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PubMed2001

Development of the professional role behaviors survey (PROBES).

BACKGROUND AND PURPOSE: This study examined the content validity, internal consistency, and underlying dimensions of the Professional Role Behaviors Survey (PROBES) for its use in future research. METHODS: Using the 26-item PROBES, 253 clinical managers reported on the direction and magnitude of change in the role behaviors of physical therapists following hospital restructuring. RESULTS: Descriptive and correlational statistics of the responses indicated that the nature of the role behavior changes was consistent with those identified in the literature and that the survey instrument had good internal consistency. A principal component factor analysis yielded 5 underlying role behavior dimensions: "evaluating and planning," "productivity," "interacting," "information sharing," and "administration/clinical." This factor structure was found to provide a good fit with role classification schemes and a clear differentiation of physical therapist role behaviors. In addition, the finding supports viewing the professional role behaviors as a single construct rather than as multiple constructs. DISCUSSION AND CONCLUSION: The PROBES was found to have good content validity and internal consistency. It provides a useful tool for the study of the changing roles of professional practitioners and a link in the study of the effect of organizational change on organizational outcomes such as job satisfaction and organizational commitment.

Behavior↗
PubMed2005

Validating DICOM content in a remote storage model.

Verifying the integrity of DICOM files transmitted between separate archives (eg, storage service providers, network attached storage, or storage area networks) is of critical importance. The software application described in this article retrieves a specified number of DICOM studies from two different DICOM storage applications; the primary picture archiving and communication system (PACS) and an off-site long-term archive. The system includes a query/retrieve (Q/R) module, storage service class provider (SCP), a DICOM comparison module, and a graphical user interface. The system checks the two studies for DICOM 3.0 compliance and then verifies that the DICOM data elements and pixel data are identical. Discrepancies in the two data sets are recorded with the data elements (tag number, value representation, value length, and value field) and pixel data (pixel value and pixel location) in question. The system can be operated automatically, in batch mode, and manually to meet a wide variety of use cases. We ran this program on a 15% statistical sample of 50,000 studies (7500 studies examined). We found 2 pixel data mismatches (resolved on retransmission) and 831 header element mismatches. We subsequently ran the program against a smaller batch of 1000 studies, identifying no pixel data mismatches and 958 header element mismatches. Although we did not find significant issues in our limited study, given other incidents that we have experienced when moving images between systems, we conclude that it is vital to maintain an ongoing, automatic, systematic validation of DICOM transfers so as to be proactive in preventing possibly catastrophic data loss.

Computer Communication Networks↗
PubMed2006

Are they relevant? A critical evaluation of the international classification of functioning, disability, and health core sets for osteoarthritis from the perspective of patients with knee osteoarthritis in Singapore.

OBJECTIVES: To determine the extent to which health items identified from the perspective of patients with knee osteoarthritis can be linked with the International Classification of Functioning, Disability and Health (ICF); and to evaluate critically the content validity of ICF comprehensive and brief core sets for osteoarthritis. METHODS: Items identified from a focus group study were linked independently by two researchers based on the 10 a priori linking rules. Both percentage agreement and kappa statistics were calculated to measure interobserver agreement. Any disagreements were resolved by reaching a consensus among the researchers. The categories linked with all items were compared with the comprehensive core set, while the categories linked with those items reported as important by over 30% of subjects within each of three local ethnic groups (Chinese, Malay, and Indian) were compared with the brief core set. Both comparisons were made only at the second level of the ICF. RESULTS: In all, 74 items were linked with 44 different ICF categories through 105 linkages with generally good interobserver agreement. The 69 items were linked with the ICF at the third or fourth levels. Both commonalities and disparities were found through comparison between the categories linked with these items and both core sets. CONCLUSIONS: All items could be successfully linked with the ICF. The comprehensive core set showed good content validity, while the brief core set needs to be supported by more empirical evidence in various sociocultural contexts. This study specifically complemented the development and refinement of both core sets from the perspective of patients with knee osteoarthritis.

