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Objectives Dealing with uncertainty is one of the critical topics in health technology assessment. The greater decision uncertainty in appraisals, the less clear the clinical- and cost-effectiveness of the health technology. Although the development of targeted cancer therapies (TCTs) has improved patient health care, additional complexity has been introduced in drug appraisals due to targeting more specific populations. Real-world data (RWD) are expected to provide helpful information to fill the evidence gaps in appraisals. This study compared appraisals of TCTs with those of non-targeted cancer therapies (non-TCTs) regarding sources of uncertainty and reviewed how RWD have been used to supplement the information in these appraisals. Methods This study reviews single technology appraisals (STAs) of oncology medicines performed by the National Institute for Health and Care Excellence (NICE) over 11 years up to December 2021. Three key sources of uncertainty were identified for comparison (generalisability of clinical trials, availability of direct treatment comparison, maturity of survival data in clinical trials). To measure the intensity of use of RWD in appraisals, three components were identified (overall survival, volume of treatment, and choice of comparators). Results TCTs received more recommendations for provision through the Cancer Drugs Fund (27.7, 23.6% for non-TCT), whereas similar proportions were recommended for routine commissioning. With respect to sources of uncertainty, the external validity of clinical trials was greater in TCT appraisals ( p  = 0.026), whereas mature survival data were available in fewer TCT appraisals ( p  = 0.027). Both groups showed similar patterns of use of RWD. There was no clear evidence that RWD have been used more intensively in appraisals of TCT. Conclusions Some differences in uncertainty were found between TCT and non-TCT appraisals. The appraisal of TCT is generally challenging, but these challenges are neither new nor distinctive. The same sources of uncertainty were often found in the non-TCT appraisals. The uncertainty when appraising TCT stems from insufficient data rather than the characteristics of the drugs. Although RWD might be expected to play a more active role in appraisals of TCT, the use of RWD has generally been limited.

ObjectivesThis study aims to identify how real-world data (RWD) have been used in single technology appraisals (STAs) of cancer drugs by the National Institute for Health and Care Excellence (NICE).DesignCross-sectional study of NICE technology appraisals of cancer drugs for which guidance was issued between January 2011 and December 2021 (n=229). The appraisals were reviewed following a published protocol to extract the data about the use of RWD. The use of RWD was analysed by reviewing the specific ways in which RWD were used and by identifying different patterns of use.Primary outcome measureThe number of appraisals where RWD are used in the economic modelling.ResultsMost appraisals used RWD in their economic models. The parametric use of RWD was commonly made in the economic models (76% of the included appraisals), whereas non-parametric use was less common (41%). Despite widespread use of RWD, there was no dominant pattern of use. Three sources of RWD (registries, administrative data, chart reviews) were found across the three important parts of the economic model (choice of comparators, overall survival and volume of treatment).ConclusionsNICE has had a long-standing interest in the use of RWD in STAs. A systematic review of oncology appraisals suggests that RWD have been widely used in diverse parts of the economic models. Between 2011 and 2021, parametric use was more commonly found in economic models than non-parametric use. Nonetheless, there was no clear pattern in the way these data were used. As each appraisal involves a different decision problem and the ability of RWD to provide the information required for the economic modelling varies, appraisals will continue to differ with respect to their use of RWD.

The increased workload for nurses due to the spread of COVID-19 has pushed back the priority of clinical training for nursing students. [...]nursing students have been removed from clinical practice in some countries where the spread of COVID-19 infection has been severe [3]. First of all, it is essential to establish a good relationship with the clinical team because meeting with patients and their families has become more limited when conducting clinical research [11]. There are various types of digital technology used in nursing practice, and research and most of them report positive effects, but the level of evidence is relatively weak, or the study sample size is small. [...]higher quality studies that can show the effects of digital procedures on nursing care are needed.

IntroductionDue to the limitations of relying on randomised controlled trials, the potential benefits of real-world data (RWD) in enriching evidence for health technology assessment (HTA) are highlighted. Despite increased interest in RWD, there is limited systematic research investigating how RWD have been used in HTA. The main purpose of this protocol is to extract relevant data from National Institute for Health and Care Excellence (NICE) appraisals in a transparent and reproducible manner in order to determine how NICE has incorporated a broader range of evidence in the appraisal of oncology medicines.Methods and analysisThe appraisals issued between January 2011 and May 2021 are included following inclusion criteria. The data extraction tool newly developed for this research includes the critical components of economic evaluation. The information is extracted from identified appraisals in accordance with extraction rules. The data extraction tool will be validated by a second researcher independently. The extracted data will be analysed quantitatively to investigate to what extent RWD have been used in appraisals. This is the first protocol to enable data to be extracted comprehensively and systematically in order to review the use of RWD.Ethics and disseminationThis study is approved by the Ethics Committee of the London School of Hygiene and Tropical Medicine on 14 November 2019 (17315). Results will be published in peer-reviewed journals.

