control of scale preparation

In the process of developing the scale, we first consulted a large number of related studies at home and abroad under the guidance of the Zarit Nursing Burden Scale (ZBI) to ensure the standardization, rigor and rationality of the scale. After 2 rounds of Delphi method, the relevant items of the scale were further revised. We selected experts in the fields of clinical nursing, geriatric nursing, nursing management, nursing education, nursing research, oncology clinics, etc., and proposed constructive suggestions for the revision of the contents of the scale to ensure its quality. In the process of sending the scale to the expert, we carefully checked whether there were missing items in each scale to ensure the effectiveness of the scale collection. After 2 rounds of Delphi method, the effective recovery rate of the scale was 100%. In the first round, 10 experts put forward their opinions, and in the second round, 2 experts put forward their opinions. The authority coefficients of the two rounds of experts are 0.838 and 0.833, respectively, indicating a high degree of authority. Kendall’s W coefficient of the first-round expert opinion test was 0.121-0.200 ( P  < 0.05), and Kendall’s W coefficient of the second-round expert opinion test was 0.115–0.136 ( P  < 0.05).

Reliability evaluation of the scale

In terms of reliability, it is generally believed that the reliability of a scale is good when the Cronbach’s α coefficient and Spearman-Brown coefficient are above 0.7. The Cronbach’s α coefficients of each dimension of the scale are 0.920, 0.889, 0.938, 0.910, 0.86, 0.817, 0.891, 0.832 and 0.927, indicating that the reliability, internal consistency and stability of the scale are good.

Validity evaluation of the scale

Content validity.

Content validity, also known as apparent validity or logical validity, refers to whether each item of the scale measures what it wants to measure, that is, whether the object’s understanding and answer to the question is consistent with what the item designer wants to ask [ 28 ]. In this study, the Delphi method was used to invite experts to score the relevance of the scale and evaluate its content validity. When I-CVI/Ave > 0.78 and S-CVI/Ave > 0.9, the content validity of the scale is good. According to the results of expert evaluation, the item-level content validity (I-CVI) is 0.90-1.00, and the average scale-level content validity (S-CVI) of the total scale is 0.967, indicating that the scale has good content validity.

Structural validity

Construct validity, also known as construct validity or feature validity, refers to whether the structure of the scale is consistent with the theoretical hypothesis of tabulation and whether the internal components of the measurement results are consistent with the field that the designer intends to measure; the commonly used statistical method is factor analysis, which reflects the contribution of a project to the field. The greater the factor load value is, the closer the relationship is to the domain [ 29 ]. Five common factors were extracted based on a characteristic root > 1, which explained 68.878% of the total variation. The commonness of 33 items in the scale is ≥ 0.4, and the factor load of each item is also ≥ 0.4, indicating that the construct validity of the scale is good.

The practicality and significance of the scale

On the basis of an extensive literature review and Delphi method, the nursing burden scale of hospice care professionals in China was developed. To clarify the current situation and influencing factors of the care burden of hospice care professionals in China, and to evaluate the effect of intervention measures on the care burden of hospice care professionals. At present, hospice care has received increasing attention, and a series of problems have emerged. One of the problems related to health care staff is the nursing burden. The scale developed in this study is practical and helpful for nursing managers to formulate intervention measures to reduce their nursing burden and improve the efficiency of hospice care.

Limitations and further research

As with any study, this study had several important limitations. In this study, exploratory factor analysis was used to develop and verify the scale, which ensured the scientific nature of the study in terms of methodology. However, in the actual investigation process, because there are many nurses involved in hospice care in the oncology department, most of the population was selected from the oncology department, which may have biased the results. There are 33 items in total. In the future, a short version of the scale will be further developed and verified in multiple centers to ensure the popularization of the scale.

Conclusions

The reliability and validity test showed that the care burden scale of hospice care professionals developed in this study has good reliability and validity and can be used to evaluate the level of care burden of hospice care professionals in China. However, confirmatory factor analysis was not performed for the scale, and the selected samples were mainly medical staff engaged in or carrying out hospice care pilot institutions in Hubei Province. The representativeness of the sample size needs to be studied, and the sample size will be further expanded in multiple centers to improve the content of the scale.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

In this study, the participants were medical staff, whose cooperation throughout the study was appreciated.

The study did not receive any funding.

Author information

Yanting Zhang and Li Zheng contributed equally to this work.

Hui Qiu and Liu Yang contributed equally to this work.

Authors and Affiliations

Department of Critical Care Medicine, Hubei Clinical Research Center for Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China

Yanting Zhang

Department of Lung Cancer Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China

Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China

Yanling He, Min Han, Yu Wang, Jinyu Xv, Hui Qiu & Liu Yang

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All listed authors have contributed substantially to the manuscript in the following ways: Z.Y.T (Conception, Design, Data Collection, Writer, Analysis and Interpretation); Z.L (Design, Data Processing, Writer, Analysis and Interpretation); H.Y.L, H.M, W.Y，X.J.Y， (Analysis and Interpretation, Literature Review); Q.H.(Literature Review, Writer, Critical Review); Y.L (Literature Review, Writer, Critical Review).

