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PubMed1995

Development and psychometric evaluation of the reciprocal empowerment scale.

This article reports on the development and evaluation of the Reciprocal Empowerment Scale (RES) which was designed to measure empowerment in the context of the leader-follower relationship in organizational settings. The instrument was developed through a process of retroductive triangulation of theoretical and empirical empowerment literature and results of a qualitative study. Deletion of items not considered valid by a panel of expert judges brought the content validity index to .97. An internal consistency reliability coefficient alpha of .95 was achieved for the RES. Subscale coefficients of .82 to .95 were obtained. Convergent and divergent validity and freedom from social desirability response bias were supported. Principal component extraction with oblique rotation resulted in a three-factor solution: reciprocity, synergy, and ownership. With further testing, the RES should prove useful for nursing administration research and practice.

Adult↗

PubMed2004

Validation of a six-task simulation model in minimally invasive surgery.

BACKGROUND: The content validity of currently available inanimate simulation models is questionable, because some tasks seem too far from clinical reality. The aim of this study was to validate a simulation model with six tasks commonly used in clinical practice (6-TSM) for the acquisition of psychomotor skills in minimally invasive surgery (MIS). METHODS: This was a prospective randomized trial comparing the 6-TSM to a previously described three-task training method (3-TTM). All first, second, and third postgraduate year surgical residents were eligible. The 6-TSM included clipping and dividing of a vessel, excision of lesion, appendectomy, mesh repair, suturing perforation, and hand-sewn anastomosis. The outcome measures of 6-TSM included accuracy error, tissue damage, sliding knot, leak, operating time, and dangerous movements. After completion of training, 6-TSM and 3-TTN residents were tested by the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Criterion-related and construct validity, responsiveness, test-retest, and interrater reliability were assessed. RESULTS: During six months, 17 residents underwent training with the 6-TSM or the 3-TTM as allocated. The mean duration of training with 6-TSM and 3-TTM was similar (7.8 vs 8.1 h). The criterion-related validity of the 6-TSM was shown by significantly increased skill improvement in the 6-TSM residents, as compared with the 3-TTM residents at MIST-VR. Construct validity the of 6-TSM was shown by the finding that the experts' baseline was superior to the residents' baseline. The responsiveness of the 6-TSM was shown by the significantly increased skill improvement of the 6-TSM residents in sliding knot, leak, and operating time. The test-retest reliability of the 6-TSM was good (> 0.80), except for accuracy error and dangerous movements (Cronbach's intraclass correlation coefficient alpha: 0.57, p < 0.0001; 0.62, p < 0.0001, respectively). The interrater reliability of the 6-TSM was good (>0.80) except for leak (Kendall's concordance coefficient tau_b:0.76, p = 0.06 for hand-sewn anastomosis) and dangerous movements (tau_b:0.72, p = 0.08 for suturing perforation and tau_b:0.68, p = 0.10 for hand-sewn anastomosis). The perresident cost for 6-TSM was 769 dollars. CONCLUSIONS: The 6-TSM is a valid and reliable learning tool for surgical residents' acquisition of laparoscopic motor skills.

Clinical Competence↗

PubMed2002

Use of fan beam dual energy x-ray absorptiometry to measure body composition of piglets.

A piglet model was used to determine whether the fan beam dual energy X-ray absorptiometry technique (DXA) could be adapted for the measurement of body composition of small subjects. Commercial domestic swine piglets (n = 14) with weights between 1.95 and 21.1 kg had duplicate fan beam-DXA scans followed by chemical analysis of body composition. Each scan required 2-3 min to complete. DXA-measured total body weight was validated against scale weights of the piglets (with and without blanket and other covering), DXA bone mineral content validated against carcass ash and calcium, and DXA lean and fat mass validated against chemical lean and fat contents. Measurements from duplicate DXA scans were highly reproducible with adjusted r(2) values from 0.992 to 1.000. Each DXA measurement was highly predictive of the scale weight or specific chemical body composition with adjusted r(2) values from 0.974 to 0.999. The intraclass reliability coefficient among measurements from individual scans with scale weight or the weight of individual chemical components was extremely high at > or =0.99 for all comparisons. The SD of residuals for DXA prediction of scale weights (with and without covering) were 168 and 157 g, respectively, and were 27, 8.8, 122 and 72 g for the prediction of carcass ash, calcium, lean and fat tissue content, respectively. We conclude that rapid scan acquisition, accurate and precise prediction of scale weight and components of body composition would support the use of fan beam-DXA for body composition studies in growing humans or animals.

