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PubMed1994

Educational objectives for medical training in the care of the terminally ill.

BACKGROUND: Palliative medicine is developing as a distinct clinical discipline worldwide. The U.S. literature describes goals for education in palliative medicine, yet this literature lacks validated educational objectives. METHOD: To develop and validate appropriate educational objectives for medical training in the care of the terminally ill, 200 randomly selected members of the Academy of Hospice Physicians were asked in 1992 to evaluate 39 educational objectives by an item-objective congruence procedure. Each objective was rated as -1 (inappropriate), 0 (unsure), or 1 (appropriate). RESULTS: Of the 200 members surveyed, 127 (64%) responded. Of the 39 objectives, 34 were considered valid, with a mean score of > or = .8. The index of content validity was .87. The objectives not considered valid all dealt with nonmedical issues related to hospice or palliative care. CONCLUSION: This study validated 34 educational objectives for medical training in the care of the terminally ill. Training programs using these objectives, amended for specific audiences, should be included in the various levels of U.S. medical education.

Adult↗

PubMed1997

Development of a scientifically valid coordinated care path.

OBJECTIVE: The goal of this study was to develop a method to scientifically create and validate a coordinated care path for use within any hospital setting. BACKGROUND: In an attempt to reduce the costs associated with high-volume and high-risk diagnosis, attention was focused on reducing patients' length of stay in the hospital. A method to reduce length of stay uses a coordinated care path. A path is a guideline used to manage the clinical care of selected patients. The literature is relatively silent regarding studies that have scientifically validated the use of these paths. METHODS: This project used a content validity method to validate the care path. Using current research findings, best practice standards both locally and nationally, a transdisciplinary team developed practice guidelines that included sequencing, timing of interventions, and expected patient outcomes. The path was rated by local and national experts using a four-point rating scale. Using Lynn's proportion of experts table computations, the validity of the path and each of its components was determined. RESULTS: Of 161 items on the care path, 10 were not validated. The experts validated the instrument as a whole. Of the 161 items, 151 were validated. This is an instrument validation rate of 0.94. No additional changes or modifications to the path were suggested by the experts. The transdisciplinary team addressed the nonvalidated items. This method can be used to develop other coordinated paths for other diagnostic groups.

Critical Pathways↗

PubMedDate not supplied

The measurement of wound infection after breast surgery.

Infection in breast wounds often occurs in the form of cellulitis, but the conventional criteria for wound infection are the presence of either pus or a serous discharge containing pathogens. Wound scoring systems may offer a more quantitative and clinically relevant approach when evaluating the morbidity caused by infection in wounds. The aim of this study was to develop a wound scoring system for patients undergoing breast surgery. The components of previously described wound scoring systems were measured in 218 women undergoing nonreconstructive breast surgery. Using conventional criteria, the incidence of wound infection was 5.5% (12/218). However, 22% of the patients exhibited at least one sign of wound infection, and 11% of the patients received antibiotics for cellulitis without any other indication of a wound infection. The validity of the wound scoring system was supported by its strong content validity, the presence of construct validity as evidenced by concordance with the conventional criteria (p < 0.001), and criterion validity in the form of an association between the presence of a seroma and a positive wound score (p < 0.001). It was also noted that 27% of the patients with an appreciable wound score (more than 40 points) had cellulitis but did not satisfy the conventional criteria for a wound infection. In conclusion, it is advisable to use a wound scoring system that includes cellulitis when evaluating patients who have undergone breast surgery.

Aged↗

PubMed2002

Psychometric validation of the State Scale of Dissociation (SSD).