Adult↗
PubMed1994

A method of developing and weighting explicit process of care criteria for quality assessment.

The use of explicit criteria to evaluate how well processes of care conform to accepted standards is a key method of quality assessment. Synthesizing four decades of literature, we devised an inexpensive, 6-step method of developing reliable, content-valid, explicit process criteria. This paper describes the method using a set of congestive heart failure criteria. In step 1 of the Criteria Development Method, criteria are derived from state-of-the-art clinical literature. In step 2, criteria are refined by expert panels. In this study, panelists refined the items by mail in a three-round Delphi process. In step 3, decisions about unit-or differential item weighting are made; we derived differential item weights from the panelists' third-round ratings. Step 4 consists of flagging items which may yield little information, i.e., consensus items of low import, and nonconsensus items. Numeric flags were computed using third-round median ratings and their interquartile ranges. Selection of a scoring method to summarize scores and communicate results is done in step 5. In step 6, chart reviewers are trained, inter-rater reliability is measured, and items with poor reliability are culled. This straightforward developmental method can be used to devise explicit process criteria for use in ambulatory or hospital settings and to evaluate care delivered by different types of providers. The method yields reliable criteria representing accepted standards of current clinical practice. This high content validity is a sine qua non for convergent and predictive validity, both of which must be demonstrated in empirical studies in which the criteria are compared against external yardsticks.

Delphi Technique↗
PubMed2002

The hardest thing is the habit: a qualitative investigation of adolescent smokers' experience of nicotine dependence.

The aims were to explore adolescent smokers' understanding and their physiological and psychological experience of addiction to nicotine and to assess the content validity of the Hooked on Nicotine Checklist (HONC), a 10-item measure of nicotine dependence in youth. Six focus group interviews were conducted with male and female smokers recruited by school staff from among known smokers at one English and two French high schools in Montreal. Participants were 64 high-school students aged 14-17 years. Measurements were focus group discussion of smoking patterns and levels for self and others; feelings and sensations while smoking; physical and mental experiences of urges, feelings and sensations when smoking is prohibited; the physical, psychological, and social meanings of being hooked, dependent, or addicted; levels of dependence, desire to quit, and quit attempts. Participants readily identified nicotine dependence as relevant to their smoking experience. Dependence was described as the need to smoke, sometimes experienced as sensations of emptiness in the chest or blood and sometimes as a feeling in the mind. Smoking urges were often situationally determined and associated with hunger. With the exception of feeling sad, blue, or depressed on smoking withdrawal, participants endorsed almost all the symptoms in the HONC as relevant to their experience of dependence and identified several other symptoms as well. Adolescents are able to provide self-reports of symptoms of dependence that are consistent with a theoretically driven conceptualization of nicotine dependence. The HONC demonstrates content validity among adolescents but could be improved through removal of the item related to depression on withdrawal and possibly addition of items related to stress and appetite.

Adolescent↗
PubMed2005

Life before death: identifying preparatory grief through the development of a new measurement in advanced cancer patients (PGAC).

GOALS OF WORK: This paper describes the development of a self-rating scale to measure preparatory grief in advanced cancer patients. PATIENTS AND METHODS: The Preparatory Grief in Advanced Cancer patients (PGAC) instrument incorporates seven multi-items scales. The final sample consisted of 200 patients. The questionnaire was completed at baseline and 3 days later with a cross-validation sample of 100 patients. MAIN RESULTS: The average time required to complete the questionnaire was 9 min. All scales met the minimum standards of reliability (Cronbach's alpha coefficient >0.70). The test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p < 0.05). Validity was demonstrated by content validity, factor analysis, convergence and discriminative validity, inter-scales correlations, concurrent validity with the Hospital Anxiety and Depression Scale (HADS) and known-group validity with the Eastern Cooperative Oncology Group (ECOG) performance status. CONCLUSIONS: The PGAC is a reliable and valid measure for the assessment of anticipatory grief in patients with advanced stage cancer.