Absorptiometry, Photon↗

PubMed2003

Validity of performance indicators for assessing prescribing quality: the case of asthma.

OBJECTIVES: The aim of this study was to assess the concurrent validity between the identification of sub-optimal treatment based on clinical information and computer generated indicators. Indicators that are associated with sub-optimal treatment in one of the four steps of asthma management were assessed. DESIGN: The ability of each indicator to identify patients with sub-optimal asthma treatment from computerised general practitioner (GP) prescription records was assessed by comparing them with the results of an individual patient assessment using clinical data. SETTING: Chronic asthma patients ( n=146) registered with 16 Dutch GPs. MAIN MEASURES: The sensitivity and positive predictive value (PPV) of each performance indicator was determined. RESULTS: The step-1 indicator, focusing on patients not prescribed a short-acting beta-agonist, had an acceptable sensitivity (0.86), but a low PPV (0.52). The two step-2 indicators, targeting under-prescription of inhaled corticosteroids, had sensitivities of 0.74 and 0.37 and PPVs of 0.46 and 0.71, respectively. The step-3 indicator, which targeted under-dosing of inhaled corticosteroids, had a sensitivity of 0.07 and a PPV of 0.2. The fourth indicator, focusing on under-prescription of long-acting beta-agonists, could not be validated due to inadequate numbers of patients with severe asthma in our study sample. DISCUSSION: None of the indicators investigated was considered valid for assessing prescriber performance, despite having good face and content validity. Performance indicators that have not been validated can only provide a broad-brush approach for assessing prescribing quality and should be used with extreme caution.

Adolescent↗

PubMed2004

Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation.

OBJECTIVES: To validate a new, self-administered questionnaire for assessing key domains of sexual function and satisfaction in aging men with urogenital health concerns. METHODS: The initial items were identified by patient interviews, review of current reports, and expert panel solicitation. The resulting 25-item questionnaire was subjected to psychometric evaluation and refinement using two discriminant validity studies in aging men with urogenital symptoms compared with age-matched controls. Psychometric tests of reliability, discriminant, and criterion validity were performed. RESULTS: Qualitative testing revealed adequate comprehension and content validity of the initial item set. Two domains of sexual function (ejaculation, erection) were identified in the first discriminant validity study, each of which showed a high degree of internal consistency (alpha = 0.81 and alpha = 0.90, respectively) and test-retest reliability (r = 0.86 and r = 0.87, respectively). Both sexual function domains discriminated well between men with and without urogenital manifestations of lower urinary tract symptoms (LUTS) and sexual dysfunction (P <0.001). An additional domain of sexual satisfaction was added in the second validation study, with similarly high internal consistency (alpha = 0.90) and test-retest reliability (r = 0.88). Tests of convergent and divergent validity, including correlations with standardized scales for depression (Center for Epidemiologic Studies-Depressed Mood Scale), sexual function (International Index of Erectile Function), and life satisfaction (Fugl-Meyer), confirmed the criterion validity of the new measure. CONCLUSIONS: The Male Sexual Health Questionnaire assesses sexual function and satisfaction in older men with urogenital symptoms of LUTS and sexual dysfunction. This new instrument has excellent psychometric properties and is well suited for use in clinical and research settings.

Age Factors↗

PubMed2006

Screening for suicide among juvenile delinquents: reliability and validity evidence for the Suicide Screening Inventory (SSI).

The purpose of this study was to test the reliability and validity of a new instrument for assessing suicidality in adjudicated delinquents. The Suicide Screening Inventory (SSI), a 14-item interview, was evaluated based on archival data from 442 adolescents, primarily male, between the ages of 12 and 20. Two estimates of reliability indicated moderate internal consistency. In addition, a moderate correlation (r= .53) between the SSI and the Reynold's Adolescent Depression Scale suggested convergent validity. Expert ratings of the instrument's utility also provided content validity evidence. Descriptive data were collected on four youth who made suicide attempts. Elevated scores among these select cases provided some evidence for consequential validity. These results are discussed with regard to practical and research implications.

