BACKGROUND: In clinical and epidemiological studies, cutoffs of patient-reported outcome measures can be used to classify patients into groups of statistical and clinical relevance. However, visual analog scale (VAS) cutoffs in MASK-air have not been tested. OBJECTIVE: To calculate cutoffs for VAS global, nasal, ocular, and asthma symptoms. METHODS: In a cross-sectional study design of all MASK-air participants, we compared (1) approaches based on the percentiles (tertiles or quartiles) of VAS distributions and (2) data-driven approaches based on clusters of data from 2 comparators (VAS work and VAS sleep). We then performed sensitivity analyses for individual countries and for VAS levels corresponding to full allergy control. Finally, we tested the different approaches using MASK-air real-world cross-sectional and longitudinal data to assess the most relevant cutoffs. RESULTS: We assessed 395,223 days from 23,201 MASK-air users with self-reported allergic rhinitis. The percentile-oriented approach resulted in lower cutoff values than the data-driven approach. We obtained consistent results in the data-driven approach. Following the latter, the proposed cutoff differentiating "controlled" and "partly-controlled" patients was similar to the cutoff value that had been arbitrarily used (20/100). However, a lower cutoff was obtained to differentiate between "partly-controlled" and "uncontrolled" patients (35 vs the arbitrarily-used value of 50/100). CONCLUSIONS: Using a data-driven approach, we were able to define cutoff values for MASK-air VASs on allergy and asthma symptoms. This may allow for a better classification of patients with rhinitis and asthma according to different levels of control, supporting improved disease management.

• Klíčová slova
• Asthma, Conjunctivitis, Cutoffs, MASK-air, Rhinitis,
• MeSH
• alergická rýma * diagnóza   MeSH
• bronchiální astma * epidemiologie   terapie   MeSH
• hodnocení výsledků péče pacientem MeSH
• lidé MeSH
• průřezové studie MeSH
• rýma * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND CONTEXT: The 6-minute walking test (6WT) has been previously shown to be a reliable and valid outcome measure. It is unclear if the 6WT may further help to detect differences in well performing patients that reach a ceiling effect in PROMs after surgery. PURPOSE: To evaluate changes and timing of change in objective functional impairment (OFI) as measured with the smartphone-based 6WT in relation to patient-reported outcome measures (PROMs) after surgery for degenerative lumbar disorders (DLD). STUDY DESIGN: Prospective observational cohort study. PATIENT SAMPLE: Fifty consecutive patients undergoing surgery for DLD. OUTCOME MEASURES: Patients self-determined their OFI using the 6WT application (6WT-app) and completed a set of paper-based PROMs before, 6 weeks and 3 months after surgery. METHODS: Fifty patients undergoing surgery for DLD were assessed preoperatively (baseline), 6 weeks (6W) and 3 months (3M) postoperatively. Paired sample t-tests were used to establish significant changes in raw 6-minute walking distance (6WD) and standardized Z-scores, as well as PROMs. Pearson correlation coefficient was used to define the relationship between 6WT and PROMs. Floor and ceiling effects were assessed for each PROM (visual analogue scale [VAS], core outcome measure index [COMI], Zurich claudication questionnaire [ZCQ]). RESULTS: Mean 6WT results improved from 377 m (standard deviation - SD 137; Z-score: 1.8, SD 1.8) to 490 m (SD 126; -0.7, SD 1.5) and 518 m (SD 112; -0.4, SD 1.41; all p<.05) at 6W and 3M follow-up. No significant improvement was observed between 6W and 3M for the ZCQ, VAS back and leg pain. While correlation between 6WT and all PROMs were weak at baseline, correlation coefficient increased to moderate at 3M. A considerable ceiling effect (best possible score) was observed, most notably for the ZCQ physical performance, VAS back and leg pain in 24%, 20%, and 16% of patient at 6W and in 30%, 24%, and 28% at 3M. CONCLUSIONS: Objective functional tests can describe the continued change in the physical recovery of a patient and may help to detect differences in well performing groups as well as in cases where patients' PROM results cannot further improve because of a ceiling effect.