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Correspondence to Hui Qiu or Liu Yang .

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The purpose of this study was to develop and validate scales. All participants signed informed consent during the reliability and validity tests. This study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University [2022119 K], and the implementation of all methods in this study complied with the Declaration of Helsinki.

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Zhang, Y., Zheng, L., He, Y. et al. Development and validation of the hospice professional coping scale among Chinese nurses. BMC Health Serv Res 24 , 491 (2024). https://doi.org/10.1186/s12913-024-10970-9

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DOI : https://doi.org/10.1186/s12913-024-10970-9

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Francis Collins: Why I’m going public with my prostate cancer diagnosis

I served medical research. now it’s serving me. and i don’t want to waste time..

Over my 40 years as a physician-scientist, I’ve had the privilege of advising many patients facing serious medical diagnoses. I’ve seen them go through the excruciating experience of waiting for the results of a critical blood test, biopsy or scan that could dramatically affect their future hopes and dreams.

But this time, I was the one lying in the PET scanner as it searched for possible evidence of spread of my aggressive prostate cancer . I spent those 30 minutes in quiet prayer. If that cancer had already spread to my lymph nodes, bones, lungs or brain, it could still be treated — but it would no longer be curable.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information, and I want all men to benefit from the medical research to which I’ve devoted my career and that is now guiding my care.

Five years before that fateful PET scan, my doctor had noted a slow rise in my PSA, the blood test for prostate-specific antigen. To contribute to knowledge and receive expert care, I enrolled in a clinical trial at the National Institutes of Health, the agency I led from 2009 through late 2021.

At first, there wasn’t much to worry about — targeted biopsies identified a slow-growing grade of prostate cancer that doesn’t require treatment and can be tracked via regular checkups, referred to as “active surveillance.” This initial diagnosis was not particularly surprising. Prostate cancer is the most commonly diagnosed cancer in men in the United States, and about 40 percent of men over age 65 — I’m 73 — have low-grade prostate cancer . Many of them never know it, and very few of them develop advanced disease.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information.

But in my case, things took a turn about a month ago when my PSA rose sharply to 22 — normal at my age is less than 5. An MRI scan showed that the tumor had significantly enlarged and might have even breached the capsule that surrounds the prostate, posing a significant risk that the cancer cells might have spread to other parts of the body.

New biopsies taken from the mass showed transformation into a much more aggressive cancer. When I heard the diagnosis was now a 9 on a cancer-grading scale that goes only to 10, I knew that everything had changed.

Thus, that PET scan, which was ordered to determine if the cancer had spread beyond the prostate, carried high significance. Would a cure still be possible, or would it be time to get my affairs in order? A few hours later, when my doctors showed me the scan results, I felt a rush of profound relief and gratitude. There was no detectable evidence of cancer outside of the primary tumor.

Later this month, I will undergo a radical prostatectomy — a procedure that will remove my entire prostate gland. This will be part of the same NIH research protocol — I want as much information as possible to be learned from my case, to help others in the future.

While there are no guarantees, my doctors believe I have a high likelihood of being cured by the surgery.

My situation is far better than my father’s when he was diagnosed with prostate cancer four decades ago. He was about the same age that I am now, but it wasn’t possible back then to assess how advanced the cancer might be. He was treated with a hormonal therapy that might not have been necessary and had a significant negative impact on his quality of life.

Because of research supported by NIH, along with highly effective collaborations with the private sector, prostate cancer can now be treated with individualized precision and improved outcomes.

As in my case, high-resolution MRI scans can now be used to delineate the precise location of a tumor. When combined with real-time ultrasound, this allows pinpoint targeting of the prostate biopsies. My surgeon will be assisted by a sophisticated robot named for Leonardo da Vinci that employs a less invasive surgical approach than previous techniques, requiring just a few small incisions.

Advances in clinical treatments have been informed by large-scale, rigorously designed trials that have assessed the risks and benefits and were possible because of the willingness of cancer patients to enroll in such trials.

I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

If my cancer recurs, the DNA analysis that has been carried out on my tumor will guide the precise choice of therapies. As a researcher who had the privilege of leading the Human Genome Project , it is truly gratifying to see how these advances in genomics have transformed the diagnosis and treatment of cancer.

I want all men to have the same opportunity that I did. Prostate cancer is still the No. 2 cancer killer among men. I want the goals of the Cancer Moonshot to be met — to end cancer as we know it. Early detection really matters, and when combined with active surveillance can identify the risky cancers like mine, and leave the rest alone. The five-year relative survival rate for prostate cancer is 97 percent, according to the American Cancer Society , but it’s only 34 percent if the cancer has spread to distant areas of the body.

But lack of information and confusion about the best approach to prostate cancer screening have impeded progress. Currently, the U.S. Preventive Services Task Force recommends that all men age 55 to 69 discuss PSA screening with their primary-care physician, but it recommends against starting PSA screening after age 70.