Adolescent↗

PubMed2005

[Construction of Jung Psychological Types Scale].

The purpose of this study was to construct Jung's Psychological Types Scale (JPTS), and to examine its reliability and validity. First, 87 pairs of items were written, and their content validity examined by two Jungian analysts, who judged 74 pairs of them to be appropriate. In Study 1 542 undergraduates, 245 men and 297 women, responded to the interim scale. Exploratory factor analysis found three factors: extraversion-introversion (E-I), thinking-feeling (T-F), and sensation-intuition (S-N). Results of additional factor analyses indicated that the three factors were almost orthogonal. Then, nine item pairs each for the subscales were selected for the JPTS. The scale had high alpha and test-retest reliability coefficients. In Study 2, concurrent validity of the scale was examined in terms of Myers-Briggs Type Indicator (MBTI) Form M. The correlations showed meaningful patterns for concurrent validity. In addition, the scale was evaluated in terms of NEO Five Factor Inventory (NEO-FFI), a five-factor model (FFM) scale. The result showed that the three factors of E-I, T-F, and S-N corresponded to Extraversion (positive), Agreeableness (negative), and Openness (negative) of NEO-FFI, respectively.

Adult↗

PubMed1999

Psychological autopsies for equivocal deaths.

Although in use since 1958, the term "psychological autopsy" and its constituent elements have yet to achieve either consensual validation or operational standardization. This calls into question issues of content validity and reliability when psychological autopsies are used in the field. This paper argues for a clear differentiation between psychological autopsies used subsequent to suicide versus equivocal deaths and for the recognition of Equivocal Death Psychological Autopsy as a clearly distinct form of psychological autopsy with its own constituent elements and training guidelines.

Autopsy↗

PubMed1991

[Standards of nursing services for private hospitals].

The formalization of nursing quality assurance in private hospitals is of critical importance. The purpose of this study was to formulate national nursing service standards for private hospitals. A structured two phase research technique was utilised to validate the standards by a representative national group of experts. Statistical validity of the standards was calculated by means of a content validity index for each standard. Fourteen (5%) of these standards (N = 275) were rejected and 25 (9%) require reformulation. It is recommended that these standards should serve as optimum standards for nurse administrators in private hospitals, and that these standards be published formally.

Disaster Planning↗

PubMed1993

[KOPS: a self-rating instrument for assessment of physical, psychological and social communication impairments].

In this article the development of a self-rating symptom questionnaire is described. The questionnaire records physical, psychological and social-interactionary impairments typical for neurotic and psychosomatic disorders. Contrary to most of the established self-assessment instruments the KOPS-questionnaire consequently records symptoms from these three areas. The questionnaire contains 64 items scaled on four steps and can be filled out by the test person in a short period of time. The results depicted here from different sample groups which were examined verify the differential and criterion related validity and furthermore an explorative factor analysis also verifies the content validity. The instrument is suited for screening purposes as well as for clinical course studies of psychological disorders. The problems of the assessor perspective (by an expert or by a patient) in recording symptoms is discussed.

Adult↗

PubMed2002

A response from the American Association of Dental Examiners.

The American Association of Dental Examiners supports a testing environments that include supervision of patient care. Extensive steps are taken in licensure examinations to ensure content validity through standardization by practice surveys, standards of competency, common core content, dental school curricula, and the limitations of practical constraints. Examining agencies report consistent, high collaboration among examiners. The examining community has developed comprehensive standards that compare favorably with standards in the testing community generally. When more reliable and valid alternatives to existing testing methods become available, they will be employed.

Clinical Competence↗

PubMed2005

Assessment of ophthalmology resident on-call performance.

