1
|
Tsay SF, Chang CY, Shueh Hung S, Su JY, Kuo CY, Mu PF. Pain prediction model based on machine learning and SHAP values for elders with dementia in Taiwan. Int J Med Inform 2024; 188:105475. [PMID: 38743995 DOI: 10.1016/j.ijmedinf.2024.105475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/06/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Pain conditions are common in elderly individuals, including those with dementia. However, symptoms associated with dementia may lead to poor recognition, assessment and management of pain. In this study, we incorporated the variables based on questionnaires into a machine learning algorithm to build a prediction model for the pain index of elderly individuals with dementia. MATERIALS AND METHODS In this study, 113 cases were collected through questionnaires and used to build prediction models for the patient's pain index. Three machine learning algorithms were incorporated for comparison in this study. To interpret the prediction model, SHapley additive explanations values were used to depict the ranking importance of variables and the relationship between features and pain index. RESULTS In the comparison of models, random forests with feature selection outperformed in terms of root mean square error and mean absolute error. A total of 11 features were selected based on embedded method. The results showed that the Karnofsky scale played a key role in predicting pain index for elderly individuals with dementia and was positively associated with pain index. Arthritis is the most important disease to predicting the pain index. CONCLUSIONS Our findings provided the key insights to predict the pain index of elderly patients with dementia. In the future, it can be used to develop an application system or webpage, which can reduce the use of labour and improve the efficiency.
Collapse
Affiliation(s)
- Shwu-Feng Tsay
- Department of Nursing and Health Care, Ministry of Health and Welfare, No. 488, Sec. 6, Zhongxiao E. Rd., Nangang District, Taipei City 115, Taiwan; School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City 100, Taiwan; Department of Health Services Administration, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City 406, Taiwan
| | - Cheng-Yu Chang
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan; Institute of Clinical Nursing, School of Nursing, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City 112304, Taiwan
| | - Sing Shueh Hung
- Hung Sing Shueh Home Care Center, No. 92-7, Sec. 1, Xingshe St., Xinshe Dist., Taichung City 426016, Taiwan
| | - Jui-Yuan Su
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan; School of Nursing, National Taipei University of Nursing and Health Sciences. No. 365, Ming-te Rd., Peitou Dist., Taipei City 112303, Taiwan
| | - Chao-Yang Kuo
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Rd., Peitou Dist., Taipei City 112303, Taiwan.
| | - Pei-Fan Mu
- Institute of Clinical Nursing, School of Nursing, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City 112304, Taiwan.
| |
Collapse
|
2
|
Wang Q. Assessing pain in older people with normal, mildly impaired or severely impaired cognition. Nurs Older People 2024:e1466. [PMID: 39015017 DOI: 10.7748/nop.2024.e1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 07/18/2024]
Abstract
Pain is a relatively common experience among older people, but unrelieved pain has significant functional, cognitive and emotional consequences for this population. A comprehensive and accurate pain assessment is essential for effective pain management. Self-report tools are suitable to assess pain in older people with normal or mildly impaired cognition, while observational tools are suitable for use with those with significant cognitive impairment or communication difficulties. However, pain assessment in older people can be challenging. The use of one tool on its own is rarely sufficient and it is crucial to involve family carers in assessment of pain in older people with severe cognitive impairment. This article discusses different tools and strategies, including the benefits and limitations, for assessing pain in older people.