• Klíčová slova
• 6-Minute walking test, 6WT, Functional self-assessment, Objective functional impairment, Responsiveness,
• MeSH
• bederní obratle chirurgie   MeSH
• bolest MeSH
• degenerace meziobratlové ploténky * chirurgie   diagnóza   MeSH
• hodnocení výsledků péče pacientem MeSH
• hodnocení výsledků zdravotní péče MeSH
• lidé MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Media, social scientists and public health researchers often present comparisons across countries, and policy makers use such comparisons to take evidence-based action. For a meaningful comparison among countries, one often needs to normalize the measure for differences in population size. To address this issue, the first choice is usually to calculate per capita ratios. Such ratios, however, normalize the measure for differences in population size directly only under the highly restrictive assumption of a proportional increase of the measure with population size. Violation of this assumption frequently leads to misleading conclusions. We compare per capita ratios with an approach based on regression, a widely used statistical procedure that eliminates many of the problems with ratios and allows for straightforward data interpretation. It turns out that the per capita measures in three global datasets (gross domestic product, COVID-19-related mortality and CO2 production) systematically overestimate values in countries with small populations, while countries with large populations tend to have misleadingly low per capita ratios owing to the large denominators. Unfortunately, despite their biases, comparisons based on per capita ratios are still ubiquitous, and they are used for influential recommendations by various global institutions. Their continued use can cause significant damage when employed as evidence for policy actions and should therefore be replaced by a more scientifically substantiated and informative method, such as a regression-based approach.

• Klíčová slova
• global comparisons, gross domestic product, per capita measures, ratios,
• Publikační typ
• časopisecké články MeSH

Differential entropy can be negative, while discrete entropy is always non-negative. This article shows that negative entropy is a significant flaw when entropy is used as a sensitivity measure in global sensitivity analysis. Global sensitivity analysis based on differential entropy cannot have negative entropy, just as Sobol sensitivity analysis does not have negative variance. Entropy is similar to variance but does not have the same properties. An alternative sensitivity measure based on the approximation of the differential entropy using dome-shaped functionals with non-negative values is proposed in the article. Case studies have shown that new sensitivity measures lead to a rational structure of sensitivity indices with a significantly lower proportion of higher-order sensitivity indices compared to other types of distributional sensitivity analysis. In terms of the concept of sensitivity analysis, a decrease in variance to zero means a transition from the differential to discrete entropy. The form of this transition is an open question, which can be studied using other scientific disciplines. The search for new functionals for distributional sensitivity analysis is not closed, and other suitable sensitivity measures may be found.

• Klíčová slova
• entropy measures, importance measure, sensitivity analysis, uncertainty quantification,
• Publikační typ
• časopisecké články MeSH

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

• Klíčová slova
• Endoscopy, key performance indicators, performance measures, quality, quality assurance,
• Publikační typ
• časopisecké články MeSH

Cognitive flexibility (CF) is the ability to adapt cognitive strategies according to the changing environment. The deficit in CF has often been linked to various neurological and psychiatric disorders including schizophrenia. However, the operationalization and assessment of CF have not been unified and the current research suggests that the available instruments measure different aspects of CF. The main objective of the present study was to compare three frequently used neuropsychological measures of CF-Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Stroop Color and Word Test (SCWT) in a population of patients (N = 220) with first-episode schizophrenia spectrum disorders in order to evaluate their convergent validity. The hypothesis of an underlying latent construct was tested via a confirmatory factor analysis. We used a one-factor CF model with scores from WCST, SCWT and TMT as observed variables. The established model showed a good fit to the data (χ2 = 1.67, p = 0.43, SRMR = 0.02, RMSEA = 0.0, CFI = 1.00). The highest factor loading was found in WCST as CF explained most of the variance in this neuropsychological measure compared to the other instruments. On the other hand, a TMT ratio index and a SCWT interference demonstrated lowest loadings in the model. The findings suggest that not all the frequently used measures share an underlying factor of CF or may capture different aspects of this construct.