PURPOSE: To design and implement a valid tool for assessment of ophthalmology resident on-call performance. DESIGN: Retrospective chart audit. SETTING: Tertiary care academic ophthalmology programs. PARTICIPANTS: Ophthalmology faculty and residents at the University of Cincinnati and the University of Iowa. METHODS: A 1-page on-call assessment tool (OCAT) and scoring rubric were developed to evaluate ophthalmology resident on-call performance. A retrospective chart audit of consecutive resident on-call charts was performed at the University of Cincinnati and the University of Iowa, and resident performance was scored using the OCAT. RESULTS: A consensus of faculty comments established the face and content validity of the OCAT. One hundred ninety-one on-call consultations were assessed. Timeliness of consultation was the most common category receiving a borderline or unsatisfactory rating. Borderline ratings in knowledge-based categories (history, examination, assessment and plan, urgency rating) occurred more often for postgraduate year 2 (PGY2) residents than for PGY3 residents (P = 0.05, chi-square test). Incomplete differential diagnosis (n = 6) and lack of follow-up instruction (n = 5) were the most common deficiencies observed. CONCLUSIONS: The OCAT has face, content, and discriminative validity. It can be used to assess resident competence in patient care, professionalism, and medical knowledge. Interrater and intrarater reliability still need to be determined. The OCAT may prove to be an additional assessment tool for meeting the Accreditation Council for Graduate Medical Education competencies mandate.

Clinical Competence↗

PubMed2006

The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): a measure of health-related quality of life and quality of life for patients with pulmonary hypertension.

OBJECTIVE: No outcome measures specific to pulmonary hypertension (PH) currently exist. The aim of the study was to develop health-related quality of life (symptoms and functioning) scales and a quality of life scale that would allow comprehensive, accurate and valid patient-reported outcome assessment in clinical studies. METHODS: The content of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was derived from qualitative interviews conducted with 35 patients. Item reduction was based on the analysis of responses to a postal survey (n=75) and patient interviews (n=15) designed to determine face and content validity. A final postal validation study (n=91) was performed to determine reproducibility and construct validity. RESULTS: The questionnaire was well received by participants who found it to be relevant, comprehensible and quick and easy to complete. Rasch and factor analyses were conducted to ensure unidimensionality of the final CAMPHOR scales; Overall symptoms (made up of Energy, Breathlessness and Mood subscales), Functioning and Quality of life. The CAMPHOR scales had good internal consistency (alpha=0.90-0.92) and reproducibility (test-retest correlations=0.86-0.92). They also exhibited convergent, divergent and known groups validity. CONCLUSIONS: The CAMPHOR is a valuable new instrument for assessing patient-reported outcome in PH clinical trials and routine practice.

Activities of Daily Living↗

PubMed2005

Media ratings for movies, music, video games, and television: a review of the research and recommendations for improvements.

This article review is organized by studies that are relevant for testing the reliability and validity of ratings systems. Specifically, the interrater reliability, consistency, temporal stability, content validity, construct validity, and criterion validity of media ratings systems are reviewed. Data that are related to testing the "forbidden fruit" and "tainted fruit" hypotheses also are reviewed. Several changes are recommended to improve the ratings systems, including the creation of a universal ratings system that could be applied equally to all media. The research reviewed here can provide a guide for how to construct a reliable, valid, and more useful ratings system. This is important because the decisions that parents make regarding their children's media use can be only as good as the information to which the parents have access.

Humans↗

PubMed2006

Implementation of a novel web-based objective structured clinical evaluation.

BACKGROUND: This study was performed to identify factors that impact student performance on a web-based objective structured clinical evaluation (OSCE) that was developed to improve the evaluation process of students who complete a fourth-year surgical clerkship in trauma-critical care. METHODS: We created a multiple-choice OSCE with commercially available software. Clinical cases were developed for incorporation into 7 quizzes that were assembled to appear as 1 examination. Students used intensive care unit flow sheets to review data, to develop a systems-based problem list and differential diagnoses, and to produce treatment recommendations. RESULTS: No difference was noted in a comparison of the mean scores that were achieved by students on a previous paper (essay format) OSCE and the new web OSCE. There was a correlation of student performance on the web OSCE to the National Board of Medical Examiners (NBME) subject examination that had been completed the previous year (r = 0.60; P < .0001). Performance on the NBME subject examination was the only independent factor that affected reporter, interpreter, and manager skills that were assessed by the OSCE (P < .01). CONCLUSION: Implementation of a web OSCE resulted in similar performance of the class as compared with performance on the previous paper OSCE. Correlation of student achievement on the web OSCE to the NBME subject examination supported the construct validity of this institutional examination beyond the areas of face and content validity in which OSCEs may excel.