Collapse
Affiliation(s)
- Qun Wang
- and lead for non-medical prescribing at an NHS trust in England
| |
Collapse
|
3
|
Yu G, Sun C, Hao S, Wu H. Comparative analysis of pressure ulcer development in stroke patients within and outside healthcare facilities: A systematic review and meta-analysis. Int Wound J 2024; 21:e14840. [PMID: 38556516 PMCID: PMC10982073 DOI: 10.1111/iwj.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
The risk of pressure ulcers in stroke patients is a significant concern, impacting their recovery and quality of life. This systematic review and meta-analysis investigate the prevalence and risk factors of pressure ulcers in stroke patients, comparing those in healthcare facilities with those in home-based or non-clinical environments. The study aims to elucidate how different care settings affect the development of pressure ulcers, serving as a crucial indicator of patient care quality and management across diverse healthcare contexts. Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Web of Science and the Cochrane Library. Inclusion criteria encompassed studies on stroke patients in various settings, reporting on the incidence or prevalence of pressure ulcers. Exclusion criteria included non-stroke patients, non-original research and studies with incomplete data. The Newcastle-Ottawa scale was used for quality assessment, and statistical analyses involved both fixed-effect and random-effects models, depending on the heterogeneity observed. A total of 1542 articles were initially identified, with 11 studies meeting the inclusion criteria. The studies exhibited significant heterogeneity, necessitating the use of a random-effects model. The pooled prevalence of pressure injuries was 9.53% in patients without family medical services and 2.64% in patients with medical services. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected through funnel plot analysis and Egger's linear regression test. The meta-analysis underscores the heightened risk of pressure injuries in stroke patients, especially post-discharge. It calls for concerted efforts among healthcare providers, policymakers and caregivers to implement targeted strategies tailored to the specific needs of different care environments. Future research should focus on developing and evaluating interventions to effectively integrate into routine care and reduce the incidence of pressure injuries in stroke patients.
Collapse
Affiliation(s)
- Guifen Yu
- Department of NeurologyThe Second People's Hospital of LinhaiLinhaiChina
| | - Changqing Sun
- Department of NeurosurgeryBaodi Hospital Affiliated To Tianjin Medical UniversityTianjinChina
| | - Sha Hao
- Department of OncologyJingmen Hospital of Traditional Chinese MedicineJingmenChina
| | - Hui Wu
- Department of NeurologyThe Second People's Hospital of YuhuanYuhuanChina
| |
Collapse
|
4
|
Pu L, Coppieters MW, Smalbrugge M, Jones C, Byrnes J, Todorovic M, Moyle W. Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study. Pain Manag Nurs 2023; 24:587-594. [PMID: 37105837 DOI: 10.1016/j.pmn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN A qualitative study. SETTINGS/PARTICIPANTS Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.
Collapse
Affiliation(s)
- Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Amsterdam Movement Sciences - Program Musculoskeletal Health, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Martin Smalbrugge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Joshua Byrnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| |
Collapse
|
5
|
Joshi S, Park T, Brody L, Cruz K, Mukhi P, Reid MC, Herr K, Pillemer K, Riffin C. Recruitment of family caregivers of persons with dementia: Lessons learned from a pilot randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1125914. [PMID: 37051457 PMCID: PMC10083411 DOI: 10.3389/fpain.2023.1125914] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Family caregivers play an essential role in supporting the health and well-being of older adults with dementia, a population projected to increase rapidly over the coming decades. Enrolling caregivers of people with dementia (PWD) in research studies is vital to generating the evidence necessary to support broader implementation of efficacious intervention programs in real-world care delivery, but a range of challenges impede recruitment and enrollment of sufficiently large and representative sample sizes. In this article, we characterize the challenges and lessons learned from recruiting caregivers of PWD to participate in a pilot randomized control trial. We utilize Bronfenbrenner's ecological model to categorize the challenges into three levels: individual (i.e., understanding caregivers' time constraints and motivations), community (i.e., reaching underrepresented populations and accessing caregiver support groups) and institutional (i.e., obtaining informed consent and navigating research registries). We found that establishing rapport and maintaining flexibility with participants was crucial for motivating individuals to enroll in our study. Building trust with local communities by collaborating with support group leaders, appointing a co-investigator who is already embedded within a given community, and establishing equitable partnerships with organizations increased recruitment rates. At the institutional level, engaging experts in regulatory affairs and geriatrics may help overcome barriers in obtaining approval from institutional review boards. We also recommend using research registries of individuals who offer their contact information to researchers. The lessons learned from our research-including the challenges and potential solutions to overcome them-may promote more effective and efficient recruitment in future research.
Collapse
Affiliation(s)
- Sama Joshi
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Kiana Cruz
- Hackensack Meridian School of Medicine, Seton Hall University, South Orange, NJ, United States
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, IA, UnitedStates
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|