Eduardo Doval

Quality of life in cirrhosis is related to potentially treatable factors.

Objective Improvement of prognosis and availability of diverse therapeutic options for complications of advanced liver disease highlight the importance of health-related quality of life (HRQOL) in cirrhosis. The aim of this study was to identify factors that influence HRQOL and may be potentially treatable in patients with cirrhosis. Methods HRQOL was measured in 212 outpatients with cirrhosis using a generic questionnaire (Medical Outcomes Study Form, SF-36) and a liver-specific questionnaire (Chronic Liver Disease Questionnaire, CLDQ). All patients underwent a systematic clinical and neuropsychological assessment. Independent factors associated with poor HRQOL were identified by multiple linear regression. Results HRQOL scores exhibited by patients were: global CLDQ: 4.8±1.2; Physical Component Score of SF-36: 38.5±10.7; Mental Component Score of SF-36: 45.3±14.3. The independent variables for global CLDQ were female sex, nonalcoholic etiology, current ascites, and a decrease in albumin (R2 = 0.22). For Physical Component Score of SF-36, the independent variables were prior hepatic encephalopathy, current ascites, and a decrease in hemoglobin (R2 = 0.22). For Mental Component Score of SF-36, the independent variables were nonalcoholic etiology, the Grooved Pegboard test, and a decrease in hemoglobin (R2 = 0.14). Conclusion Several clinical variables, potentially treatable, may alter particular aspects of HRQOL. Correction of ascites, hypoalbuminemia, minimal hepatic encephalopathy, and anemia may cause a positive impact on HRQOL of patients with cirrhosis.

Effects of Branched-Chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: A Randomized Study

OBJECTIVES:Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA.METHODS:A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks.RESULTS:The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function.CONCLUSIONS:Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

Development of a clinical hepatic encephalopathy staging scale.

To develop a scale to assess the severity of hepatic encephalopathy using simple dichotomic items.

Individual Consistencies Across Time and Tasks: A Replication of Interactive Styles

Three experimental studies were carried out in order to find within-subject consistencies as well as individual differences in a concurrent choice situation involving risk-taking. Four subjects were exposed twice, with a 4-month delay, to a horse-race game and a stock-exchange game, in order to evaluate their choices for a conservative versus a risky condition under open contingencies. The results in the 3 experiments showed reliable profiles in all subjects when frequency of changeovers was correlated with number of accumulated earnings. Results are discussed in terms of interactive styles.

A journey around alpha and omega to estimate internal consistency reliability

Resumen: En este trabajo se presenta una guía conceptual y práctica para estimar la fiabilidad de consistencia interna de medidas obtenidas mediante suma o promedio de ítems con base en las aportaciones más recientes de la psicometría. El coeficiente de fiabilidad de consistencia interna se presenta como un subproducto del modelo de medida subyacente en las respuestas a los ítems y se propone su estimación mediante un procedimiento de análisis de los ítems en tres fases, a saber, análisis descriptivo, comprobación de los modelos de medida pertinentes y cálculo del coeficiente de consistencia interna y su intervalo de confianza. Se proporcionan las siguientes fórmulas: (a) los coeficientes alfa de Cronbach y omega para medidas unidimensionales con ítems cuantitativos (b) los coeficientes omega ordinal, alfa ordinal y de fiabilidad no lineal para ítems dicotómicos y ordinales, y (c) los coeficientes omega y omega jerárquico para medidas esencialmente unidimensionales con efectos de método. El procedimiento se generaliza al análisis de medidas obtenidas por suma ponderada, de escalas multidimensionales, de diseños complejos con datos multinivel y/o faltantes y también al desarrollo de escalas. Con fines ilustrativos se expone el análisis de cuatro ejemplos numéricos y se proporcionan los datos y la sintaxis en R. Palabras clave: Fiabilidad; consistencia interna; coeficiente alfa; coeficiente omega; medidas congenéricas; medidas tau-equivalentes; análisis factorial confirmatorio. Title: A journey around alpha and omega to estimate internal consistency reliability. Abstract: Based on recent psychometric developments, this paper presents a conceptual and practical guide for estimating internal consistency reliability of measures obtained as item sum or mean. The internal consistency reliability coefficient is presented as a by-product of the measurement model underlying the item responses. A three-step procedure is proposed for its estimation, including descriptive data analysis, test of relevant measurement models, and computation of internal consistency coefficient and its confidence interval. Provided formulas include: (a) Cronbach’s alpha and omega coefficients for unidimensional measures with quantitative item response scales, (b) coefficients ordinal omega, ordinal alpha and nonlinear reliability for unidimensional measures with dichotomic and ordinal items, (c) coefficients omega and omega hierarchical for essentially unidimensional scales presenting method effects. The procedure is generalized to weighted sum measures, multidimensional scales, complex designs with multilevel and/or missing data and to scale development. Four illustrative numerical examples are fully explained and the data and the R syntax are provided.

How does emotional exhaustion influence work stress? Relationships between stressor appraisals, hedonic tone, and fatigue in nurses’ daily tasks: A longitudinal cohort study

BACKGROUND Work-related stress is a prevalent condition in the nursing profession, and its influence may vary according to changeable individual and situational factors. It is, therefore, important to investigate the real-time momentary changes in these factors and their relationship to emotional exhaustion experienced by nurses. OBJECTIVES We aim to analyse how their perceptions of demand, control, effort and reward change according to the task performed through real-time assessment and interact with the emotional exhaustion level of ward nurses. DESIGN The research design was longitudinal. METHOD A three-level hierarchical model with a repeated measures design was used to assess the momentary self-reports of 96 hospital ward nurses, completed using a smartphone programmed with random alarms. RESULTS Findings show that demand, effort, and control appraisals depend on the task performed. The task appraised as most demanding, effortful, and controllable was direct care. Reward appraisal depends on the task performed and personal variables, i.e. emotional exhaustion. The situations perceived as more rewarding were rest and direct care. Momentary hedonic tone can be explained by the task performed, demand, reward, emotional exhaustion and by the interaction between emotional exhaustion and demand appraisal. Momentary fatigue can be explained by the task performed, demand, reward, and the emotional exhaustion. CONCLUSIONS This study highlights the importance of using momentary measures to understand complex and changeable inter-relationships. While also clarifying the targets of intervention programmes aimed at preventing burnout within the nursing profession.