COVID-19 and communication: A sentiment analysis of US state governors' official press releases.

OBJECTIVES: This study examines the contents of official communication from United States governors' offices related to the COVID-19 pandemic to assess patterns in communication and to determine if they correlate with trends for COVID cases and deaths. METHODS: We collected text data for all COVID-19 related press releases between March 1 and December 31, 2020 from the US governors' office websites in all 50 states. An automated parsing and sentiment analyzer assessed descriptive statistics and trends in tone, including positivity and negativity. RESULTS: We included a total of 7,720 press releases in this study. We found that both positive and negative sentiments were homogenous across states at the beginning of the pandemic but became heterogeneous as the pandemic evolved. The same trend applied to the frequency and tone of press releases. Sentiments across states were overall positive with a small level of negativity. We observed a reactive official communication to the evolution of the number of COVID-19 cases rather than responsive or preventive. CONCLUSIONS: The findings of both positivity and negativity in press communications suggest that the effect of discounted importance was present in official communications. Our findings support a state-dependent optimal communication frequency and tone, agreeing with the curvilinear communication model of organizational theory and implying that feedback cycles between government officials and public response should be shortened to rapidly maximize communication efficacy during the pandemic. Future research should identify and evaluate the drivers of the large differences in communication tone across states and validate the reactive characteristics of COVID-19 official communications.

Quantifying Occupational Stress in Intensive Care Unit Nurses: An Applied Naturalistic Study of Correlations Among Stress, Heart Rate, Electrodermal Activity, and Skin Temperature.

OBJECTIVE: To identify physiological correlates to stress in intensive care unit nurses. BACKGROUND: Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap. METHOD: Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4). RESULTS: Positive correlations included stress and heart rate (ρ = .35, p < .001), stress and skin temperature (ρ = .49, p < .05), and heart rate and skin temperatures (ρ = .54, p = .0008). DISCUSSION: The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses. APPLICATION: Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures.

Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review.

BACKGROUND: Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of insurance coverage. Without the requisite resources, underserved populations lack the ability to access healthcare and afford prescription drugs to manage their condition. The aim of this systematic review is to synthesize the findings from cost-effectiveness studies of diabetes management in underserved populations. METHODS: Original, English, peer-reviewed cost-effectiveness studies of diabetes management in U.S. underserved populations were obtained from 8 databases, and PRISMA 2009 reporting guidelines were followed. Evidence was categorized as strong or weak based on a combination of GRADE and American Diabetes Association guidelines. Internal validity was assessed by the Cochrane methodology. Studies were classified by incremental cost-effectiveness ratio as very cost-effective (ICER≤US$25,000), cost-effective (US$25,000US$100,000). Reporting and quality of economic evaluations was assessed using the CHEERS guidelines and Recommendations of Second Panel for Cost-Effectiveness in Health and Medicine, respectively. FINDINGS: Fourteen studies were included. All interventions were found to be cost-effective or very cost-effective. None of the studies reported all 24 points of the CHEERS guidelines. Given the considered cost categories vary significantly between studies, assessing cost-effectiveness across studies has many limitations. Program costs were consistently analyzed, and a third of the included studies (n = 5) only examined these costs, without considering other costs of diabetes care. INTERPRETATION: Cost-effectiveness studies are not based on a standardized methodology and present incomplete or limited analyses. More accurate assessment of all direct and indirect costs could widen the gap between intervention and usual care. This demonstrates the urgent need for a more standardized and comprehensive cost-effectiveness framework for future studies.

Effectiveness of Bariatric Surgery in Increasing Kidney Transplant Eligibility in Patients with Kidney Failure Requiring Dialysis.

PURPOSE: Severe obesity can increase risk of complications after kidney transplantation. There is a paucity of literature on bariatric surgery outcomes in renal transplant candidates. The objective of this study was to analyze outcomes of bariatric surgery as a weight reduction strategy for patients with kidney failure to enhance eligibility for kidney transplantation. MATERIALS AND METHODS: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database at a single institution for patients with chronic kidney disease receiving hemodialysis therapy (CKD G5D) undergoing bariatric surgery between 2011 and 2018. RESULTS: Of 2363 patients who underwent bariatric surgery, 38 (1.6%) had CKD G5D; median age (range) was 49 years (33; 69), 52.6% were female, and mean BMI was 44.2 kg/m2. Twenty-four patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), and 14 patients underwent laparoscopic sleeve gastrectomy. Seventeen patients (46%, n=37) had a BMI≤35 at 6 months, while 25 patients (75.8%, n=33) achieved a BMI≤35 at 12 months. Of these, 18 patients (47%) were listed for kidney transplant, and 8 patients (21%) received kidney transplant. There was no statistically significant difference between sleeve and LRYGB procedures in patients who reached BMI of 35 at 12 months (P=0.58). Median length of stay was 2.3 days. Thirty-day readmission rate was 2 patients (5.3%), and 2 patients (5.3%) required reoperation (one for bleeding, one for acute recurrent hiatal hernia). No mortality occurred. CONCLUSION: Laparoscopic bariatric surgery offers effective weight loss for CKD G5D patients to achieve transplant eligibility with acceptable outcomes.