Adult↗
PubMed2004

Computer science education for medical informaticians.

The core curriculum in the education of medical informaticians remains a topic of concern and discussion. This paper reports on a survey of medical informaticians with Master's level credentials that asked about computer science (CS) topics or skills that they need in their employment. All subjects were graduates or "near-graduates" of a single medical informatics Master's program that they entered with widely varying educational backgrounds. The survey instrument was validated for face and content validity prior to use. All survey items were rated as having some degree of importance in the work of these professionals, with retrieval and analysis of data from databases, database design and web technologies deemed most important. Least important were networking skills and object-oriented design and concepts. These results are consistent with other work done in the field and suggest that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are part of the core curriculum for medical informatics.

Curriculum↗
PubMed1991

Dimensions, content and validation of the fear of AIDS schedule in health professionals.

We examined the structure of the Fear of AIDS Schedule (FAIDSS) in a sample of 134 health care workers. Factor analysis indicated that there were five discrete dimension of fear of AIDS: fears of loss of control, of sex, of HIV infection through blood and illness, of death and medical interventions, and of contact with outsiders. These dimensions had low to moderate intercorrelations. The dimensions of fear of HIV infection through blood or illness, was significantly correlated with desired personal social distance from people with AIDS, and this dimension along with fear of death and medical interventions were correlated with desired public social distance. Fear of infection through blood and illness were predictors of both desired personal social distance and public social distance from people with HIV infection. The data suggest greater discrimination of AIDS fears with greater closeness of interaction with people with HIV disease, and that these dimensions of the FAIDSS are both reliable and valid measures of AIDS fears.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Basic ultrasound curriculum for medical students: validation of content and phantom.

Effective use of ultrasound requires an understanding of the physics, combined with the ability to interpret the sonographic images. The aim of our study was to evaluate the impact of a basic ultrasound curriculum using a phantom to train medical students. Twenty-eight first- to fourth-year medical students were randomized to two groups: a control group that received no formal training and a trained group that received basic ultrasound training. Both groups took an initial multiple-choice written test and an ultrasound hands-on test using an agarose-based tissue mimic containing various objects. The curriculum for the trained group consisted of reading the principles of ultrasound and a hands-on session over the phantom. After training, both groups underwent a second multiple-choice exam and ultrasound practical test. The initial and the post-training test results were analyzed using a two-tailed Student's t-test. Baseline written and practical test scores were similar for both groups. After training, written test scores improved (82% trained vs. 66% control, P < 0.001). Hands-on ultrasound task performance also improved with training (96% trained vs. 60% control, P <0.001). The trained group took a shorter time to obtain a clear image and found on average one more object per scan. Parameters such as time to obtain a useful image and number of objects recognized also improved with training. Basic sonographic physics, imaging, and interpretation can be effectively taught to medical students during a short training session.

Curriculum↗
PubMed1997

Risk-adjusted outcome measures and quality of care in nursing homes.

OBJECTIVES: This study examines the use of the patient review instrument (PRI), a reimbursement reporting system used by the New York State Department of Health, to assess quality of care based on risk-adjusted outcomes. METHODS: Data for all residents in approximately 550 nursing homes in upstate New York are used to develop five risk-adjusted outcome measures. The five measures are rates of decline in functional status activities of daily living (ADL), rates of increases in severity of decubitus ulcers, physical restraints rates, dehydration rates, and rates of major accidents. Logistic models are used to adjust for individual patients' risk factors. The face validity, content, construct, and criterion validity of these measures is examined. RESULTS: Measures based on ADL decline, deterioration in decubiti, and physical restraints rates met all validity criteria and were correlated significantly with deficiency citations. Measures based on accident rates and rates of dehydration did not perform as well. There was significant variation in these quality measures across regions and between for-profit and nonprofit nursing homes. CONCLUSIONS: Information about quality of care is important to the efficient operation of competitive markets. Such information, however, often is costly to obtain and not available to individual patients. This study demonstrates that valid risk-adjusted outcome measures of quality can be developed based on data collected for reimbursement purposes.