Other groups, like the American Urological Association , suggest that screening should start earlier, especially for men with a family history — like me — and for African American men, who have a higher risk of prostate cancer. But these recommendations are not consistently being followed.

Our health-care system is afflicted with health inequities. For example, the image-guided biopsies are not available everywhere and to everyone. Finally, many men are fearful of the surgical approach to prostate cancer because of the risk of incontinence and impotence, but advances in surgical techniques have made those outcomes considerably less troublesome than in the past. Similarly, the alternative therapeutic approaches of radiation and hormonal therapy have seen significant advances.

A little over a year ago, while I was praying for a dying friend, I had the experience of receiving a clear and unmistakable message. This has almost never happened to me. It was just this: “Don’t waste your time, you may not have much left.” Gulp.

Having now received a diagnosis of aggressive prostate cancer and feeling grateful for all the ways I have benefited from research advances, I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

Francis S. Collins served as director of the National Institutes of Health from 2009 to 2021 and as director of the National Human Genome Research Institute at NIH from 1993 to 2008. He is a physician-geneticist and leads a White House initiative to eliminate hepatitis C in the United States, while also continuing to pursue his research interests as a distinguished NIH investigator.

An earlier version of this article said prostate cancer is the No. 2 killer of men. It is the No. 2 cause of cancer death among men. The article has been updated.

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Growing public concern about the role of artificial intelligence in daily life

A growing share of Americans express concern about the role artificial intelligence (AI) is playing in daily life, according to a new Pew Research Center survey.

Pew Research Center conducted this study to understand attitudes about artificial intelligence and its uses. For this analysis, we surveyed 11,201 U.S. adults from July 31 to Aug. 6, 2023.

Everyone who took part in the survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for this analysis , along with responses, and its methodology .

Overall, 52% of Americans say they feel more concerned than excited about the increased use of artificial intelligence. Just 10% say they are more excited than concerned, while 36% say they feel an equal mix of these emotions.

The share of Americans who are mostly concerned about AI in daily life is up 14 percentage points since December 2022, when 38% expressed this view.

Concern about AI outweighs excitement across all major demographic groups. Still, there are some notable differences, particularly by age. About six-in-ten adults ages 65 and older (61%) are mostly concerned about the growing use of AI in daily life, while 4% are mostly excited. That gap is much smaller among those ages 18 to 29: 42% are more concerned and 17% are more excited.

Rising awareness, and concern, about AI

The rise in concern about AI has taken place alongside growing public awareness. Nine-in-ten adults have heard either a lot (33%) or a little (56%) about artificial intelligence. The share who have heard a lot about AI is up 7 points since December 2022.

Those who have heard a lot about AI are 16 points more likely now than they were in December 2022 to express greater concern than excitement about it. Among this most aware group, concern now outweighs excitement by 47% to 15%. In December, this margin was 31% to 23%.

Similarly, people who have heard a little about AI are 19 points more likely to express concern today than they were in December. A majority now express greater concern than excitement (58%) about AI’s growing role in daily life, while just 8% report the opposite feeling.

Our previous analyses have found that Americans’ concerns about AI include a desire to maintain human control over these technologies , doubts that AI will improve the way things are now, and caution over the pace of AI adoption in fields like health and medicine .

Opinions of whether AI helps or hurts in specific settings

Despite growing public concern over the use of artificial intelligence in daily life, opinions about its impact in specific areas are more mixed. There are several uses of AI where the public sees a more positive than negative impact.

For instance, 49% say AI helps more than hurts when people want to find products and services they are interested in online. Just 15% say it mostly hurts when used for this purpose, and 35% aren’t sure.

Other uses of AI where opinions tilt more positive than negative include helping companies make safe cars and trucks and helping people take care of their health.

In contrast, public views of AI’s impact on privacy are much more negative. Overall, 53% of Americans say AI is doing more to hurt than help people keep their personal information private. Only 10% say AI helps more than it hurts, and 37% aren’t sure. Our past research has found majorities of Americans express concern about online privacy generally and a lack of control over their own personal information.

Public views on AI’s impact are still developing, though. Across the eight use cases in the survey, 35% to 49% of Americans say they’re not sure what impact AI is having.

Demographic differences in views of AI’s impact

There are significant demographic differences in the perceived impact of AI in specific use cases.

Americans with higher levels of education are more likely than others to say AI is having a positive impact across most uses included in the survey. For example, 46% of college graduates say AI is doing more to help than hurt doctors in providing quality care to patients. Among adults with less education, 32% take this view.

A similar pattern exists with household income, where Americans with higher incomes tend to view AI as more helpful for completing certain tasks.

A big exception to this pattern is views of AI’s impact on privacy. About six-in-ten college graduates (59%) say that AI hurts more than it helps at keeping people’s personal information private. Half of adults with lower levels of education also hold this view.

Men also tend to view AI’s impact in specific areas more positively than women. These differences by education, income and gender are generally consistent with our previous work on artificial intelligence .

Note: Here are the questions used for this analysis , along with responses, and its methodology .

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