New model of integrated care for uncontrolled type 2 diabetes in a retrospective, underserved adult population in the USA: a study protocol for an effectiveness and cost-effectiveness analysis.

INTRODUCTION: Type 2 diabetes prevalence is increasing in the USA, especially in underserved populations. Patient outcomes can be improved by providing access to specialty care within Federally Qualified Health Centers, possibly improving the cost-effectiveness of diabetes care. METHODS AND ANALYSIS: A new model of diabetes care based on multidisciplinary teams of clinical fellows, supported by an endocrinologist for underserved adult populations, is presented. The study uses a retrospective, non-randomised cohort of patients with diabetes who visited the community clinic between 1 January 2012 and 31 December 2018. A quasi-experimental method to analyse the causal evidence of the effect of the new model is presented. Discontinuity regression is used to compare two interventions, the intervention by a Clinical Fellow Endocrinology Programme and usual care by a primary care physician. Patients are referred to the Clinical Fellow Endocrinology Programme in case of uncontrolled diabetes (glycated haemoglobin (HbA1c)≥9%). The regression discontinuity design allows the construction of a treatment group for patients with an HbA1c equal or above the threshold in comparison with a control group for patients with an HbA1c below the threshold. The patient outcomes and cost-effectiveness of the new model are analysed. Regression models will be used to assess the differences between treatment and control groups. ETHICS AND DISSEMINATION: Quantitative patient data are received by the study team in a de-identified format for analysis via an institutional review board-approved protocol. The quantitative study has been approved by the Houston Methodist Research Institute Institutional Review Board, Houston, Texas, USA. Anticipated results will not only provide evidence about the impact of patient outcomes in underserved diabetic populations, but also give an idea of the cost-effectiveness of the new model and whether or not cost savings can be attained for patients, third-party payers and society. The results will help set up evidence-based policy guidelines in diabetes care. Results will be disseminated through papers, conferences and public health/policy fora.

Cost-effectiveness of gemcitabine versus PEGylated liposomal doxorubicin for recurrent or progressive ovarian cancer: comparing chemotherapy with nanotherapy.

This article examines the cost-effectiveness of chemotherapy (gemcitabine) versus nanotherapy (PEGylated liposomal doxorubicin) in the treatment of ovarian cancer. Significant differences in costs were mainly due to the initial drug costs, which were €1285.28 in favor of chemotherapy. These costs were more than offset by hospitalization costs, which were €2670.21 in favor of the nanotherapy. The cost per quality-adjusted life week (QALW) for the nanotherapy was estimated to be €220.92/QALW for the base case and ranged from €170-318/QALW based on model assumptions. The clinical benefit associated with nanotherapy was achieved, yielding not only positive cost-effectiveness results, but also, surprisingly, financial savings. Although more studies are necessary, this first comprehensive analysis supports the further use of nanotherapy for ovarian cancer.

Assessing the need for quality-adjusted cost-effectiveness studies of nanotechnological cancer therapies.

New therapies, such as nanotechnology-based cancer treatments, typically entail high acquisition costs. Their use can be justified, however, by their superior cost-effectiveness. This article assesses the quality of cost-effectiveness analyses of nanotechnological cancer therapies by screening nine major studies. They conclude that nanotherapies are cost effective for the treatment of ovarian and breast cancer, as well as multiple myeloma, but not for other types of cancer. However, these studies have some serious methodological flaws. Typically, the results are not quality adjusted, although both length and quality of life are affected. Moreover, only fragmented direct medical costs are included, neglecting indirect costs that impose a significant economic burden on patients and society. Finally, cost definitions differ widely making any comparison between studies virtually impossible. This article concludes that economic research of nanotechnology-based therapeutics is still in its infancy. It warns that incomplete economic analysis may lead to inefficient policy recommendations.

The impact of effective patents on future innovations in nanomedicine.

The success of nanomedicine is dependent upon an effective protection of IP rights. Unfortunately, the US nanomedicine patent system is dysfunctional because long R&D procedures as well as the patent pendency are insufficiently taken into account. This could be solved by changing the patent-protection starting point and increasing the capacity of the US PTO. The nanotechnology industry also suffers from overlapping patents. This could be avoided by improving the expertise of the PTO, using a more accurate definition of nanotechnology and devising a generally accepted nomenclature that enhances prior-art searches. To avoid disputes, inference practices and strategic patenting can be used. In the case of a dispute, parties can fall back on re-examination, cross-licensing and patent litigation. Cross-licensing agreements are recommended since they allows parties to access technology, create synergies and exclude third-party competitors. Solving the patent problems in the nanotechnology industry is a necessary step for future success.

Future of nanomedicine: obstacles and remedies.

The future of nanomedicines is undermined by the lack of financial profitability, consumer distrust, ineffective regulation of new and generic products, weak patent protection and insurance market failure. Its economic breakthrough is dependent on a series of countervailing measures and actions. Success requires more investment induced by cost-effectiveness analyses and business plans based on clinical data, public education based on nanotoxicology studies, smart regulatory reform in the areas of testing, market entry and liability, effective and strategic patenting, patent dispute prevention and resolution, and innovative insurance policies.