Accidents↗
PubMed2004

Development of the PsAQoL: a quality of life instrument specific to psoriatic arthritis.

BACKGROUND: Patient reported outcome measures used in studies of psoriatic arthritis (PsA) have been found to be inadequate for determining the impact of the disease from the patient's perspective. OBJECTIVE: To produce the PsAQoL, a PsA-specific quality of life (QoL) instrument, employing the needs based model of QoL that would be relevant and acceptable to respondents, valid, and reliable. METHODS: Content was derived from qualitative interviews conducted with patients with PsA. Face and content validity were assessed by field test interviews with a new sample of patients with PsA. A postal survey was conducted to improve the scaling properties of the new measure. Finally, a test-retest postal survey was used to identify the final measure and to test its scaling properties, reliability, internal consistency, and validity. RESULTS: Analysis of the qualitative interview transcripts identified a 51 item questionnaire. Field test interviews confirmed the acceptability and relevance of the measure. Analysis of data from the first postal survey (n = 94) reduced the questionnaire to 35 items. Rasch analysis of data from the test-retest survey (n = 286) identified a 20 item version of the PsAQoL with good item fit. This version had excellent internal consistency (alpha = 0.91), test-retest reliability (0.89), and validity. CONCLUSIONS: The PsAQoL is a valuable tool for assessing the impact of interventions for PsA in clinical studies and trials. It is well accepted by patients, taking about three minutes to complete, is easy to administer, and has excellent scaling and psychometric properties.

Adult↗
PubMed1993

The role of motor excess and instrumented activity measurement in attention deficit hyperactivity disorder.

Motor excess was once recognized as a primary aspect of childhood behavior disorder but has been largely discounted by current investigators despite consistent reference to hyperactivity in titles of articles, chapters, and books. The presumed minor relevance of hyperactivity to attention deficit hyperactivity disorder (ADHD) is based on analogue assessment procedures that remain to be validated. Results of content-valid instrumented behavioral measurements show that ADHD children are pervasively hyperactive. These findings are consistent with recent research showing activity to be an important aspect of temperament and a well-documented factor of externalizing disorders of childhood. Theoretical analyses of the relationship between hyperactivity and ADHD disorder are presented.

Adolescent↗
PubMed1975

Validating the content of pediatric outpatient medical records by means of tape-recording doctor-patient encounters.

Information in 51 tape-recorded physician-patient encounters was compared with information written in the patients' medical records. Diagnoses, chief complaints, scheduled appointments, non-drug therapy, and diagnostic studies were uniformly well-recorded. Medication names were well-recorded but dosages were not. Characteristics of care such as levels of function, probable cause of illness, reason for follow-up, and compliance were recorded poorly. Patients were more likely to known about and understand their diagnosis, and names, dosage, and intended function of their medications when this information was written in the record than when it was not. These findings indicate a relationship between the quality of medical records and the effectiveness of care.

Child↗
PubMed1998

An abilities assessment instrument for elderly persons with cognitive impairment: psychometric properties and clinical utility.

In this article the psychometric properties of an Abilities Assessment Instrument (AAI), developed to assess the self-care, social, interactional and interpretive abilities of older people with cognitive impairment (CI) related to dementia, are described. The sample consisted of 112 institutionalized older men with CI and 60 institutionalized older men without CI. The psychometric evaluation of the AAI indicated that: (a) it is reliable in terms of test-retest (Pearson's r range .93-.99), interrater (Pearson's r range .95- .99), and internal consistency evaluations (Cronbach's alpha .90-.98), as well as through confirmatory factor analysis; and (b) that it is valid with respect to content validity (CVI 87.3%), concurrent validity (Pearson's r correlations ranging from -.67-.80 on the London Psychogeriatric Rating Scale [LPRS], and from -.76-.85 on the Functional Assessment Stages Scale [FAST]), and construct validity with significant differences between subjects with and without CI (t values ranging from 5.13-9.30). The AAI is a reliable and valid instrument that can be used to provide assessment data.

