Including the voice of paediatric patients: Cocreation of an engagement game

BackgroundEngaging patients in health care, research and policy is essential to improving patient‐important health outcomes and the quality of care. Although the importance of patient engagement is increasingly acknowledged, clinicians and researchers still find it difficult to engage patients, especially paediatric patients. To facilitate the engagement of children and adolescents in health care, the aim of this project is to develop an engagement game.MethodsA user‐centred design was used to develop a patient engagement game in three steps: (1) identification of important themes for adolescents regarding their illness, treatment and hospital care, (2) evaluation of the draft version of the game and (3) testing usability in clinical practice. Adolescents (12–18 years) were engaged in all steps of the development process through focus groups, interviews or a workshop. These were audio‐recorded, transcribed verbatim and analysed in MAXQDA.Results(1) The important themes for adolescents (N = 15) were included: visiting the hospital, participating, disease and treatment, social environment, feelings, dealing with staff, acceptation, autonomy, disclosure and chronically ill peers. (2) Then, based on these themes, the engagement game was developed and the draft version was evaluated by 13 adolescents. Based on their feedback, changes were made to the game (e.g., adjusting the images and changing the game rules). (3) Regarding usability, the pilot version was evaluated positively. The game helped adolescents to give their opinion. Based on the feedback of adolescents, some last adjustments (e.g., changing colours and adding a game board) were made, which led to the final version of the game, All Voices Count.ConclusionsWorking together with adolescents, All Voices Count, a patient engagement game was developed. This game provides clinicians with a tool that supports shared decision‐making to address adolescents'' wishes and needs.Patient or Public ContributionPaediatric patients, clinicians, researchers, youth panel of Fonds NutsOhra and patient associations (Patient Alliance for Rare and Genetic Diseases, Dutch Childhood Cancer Organization) were involved in all phases of the development of the patient engagement game—from writing the project plan to the final version of the game.     

Magnesium-to-Calcium Ratio and Mortality from COVID-19

Obesity, type 2 diabetes, arterial hypertension, decrease in immune response, cytokine storm, endothelial dysfunction, and arrhythmias, which are frequent in COVID-19 patients, are associated with hypomagnesemia. Given that cellular influx and efflux of magnesium and calcium involve the same transporters, we aimed to evaluate the association of serum magnesium-to-calcium ratio with mortality from severe COVID-19. The clinical and laboratory data of 1064 patients, aged 60.3 ± 15.7 years, and hospitalized by COVID-19 from March 2020 to July 2021 were analyzed. The data of 554 (52%) patients discharged per death were compared with the data of 510 (48%) patients discharged per recovery. The ROC curve showed that the best cut-off point of the magnesium-to-calcium ratio for identifying individuals at high risk of mortality from COVID-19 was 0.20. The sensitivity and specificity were 83% and 24%. The adjusted multivariate regression model showed that the odds ratio between the magnesium-to-calcium ratio ≤0.20 and discharge per death from COVID-19 was 6.93 (_95%CI 1.6–29.1) in the whole population, 4.93 (_95%CI 1.4–19.1, p = 0.003) in men, and 3.93 (_95%CI 1.6–9.3) in women. In conclusion, our results show that a magnesium-to-calcium ratio ≤0.20 is strongly associated with mortality in patients with severe COVID-19.     

“A” protein of amyloidosis isolation of a cross-reacting component from serum by affinity chromatography

A nonimmunoglobulin protein (A protein) has been isolated from amyloidotic tissue of secondary type. Antisera prepared to this protein identified a cross-reacting substance in the sera of patients with secondary amyloidosis. Sera from 70 persons with amyloidosis, 120 normal adults, 20 aged persons, and 97 patients with chronic diseases were tested for this substance. One hundred percent of secondary amyloid sera had amounts of amyloid serum component detectable by double diffusion in agar, whereas only 19% of primary amyloid sera were positive. Approximately 60% of rheumatoid sera as well as 60% of sera from aged individuals were positive. Only 3% of normal blood donors had detectable amounts of this circulating substance. Isolation of the serum component by affinity chromatography and partial characterization have shown that it is an α-globulin with a molecular weight of 100,000–120,000, that it is not related antigenically to immunoglobulin or amyloid P-component, and that it has an amino acid analysis that is markedly different from tissue A protein. The possible participation of this substance in the genesis of amyloid is discussed.     

HOLISTIC OBSTETRICAL PROBLEM EVALUATION (HOPE): TESTING A THEORY TO PREDICT BIRTH OUTCOMES IN A GROUP OF WOMEN FROM APPALACHIA

The purpose of this study was to test the Holistic Obstetrical Problem Evaluation (HOPE) theory by determining the effects of prenatal factors from the biophysical, psychosocial, spiritual, and perceptual domains of the HOPE theory with infant birth outcomes. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between the ages of 14 and 44 years and 16-28 weeks gestation, and attending three prenatal clinics in East Tennessee. Based on the multiple regression analysis, absence of maternal partner support during pregnancy and African-American race predicted variance for infant birth weight ( p < .05), while lower levels of self-esteem, use of drugs and alcohol, and active religiosity predicted shorter length of gestation at birth ( p < .05). The multiple logistic regression analysis model revealed that the HOPE theory was significantly related to a greater incidence of preterm birth ( p = .03), Chi 2 = 28.16, R 2 = .22. Within this model, lower levels of self-esteem and a woman's negative perception of her pregnancy, were significant predictors for preterm birth ( p < .05). Although there was preliminary support for this holistic theory, further research with a larger and more diverse population of women is needed.     

Misuse of analysis of covariance in aging research and some partial solutions

Abstract

Geron-tological researchers are reminded of the inappropriateness of analysis of covariance wherein the covariate is correlated with the independent variable, typically age. Two partial solutions are suggested that deal with the confounding of age effects with such uncontrolled variables as, for example, initial ability level or level of education.