Although dissociative phenomena are often transient features of mental states, existing measures of dissociation are designed to measure enduring traits. A new present-state self-report measure, sensitive to changes in dissociative states, was therefore developed and psychometrically validated. Fifty-six items were formulated to measure state features, and sorted according to seven subscales: derealization, depersonalization, identity confusion, identity alteration, conversion, amnesia and hypermnesia. The State Scale of Dissociation (SSD) was administered with other psychiatric scales (DES, BDI, BAI, SCI-PANSS) to 130 participants with DSM-IV major depressive disorder schizophrenia, alcohol withdrawal, dissociative disorders and controls. In these sample populations, the SSD was demonstrated as a valid and reliable measure of changes in and the severity of dissociative states. Discriminant validity, content, concurrent, predictive, internal criterion-related, internal construct and convergent validities, and internal consistency and split-half reliability were confirmed statistically. Clinical observations of dissociative states, and their comorbidity with symptoms of depression and psychotic illness, were confirmed empirically. The SSD, an acceptable, valid and reliable scale measuring state features of dissociation at the time of completion, was obtained. This is a prerequisite for further investigation of correlations between changes in dissociative states and concurrent physiological parameters.

Adult↗

PubMedDate not supplied

Principal components analysis of an evaluation of the hemiplegic subject based on the Bobath approach.

An evaluation based on the Bobath approach to treatment has previously been developed and partially validated. The purpose of the present study was to verify the content validity of this evaluation with the use of a statistical approach known as principal components analysis. Thirty-eight hemiplegic subjects participated in the study. Analysis of the scores on each of six parameters (sensorium, active movements, muscle tone, reflex activity, postural reactions, and pain) was evaluated on three occasions across a 2-month period. Each time this produced three factors that contained 70% of the variation in the data set. The first component mainly reflected variations in mobility, the second mainly variations in muscle tone, and the third mainly variations in sensorium and pain. The results of such exploratory analysis highlight the fact that some of the parameters are not only important but also interrelated. These results seem to partially support the conceptual framework substantiating the Bobath approach to treatment.

Cerebrovascular Disorders↗

PubMed1994

Does a muscle strength index provide complementary information to traditional disease activity variables in patients with rheumatoid arthritis?

OBJECTIVE: To develop a muscle strength index (MSI) and determine whether it provides complementary information to traditional disease activity variables in patients with rheumatoid arthritis (RA). METHODS: The MSI was developed on the basis of practical and empirical aspects and statistical considerations. Intra and interobserver reliability was assessed on the data from 3 observers on 2 strength measurements in each of 10 patients. The association of the MSI with variables of disease activity and severity was assessed in univariate analysis. The contribution of the MSI in the explanation of physician's global disease activity after accounting for the effect of traditional measures of disease activity was assessed in multiple linear regression models. RESULTS: Eight strength measurements (extension and flexion of knee and elbow joints) obtained with a hand held pull gauge were aggregated into the MSI as the mean of the standardized scores. In 65 patients with RA, the MSI had a high internal consistency (Cronbach's alpha 0.95) and intra and interobserver reliability (Pearson correlation coefficient 0.94 each). The MSI correlated moderately with traditional measures of disease activity and strongly with physical functional disability and radiological damage. In contrast to grip strength, the MSI explained additional variation of physician's global assessment of disease activity if added to variables of pooled activity indices. CONCLUSION: The MSI is a reliable and valid measure of disease activity and severity and may improve the content validity of pooled disease activity indices.

Adult↗

PubMed1998

Student assessment in community settings: a comprehensive approach.

Student assessment in community settings presents problems for medical teachers, e.g., difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0.77 and 0.92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.

Clinical Competence↗

PubMedDate not supplied

Adolescent health promotion scale: development and psychometric testing.

The purpose of this study was to assess the psychometric properties of a newly devised instrument, the Adolescent Health Promotion scale (AHP), a 40-item Likert-type self-report instrument used to detect unhealthy lifestyles in adolescents. Content validity was considered to be supported based on the findings of previous studies and the observations of a panel of 14 content experts. This study examined the construct validity and reliability of the instrument. The psychometric properties of the AHP, including item analysis, factor analysis, and reliability measures, were assessed based on the responses of 1,128 Taiwanese adolescents. Kaiser-Meyer-Olkin (KMO) measures and Bartlett's sphericity test showed that the samples met the criteria for factor analysis. Factor analysis yielded a six-factor instrument that explained 51.14% of the variance in the 40 items. The six factors were social support, life appreciation, health responsibility, nutritional behaviors, exercise behaviors, and stress management. The Cronbach alpha reliability coefficient for the total scale was 0.932, and alpha coefficients for the subscales ranged from 0.75 to 0.88. The results of this study indicate that the AHP has good construct validity and reliability in Taiwanese and that its use by school health nurses to assess adolescent health promotion programs is warranted.