Clinical Clerkship↗

PubMed1997

[Investigation methods in clinical cardiology. IV. Clinical measurements in cardiology: validity and errors of measurements].

Measurements represent an essential part of clinical activity. Very often, however, relevant disagreement in clinical measurements becomes apparent. The sources of this variability are the subjects (patients) that are measured, the measurement instrument itself, and the observer. The assessment of the quality of measurement usually relies on the evaluation of its reproducibility and its validity. The reproducibility is basically measured as the inter-observer concordance, the intra-observer concordance, and the test-retest concordance. The specific parameter used to its quantification (intra-class correlation coefficient, kappa index, graphic methods, etc.) depend on the kind of variable to be measured. The validity of the measurement is the degree to which the measurement is really measuring what we think it should. If an acceptable standard is available, then so called criterion validity is usually assessed. Otherwise the validity should be assessed by other ways that use subjective criteria (content validity and face validity) or empirical criteria (construct validity).

Cardiology↗

PubMed1998

End-of-life decisions and advance directives in palliative care: a cross-cultural survey of patients and health-care professionals.

In order to explore possible differences in the scope of end-of-life decisions and attitudes toward advance directives (AD) in palliative care, we conducted a survey of 159 patients in palliative care institutions and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The prevalence of a formal written AD was 79% in the United States, 18% in Germany, and 9% in Japan. In Japan, there was a high prevalence of entrusting all decisions to the family (known as omakase). More than 80% of the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Although favored by the professionals, there were no specific instruments for obtaining ADs. In Germany and Japan, some patients had given an informal AD. As a pilot content validity step, survey results were used to derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care specialists, in communication with their patients and their families in this difficult clinical situation.

Advance Directives↗

PubMed2005

Development of a Chinese medicine assessment measure: an interdisciplinary approach using the delphi method.

BACKGROUND: The diagnostic framework and clinical reasoning process in Chinese medicine emphasizes the contextual and qualitative nature of a patient's illness. Chinese medicine assessment data may help interpret clinical outcomes. OBJECTIVES: As part of a study aimed at assessing the validity and improving the inter-rater reliability of the Chinese diagnostic process, a structured assessment instrument was developed for use in clinical trials of acupuncture and other Chinese medical therapies. STUDY DESIGN: To foster collaboration and maximize resources and information, an interdisciplinary advisory team was assembled. Under the guidance of two group process facilitators, and in order to establish whether the assessment instrument was consistent with accepted Chinese medicine diagnostic categories (face validity) and included the full range of each concept's meaning (content validity), a panel of Traditional Chinese Medicine (TCM) expert clinicians was convened and their responses were organized using the Delphi process, an iterative, anonymous, idea-generating and consensus-building process. An aggregate rating measure was obtained by taking the mean of mean ratings for each question across all 10 experts. RESULTS: Over three rounds, the overall rating increased from 7.4 (SD = 1.3) in Round 1 to 9.1 (SD = 0.5) in Round 3. The level of agreement among clinicians was measured by a decrease in SD. CONCLUSIONS: The final instrument TEAMSI-TCM (Traditional East Asian Medicine Structured Interview, TCM version) uses the pattern differentiation model characteristic of TCM. This modular, dynamic version was specifically designed to assess women, with a focus on gynecologic conditions; with modifications it can be adapted for use with other populations and conditions. TEAMSI-TCM is a prescriptive instrument that guides clinicians to use the proper indicators, combine them in a systematic manner, and generate conclusions. In conjunction with treatment manualization and training it may serve to increase inter-rater reliability and inter-trial reproducibility in Chinese medicine clinical trials. Testing of the validity and reliability of this instrument currently is underway.

Data Interpretation, Statistical↗