• Klíčová slova
• Cognitive flexibility, confirmatory factor analysis, factor analysis, first-episode, neuropsychological measures, schizophrenia,
• Publikační typ
• časopisecké články MeSH

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

• Klíčová slova
• Colonoscopy, patient safety, performance measures, quality, quality indicators,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1) to 8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1) to 4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

• Klíčová slova
• TNF inhibitors, axial spondyloarthritis, patient-reported outcome measures, sex differences,
• MeSH
• antirevmatika * terapeutické užití   MeSH
• axiální spondyloartritida * farmakoterapie   MeSH
• dospělí MeSH
• hodnocení výsledků péče pacientem * MeSH
• inhibitory TNF * terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• registrace MeSH
• sexuální faktory MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antirevmatika * MeSH
• inhibitory TNF * MeSH

BACKGROUND: Patient-reported outcome measures (PROMs) have become an integral part of the evaluation of reconstruction surgery outcomes. However, there are limitations in current PROMs when it comes to the assessment of well-being during inpatient stay, patient perception of health, relationship with partner, and vitality (i.e., mood and ability to work and pursue hobbies, carry out daily tasks, and sleep) following breast reconstructive surgery. The aim was to develop a novel set of measures to compare patient satisfaction and health-related quality of life following different types of postmastectomy breast reconstruction. METHODS: A novel questionnaire was created and refined through cognitive interviews with patients and expert feedback. A field test study was conducted, including patients who had undergone delayed postmastectomy breast reconstruction with implant, autologous tissue, or combination of implant and autologous tissue. Based on the results, confirmatory factor analysis and examination of reliability of the questionnaire were conducted. Results of patient responses were analyzed using Chi-square test, Kruskal-Wallis test, and Mann-Whitney U test. RESULTS: Confirmatory factor analysis showed good model fit, and Cronbach's alpha indicated high internal consistency of the questionnaire. Besides that, patients with combination reconstruction reported significantly lower vitality than patients with implant and autologous reconstruction (p = 0.048). CONCLUSIONS: This novel questionnaire expands the current knowledge base of postmastectomy breast reconstruction PROMs. Results of the field test study showed that combination reconstruction was associated with lower patient vitality than other reconstruction types. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

• Klíčová slova
• Breast reconstruction, Health-related quality of life, Novel questionnaire, Patient satisfaction, Patient-reported outcome measures,
• MeSH
• estetika MeSH
• hodnocení výsledků péče pacientem MeSH
• kohortové studie MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * chirurgie   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• spokojenost pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The coronavirus disease 2019 (Covid-19) has created emerging mental health challenges around the world. Like other countries, Pakistan is also confronted with covid-19 calamities. The aim of the study is to examine the impacts of workplace measures (WM) on the job performance (JP) and covid-19 fears (CF) along with the moderating role of academic competence (AC) based on the organizational support theory (OST) and job demand and resources (JDR) theory. A quantitative approach was applied to collect data from 333 banking employees in Gujranwala (Pakistan), and the hypothesis were tested via structural equation modeling using SPSS and AMOS. The study findings indicate that workplace measures significantly affect covid-19 fears except for individual preventive measures (IPM). Similarly, workplace measures significantly impact on job performance apart from information about the pandemic (IAP). Moreover, academic competence insignificantly moderates between workplace measures and covid-19 fears, but a significant moderation is found between information about pandemic (IAP) and covid-19 fears. Meanwhile, academic competence significantly moderates between workplace measures and job performance instead of a relationship between information about pandemic and job performance. However, this study was limited only to the banking sector of Pakistan. So, it will open the doors for future researchers to investigate other cultural contexts and sectors. This research gives a holistic understanding of workplace measures and contributes to the body of knowledge by enlightening the moderating role of academic competence in the banking sector of Pakistan. These useful insights would enable practitioners and policy makers to develop more efficient strategies and workplace measures to enhance job performance and reduce the fears of covid-19 among employees.

• Klíčová slova
• Academic competence, Covid-19 fear, Job performance, Workplace measures,
• Publikační typ
• časopisecké články MeSH