Adolescent↗

PubMed2002

Evaluating the quality of internet-based information about alternative therapies: development of the BIOME guidelines.

BACKGROUND: The aim of the study was to develop guidelines for evaluating the quality of Internet-based information about alternative therapies. METHOD: An expert committee drafted a set of guidelines for evaluating information relating to alternative therapies. The guidelines were subsequently refined by testing them using resources already included in the BIOME databases. The first 20 unique web sites about alternative therapies for cancer retrieved using a general search engine and a United Kingdom focused search engine were then evaluated using the refined guidelines. Those undertaking the evaluations also completed a questionnaire relating to the face and content validity of the guidelines. The participants in the implementation stage were six content providers. Content providers identify, evaluate and describe resources for inclusion in the BIOME databases. RESULTS: Only one web site out of 20 was selected by all six content providers for inclusion in the BIOME databases according to the alternative therapies guidelines. All content providers were in agreement regarding the exclusion of nine sites, but there were discrepancies regarding the remaining 10 resources. There was general agreement that the guidelines were easy to understand and that all points raised were necessary. However, there were differences of opinion regarding whether all issues were covered, whether the guidelines allowed the selection of only the highest quality resources, and whether the guidelines were applicable to a wide range of Internet-based resources about alternative therapies. CONCLUSIONS: The levels of inconsistencies in the results indicate the need for the further development of the BIOME guidelines for selecting information about alternative therapies.

Complementary Therapies↗

PubMed2002

Measuring the meaning of disability in rheumatoid arthritis: the Personal Impact Health Assessment Questionnaire (PI HAQ).

BACKGROUND: Measurement of disability in rheumatoid arthritis is often used to support treatment decisions and outcome assessments, but is used without reference to the impact of disability on individual patients. OBJECTIVE: To develop and validate a scale to measure individual values for functions, which is used to weight the level of an individual patient's functional loss and thus calculate the personal impact of disability. METHODS: In four linked studies, first the phraseology for values was explored to develop a stem question for the value scale couched in terms patients understand (face validity). Then short and long versions of the value scale were compared (content validity) and tests of internal consistency and short term reliability undertaken (criterion validity). Finally, the value scale was examined for long term reliability and agreement with expected variables (criterion and construct validity), after which personal impact scores were calculated and their construct validity examined. RESULTS: Patients understand the concept of values, and a positively phrased stem question was developed for the value scale, for which a short version was reasonably equivalent to a long version. The value scale was reliable over one week (96% changed by <1 point) with positive interitem correlation. Reasonable six and 12 month reliability was shown (52% changed by <0.5 points), and the value scale was independent of disability and clinical, psychological, personality, and social support variables. Personal impact scores were then calculated by using the value scores to weight disability scores. Impact scores varied widely between patients of similar disability. Personal impact for disability showed convergent validity with dissatisfaction with disability, perceived increase in disability, increased disease activity, worse psychological status, low social support, and time trade off for disability. It discriminated between patients with low and high dissatisfaction with disability, life satisfaction, depression, pain, and helplessness. CONCLUSION: This individualised personal impact scale should lend meaning to disability scores, improving the interpretation of clinical and research data.

Activities of Daily Living↗

PubMed2006

Psychometric properties of the Post-Fall Index.