This study aimed to investigate the association between patient-centered care, experiences in the intensive care unit (ICU), and post-intensive care syndrome among critical care survivors. This was a prospective, multicenter cohort study conducted in the second year, focusing on post-intensive care syndrome among ICU survivors. This study was conducted in 19 ICUs at four university hospitals located in Busan, South Korea. The participants were 618 adults who had been admitted to the ICU for more than 24 hours between May 2019 and July 2021. At the time of ICU discharge, participants completed a person-centered care and an intensive care experience questionnaire. We evaluated the post-intensive care syndrome of the participants at 3, 6, and 12 months after hospital discharge. Data analysis was performed using descriptive analysis, Pearson's correlations, multiple regression, and linear mixed model. The mediating effect of person-centered care was analyzed using hierarchical regression and path analysis. Frightening experience in the ICU was significantly associated with a higher post-intensive care syndrome at 3 (β = .09, p = .021) and 6 (β = .09, p = .032) months after discharge. Person-centered care partially mediated the effect of the frightening experience on post-intensive care syndrome at 12 months after discharge (B = 0.05, 95% CI: 0.01–0.10). Female gender, older age, comorbidities, delirium, and discharge to an extended care facility were factors associated with increased post-intensive care syndrome at 3, 6, and 12 months. Furthermore, changes in post-intensive care syndrome during the one-year follow-up period were associated with comorbidities and the discharge place. We observed that frightening experiences in the ICU are associated with an increased risk of post-intensive care syndrome in survivors. Person-centered care may be a potential factor in mediating the relationship between patients' frightening experiences and post-intensive care syndrome. This study is registered at the Korean Clinical Research Information Service (#KCT0004045).

The purpose of this study was to investigate the relationship between Type D personality and post-traumatic stress disorder (PTSD) symptoms of intensive care unit (ICU) nurses and to determine the mediating effect of resilience on this relationship. A cross-sectional survey was performed with 179 ICU nurses from 7 hospitals in Gyeong-Nam province, South Korea. The Type D personality, resilience, and PTSD symptoms of subjects were measured using a self-report questionnaire. The mediating effect was analyzed by a series of hierarchical multiple regressions. A total of 38.6% of the study participants turned out to have Type D personality. The Type D personality was positively correlated with PTSD symptoms, and negatively correlated with resilience. There was a negative correlation between resilience and PTSD symptoms. The indirect effect of Type D personality on PTSD symptoms via resilience (β = .51, p < .001) was smaller than the direct effect (β = .58, p < .001). Based on the above results, it can be concluded that resilience had a partial mediating effect on the relationship between Type D personality and PTSD symptoms of ICU nurses. Further studies need to be done to develop interventions for enhancing resilience in ICU nurses.

This study aimed to determine whether family-centered multidisciplinary rounds could alleviate anxiety and uncertainty in illness and meet needs for critically ill patients' families. A family-centered multidisciplinary rounds protocol was developed identifying needs of critically ill patients' families, and family experiences were reviewed through in-depth interviews. A sequential mixed-methods study was utilized, combining survey data and semi-structured interviews in a tertiary medical intensive care unit in South Korea. A structured questionnaire assessed needs, anxiety, and uncertainty in illness for 50 participants. Interview data of 10 participants were analyzed using grounded theory. Assurance was the highest family need, followed by information need. Family needs differed according to gender, relationship to the patient, and length of intensive care unit stay. Participants reported family-centered multidisciplinary rounds provided a sense of relief, a chance to listen to medical staff, and a chance to provide medical staff with comprehensive information about patient care. Proximity needs were found to have a positive correlation with state anxiety, while comfort needs had a negative correlation with uncertainty in illness. Families reported family-centered multidisciplinary rounds were positive, useful experiences. Thus, standardization of family-centered multidisciplinary rounds is needed to meet families' various needs.

Myoelectric control of prostheses is a long-established technique, using surface electromyography (sEMG) to detect user intention and perform subsequent mechanical actions.Most machine learning models utilized in control systems are trained using isolated movements that do not reflect the natural movements occurring during daily activities. Moreover, movements are often affected by arm postures, the duration of activities, and personal habits. It is crucial to have a control system for multi-degree-of-freedom (DoF) prosthetic arms that is trained using sEMG data collected from activities of daily living (ADL) tasks. This work focuses on two major functional wrist movements: pronation-supination and dart-throwing movement (DTM), and introduces a new wrist control system that directly maps sEMG signals to the joint velocities of the multi-DoF wrist. Additionally, a specific training strategy (Quick training) is proposed that enables the controller to be applied to new subjects and handle situations where sensors may displace during daily living, muscles can become fatigued, or sensors can become contaminated (e.g. due to sweat). The prosthetic wrist controller is designed based on data from 24 participants and its performance is evaluated using the Root Mean Square Error (RMSE) and Pearson Correlation. The results are found to depend on the characteristics of the tasks. For example, tasks with dart-throwing motion show smaller RSME values (Hammer: 6.68 deg/s and Cup: 7.92 deg/s) compared to tasks with pronation-supination (Bulb: 43.98 deg/s and Screw: 53.64 deg/s). The proposed control technique utilizing Quick training demonstrates a decrease in the average root mean square error (RMSE) value by 35 % and an increase in the average Pearson correlation value by 40 % across all four ADL tasks.

This qualitative study explored the role and limitations of families as mediators of medical communication among cancer patients in South Korea. Semi-structured interviews were conducted with 46 participants including patients, family members, doctors, and nurses. This study examined how families alleviate communication burdens and navigate power dynamics between patients and physicians. The findings revealed that families gather, interpret, and translate medical information, often acting as intermediaries, owing to limited consultation times and complex medical terminology. They provide emotional, financial, and integrated care; influence treatment decisions; and ensure compliance. However, the study also identified limitations, such as disagreements among family members, information concealment, and the potential undermining of patient autonomy. This study underscores the need for nuanced approaches to family involvement that prioritize patient-centered care and respect individual preferences.