Activities of Daily Living↗
PubMed1993

Validity and reliability of a bone marrow transplant acuity tool.

The purpose of this project was to develop a valid and reliable patient-acuity tool for patients undergoing bone marrow transplant (BMT) as part of an overall patient-acuity system. A survey of other cancer centers and a review of the literature revealed no acuity tools that were designed for patients undergoing BMT. A four-level, nursing-diagnosis-based tool was developed with multiple indicators in each level, and its validity and reliability were studied. Content validity indexes (CVIs) were generated for each indicator by a panel of content experts. CVIs ranged from 0.4 to 1.0 with an overall CVI of 0.93 for the tool. Interrater reliability using two raters for 79 patients was high (r = 0.94, p < 0.001). Results of the study provide sufficient evidence of validity and reliability to warrant use of the tool, but further study is needed.

Bone Marrow Transplantation↗
PubMed2005

What is being assessed in the MRCGP oral examination? A qualitative study.

BACKGROUND: Oral examinations are a popular method of assessment within medicine, being capable of measuring candidates' ability to carry out tasks or develop skills (operational knowledge). One example of this is the oral examination for membership of the Royal College of General Practitioners (RCGP), which is designed to assess candidates' decision-making skills and the professional values that underpin these decisions. While the reliability of oral examinations has been investigated, to date, little is known about their ability to measure what they set out to measure (validity). AIM: To investigate the content validity of the MRCGP oral examination, with particular focus on its ability to assess the process of decision-making. DESIGN OF STUDY: An evaluation of oral examination video recordings, using qualitative methods. METHOD: The MRCGP oral examinations are video recorded as part of an ongoing quality assurance programme. Fifty of the recordings carried out in 2002 were selected randomly and analysed for content and dialogue patterns reflecting the assessment of the decisionmaking process. RESULTS: All examiners used the specified contexts outlined in the examination objectives to present candidates with dilemmas. The assessment of decision-making skills, however, was limited by a tendency among examiners to present the candidate with new, more complex dilemmas rather than giving them the opportunity to discuss the implications, make choices and ultimately, justify their decision. Moreover, while examiners frequently asked candidates questions relating to professional values, they rarely asked them to demonstrate how those values support their decisions. CONCLUSION: In order that the benefits of oral examination can be fully realised, questions need to be structured in a way that encourages candidates to discuss all stages of the decision-making process.

Clinical Competence↗
PubMed1991

Validity and reliability of a pediatric hematology oncology patient acuity tool.

Appropriate use of nursing resources in the pediatric hematology and oncology inpatient settings demands a patient acuity system that is easy to use and accurate, and that objectively measures nursing care needs of a specialized patient population. Structured survey of 13 comprehensive cancer centers and a review of the literature show no valid and reliable acuity tools for this pediatric population. The purpose of this project was to study the validity and reliability of a newly developed pediatric hematology and oncology acuity system designed to quantify patient care needs. A new acuity tool for this pediatric population was developed based on the patient classification tool used at Johns Hopkins Hospital Oncology Center (JHHOC). The levels of care from the JHHOC tool were adopted, with therapeutic indicators modified to reflect nursing diagnoses relevant to the pediatric inpatient. Nursing care hours required for each level of care were also identified. Validity was studied using a content validity index (CVI). Experts from the pediatric unit where the tool would be used were asked whether each therapeutic indicator was assigned to the correct level of care (1 thru 5) based on patient care hours. CVIs for items ranged from .5 to 1.0; the overall CVI for the tool was .93. Interrater reliability was studied using two raters from the unit. Data were collected for 150 patient observations on a 12-bed pediatric hematology and oncology inpatient and short-stay outpatient unit. The resulting Pearson correlation coefficient was r = .97 (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