Evaluation and prevention of falls begin with a thorough understanding of their occurrence. Post-fall assessment (PFA) tools should be available to sufficiently guide nursing staff in identification of all possible causes. Absence of empirically tested PFA tools led to the development of the Post-Fall Index (PFI). Developed and validated in three phases, a 76-item PFI was first tested for content validity by national experts. Next, it was tested for feasibility with registered nurses practicing in nursing homes. Last, it was piloted with a sample of 30 falls by older residents of a skilled nursing unit in a continuing care retirement community. Review of data from these 30 falls provided the item analysis. Reflective of evidenced-based guidelines, a 30-item PFI emerged, containing essential items causing falls. Although lengthier than incident reports, its comprehensiveness was deemed of higher value. Large absolute agreement of items (70%-100%) indicates good interrater reliability. The PFI is valid, reliable, and feasible and has clinical utility for the secondary prevention of falls.

Accidental Falls↗

PubMed1999

Measuring nursing work in long-term care. The reliability and validity of the Leatt Measure of Nursing Technology.

A projected 400% increase in the number of people age 85 and older by the year 2010, with one fourth of them needing nursing home care, forces attention on long-term care. This study establishes the validity and reliability of the Leatt Measure of Nursing Technology (LMNT) as a measure of the nature of nursing work in long-term care settings. The LMNT subscales measure the amount of uncertainty, instability, and variability of work which includes, but is not limited to, the technical equipment used. The LMNT was administered to licensed nursing staff in nine long-term care facilities in the Seattle area to evaluate its use in this environment. The nursing homes represented both for-profit and not-for-profit, and large (more than 250 beds) and small (70 beds) facilities. A total of 113 usable questionnaires were returned (45% response rate). Cronbach's alpha for subscales were .71 for Uncertainty, .66 for Instability, and .56 for Variability, with .77 for the total scale. Construct validity was evaluated by factor analysis, which confirmed the original factor structure. Content validity was evaluated using focus group discussions with key informants at each facility. A comparative analysis was used to determine major and minor themes in each of the instrument subscale topic areas. Qualitative analysis, combined with reliability and item level analyses, resulted in suggested minor changes in the instrument to make it more usable in long-term care settings. While some revisions are suggested, a concerted effort must be made to preserve the ability to compare findings with those obtained using the LMNT in acute care settings by retaining the general structures and factors of the measure.

Aged↗

PubMed1999

A taxonomy of requests by patients (TORP): a new system for understanding clinical negotiation in office practice.

BACKGROUND: The goal of our investigation was to facilitate research on clinical negotiation between patients and physicians by developing a reliable and valid classification system for patients' requests in office practice. METHODS: We developed the Taxonomy of Requests by Patients (TORP) using input from researchers, clinicians, and patient focus groups. To assess the system's reliability and validity, we applied TORP to audiotaped encounters between 139 patients and 6 northern California internists. Reliability was assessed with the kappa statistic as a measure of interrater agreement. Face validity was assessed through expert and patient judgment of the coding system. Content validity was examined by monitoring the incidence of unclassifiable requests. Construct validity was evaluated by examining the relationship between patient requests and patient health status; patient request fulfillment and patient satisfaction; and patient requests and physician perceptions of the visit. RESULTS: The 139 patients made 772 requests (619 requests for information and 153 requests for physician action). Average interrater agreement across a sample of 40 cases was 94% (kappa = 0.93; P <.001). Patients with better health status made fewer requests (r = -0.17; P = .048). Having more chronic diseases was associated with more requests for physician action (r = 0.32; P = .0002). Patients with more unfulfilled requests had lower visit satisfaction (r = -0.32; P <.001). More patient requests was also associated with physician reports of longer visit times (P = .016) and increased visit demands (P = .006). CONCLUSIONS: Our study provides evidence that TORP is a reliable and valid system for capturing and categorizing patients' requests in adult primary care. Further research is needed to confirm the system's validity, expand its applicability, and explore its usefulness as a tool for studying clinical negotiation.

California↗

PubMed2002

Children's perceptions of their abusive experience: measurement and preliminary findings.

Contemporary clinical formulations and recent research highlight the importance of cognitive-attributional symptoms in explaining the outcomes of child abuse. This study is directed toward the preliminary identification and measurement of these attributions. From a larger sample, 47 child abuse victims (ages 6 to 18) were administered a 16-item interview measure designed to evaluate several attributions common to this population. Children and their caregivers also completed several other clinical measures. A priori constructs containing most items were formed andfound to possess internal consistency and modest stability. Analyses revealed the utility (e.g., differences across abuse types and relationships with perpetrator), criterion validity (e.g., relationship to post-traumatic stress disorder, internalizing symptoms), and content validity (e.g., professional input/ratings) of certain constructs and individual items. These findings identify some of the attributional sequelae of child abuse that deserve further clinical attention and research evaluation. Suggestions for developments in these two areas are discussed.

Analysis of Variance↗

PubMed1999

[Development of a scale for quality of care management process. A Delphi survey and studies on reliability and validity].

The purpose of this study was to develop a measurement tool for assessing quality in care management and to test its reliability and validity. A Delphi survey was initially administered on 96 experienced community health nurses, to improve the content validity of a questionnaire that was developed after three repeated rounds of data collection and content analysis. A total of 353 community health nurses, from 121 cities and towns across Japan, completed the mailed questionnaire. Cronbach's alpha value was more than 0.8, respectively, for all items in questionnaires, and for each factor, indicating internal consistency in reliability. Five factors were identified through factor analysis using a principal factor method with varimax rotation. These factors were good reflections of components classified by some researchers, indicating construct validity. In addition, care managers were grouped according to such criteria as their age and work experience. The QCM-P (Quality of Care Management-Process Measurement) score of each group was compared, as theoretically differences are expected. The questionnaire's validity was evidenced by significant differences in the QCM-P score among each group. Further studies on criterion-related validity and stability which relates to reliability are required. Thus, although further work is needed, QCM-P was found to have both reliability and validity at a permissible level as a scale for measuring the quality of care management process.

Adult↗

PubMed1993

The validity of health assessments: resolving some recent differences.

The purpose of this paper is to examine what is meant by a valid measure of health. Guyatt, Kirshner and Jaeschke propose that health tests should be designed so as to have one of several kinds of validity: "longitudinal construct validity" for those which are used for longitudinal research designs, and "cross-sectional construct validity" for those which are used for cross-sectional designs. Williams and Naylor argue that this approach to test classification and validation confuses what a test purports to measure with the purpose for which it is used, and that some tests have multiple uses. A review of the meanings of validity in the psychological test literature shows that both sets of authors use the term validity in an idiosyncratic way. Although the use of a test (evaluated by content validity) should not be conflated with whether the test actually measures a specified construct (evaluated by construct validity), if health is actually made up of several constructs (as suggested in Hyland's interactional model) then there may be an association between types of construct and types of purpose. Evidence is reviewed that people make several, independent judgements about their health: cognitive perceptions of health problems are likely to be more sensitive to change in a longitudinal research design, whereas emotional evaluations of health provide less bias in cross-sectional designs. Thus, a classification of health measures in terms of the purpose of the test may parallel a classification in terms of what tests purport to measure.

Health↗

PubMed2006

Gait classification in children with cerebral palsy: a systematic review.

This systematic review of the literature evaluates the validity of existing classifications of gait deviations in children with cerebral palsy (CP). Numerous efforts have been made to develop classification systems for gait in CP to assist in diagnosis, clinical decision-making and communication. The internal and external validity of gait classifications in 18 studies were examined, including their sampling methods, content validity, construct validity, reliability and clinical utility. Half of the studies used qualitative pattern recognition to construct the gait classification and the remainder used statistical techniques such as cluster analysis. Few adequately defined their samples or sampling methods. Most classifications were constructed using only sagittal plane gait data. Many did not provide adequate guidelines or evidence of reliability and validity of the classification system. No single classification addressed the full magnitude or range of gait deviations in children with CP. Although gait classification in CP can be useful in clinical and research settings, the methodological limitations of many classifications restrict their clinical and research applicability.

Cerebral Palsy↗

PubMed2006

Development of competency inventory for registered nurses in the People's Republic of China: scale development.

BACKGROUND: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN). METHODS: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. RESULTS: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001). CONCLUSION: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.

Adult↗