Investigation of Biases in the General Public in Evaluating Mild Head Injury Using Neuropsychological and CT Scan Results: Forensic Implications

The purpose of this study was to determine how the general public considers neuropsychological (NP) vs. CT scan data in assessing the effects of a possible mild traumatic brain injury (MTBI). Ten scenarios depicting an MTBI from a motor vehicle accident were presented to community volunteer participants. Case scenarios differed with regard to diagnostic information presented (i.e., all combinations of normal, abnormal, or absent NP and CT results were provided). The number of participants ranged from 31 to 42 across the 10 cases and there were no age or educational differences among the groups. Participants rated the likelihood of symptoms being attributable to brain damage from the accident on a 7-point Likert-type scale. Scenarios with positive NP or CT results were rated as more likely to have sustained brain damage than when NP/CT results were negative. However, when NP and CT data were contradictory (i.e., one positive and the other negative), there were no differences in the ratings of the participants. Thus, members of the general public did not demonstrate any preconceived bias about the validity of NP vs. CT results in MTBI. Women were more likely than men to attribute symptoms to brain damage from the motor vehicle accident, as did participants with a history of TBI. Forensic implications are discussed.     

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

Cronbach's α reliability,concurrent validity,and factorial structure of the Death Depression Scale in an Iranian hospital staff sample

ObjectiveDeath depression is an important component in the process of death and dying. Death depression is the second element of death. Depression is one of the important features in death distress. The aim of this study was to explore the performance of the Farsi version of the Death Depression Scale with an Iranian convenience sample of nurses (n = 106).MethodsNurses were selected using a convenience sampling method, and completed the Death Depression Scale (DDS), Death Concern Scale (DCS), Collett-Lester Fear of Death Scale (CLFDS), Reasons for Death Fear Scale (RDFS), Templer's Death Anxiety Scale (DAS), and Death Obsession Scale (DOS).ResultsThe results of exploratory factor analysis on DDS identified 4 factors (56.16% of variance). Factor 1 labeled “Death sadness”, Factor 2 labeled “Death finality/end and Death dread/fear”, Factor 3 labeled “Death despair and Death depression”, and Factor 4 labeled “Death loneliness”. Cronbach's α coefficient was 0.84, Spearman-Brown coefficient 0.85, and Guttman Split-Half coefficient 0.81 The DDS correlated 0.40 with the DCS, 0.39 with the CLFDS, 0.50 with the DAS, 0.35 with the RDFS, and 0.44 with the DOS, indicating good construct and criterion-related validity. Concurrent validity for the DDS with the other scales were significant.ConclusionsThe DDS has good validity and reliability, and it can use in clinical and research settings.     

Congress On Spinal Cord Medicine and Rehabilitation September 23-26, 2009 Sheraton Dallas Hotel Dallas,Texas Platform Abstracts

Abstract

Objective

To examine the psychometric properties of the Community Integration Questionnaire (CIQ) in large samples of individuals with spinal cord injury (SCI).

Design

Longitudinal 12-month survey study.

Setting

Nation-wide, community dwelling.

Participants

Adults with SCI: 627 at Time 1, 494 at Time 2.

Interventions

Not applicable.

Outcome measures

The CIQ is a 15-item measure developed to measure three domains of community integration in individuals with traumatic brain injury: home integration, social integration, and productive activity. SCI consumer input suggested the need for two additional items assessing socializing at home and internet/email activity.

Results

Exploratory factor analyses at Time 1 indicated three factors. Time 2 confirmatory factor analysis did not show a good fit of the 3-factor model. CIQ scores were normally distributed and only the Productive subscale demonstrated problems with high (25%) ceiling effects. Internal reliability was acceptable for the Total and Home scales, but low for the Social and Productive activity scales. Validity of the CIQ is suggested by significant differences by sex, age, and wheelchair use.

Conclusions

The factor structure of the CIQ was not stable over time. The CIQ may be most useful for assessing home integration, as this is the subscale with the most scale stability and internal reliability. The CIQ may be improved for use in SCI by including items that reflect higher levels of productive functioning, integration across the life span, and home- and internet-based social functioning.     

The Sensational Hand: Clinical Assessment after Nerve Repair

Following the transection and repair of major nerve trunks in the forearm, the functional outcome is influenced by mechanisms in the peripheral, as well as in the central nervous system. In the present thesis the interest is focused on assessment of the outcome after nerve repair, central nervous factors influencing the outcome, and sense substitution to compensate for sensory loss. A new model instrument for routine documentation of the outcome after repair of a peripheral nerve is identified. The model includes assessments reflecting sensory, motor and pain/discomfort domains. Investigations of frequently used assessment instruments led to the construction and evaluation of a new test instrument for assessment of discriminative sensibility (tactile gnosis) to fit in the model. The summarised outcome, calculated from the model instrument and with a numerical scoring system, conforms well with the patient's opinion on the influence on activities of daily living resulting from the nerve injury, and demonstrates good reliability and validity. A reference interval for the outcome is presented, with the estimated 95% predicted values for the outcome up to five years after the nerve repair. Brain plasticity is a factor sensibility - tactile gnosis - in the adaptive process after a nerve injury, when the mind has to interpret new signal patterns, when objects are touched. For better understanding of the sensory outcome after nerve repair, central nervous factors were examined. Specific cognitive capacities, such as verbal learning and visuo-spatial logic capacity could be identified as being of importance for recovery of tactile gnosis. For patients with temporary or permanent sensory loss, a new principle for artificial sensibility based on sense substitution is presented. The hearing sense substitutes the sense of touch. The resemblance in perceptual experience between sound and touch is bridged by the stereophonic friction sound generated by touching objects, which is then amplified and transmitted to earphones. The delicate capacity of the sense of hearing to discriminate between the complex pattern of frequencies makes it reasonable to assume that hearing is able to take over functions normally devoted to touch. This is demonstrated in the thesis.     

Adolescent Stress Questionnaire: Reliability and validity of the Greek version and its description in a sample of high school (lyceum) students

Adolescence is a crucial phase of human life characterized by enhanced exposure and vulnerability to various stressful stimuli. The Adolescent Stress Questionnaire (ASQ) is a useful measure to evaluate possible sources of stressors affecting the adolescent equilibrium. The present study examines the scientific properties of the Greek version of ASQ to measure perceived stress among 250 Greek adolescents. The confirmatory factor analysis (CFA) results showed a good fit of the original structure of ASQ to the observed data in the Greek sample. A good internal reliability was also confirmed by high Cronbach's alpha values. In line with previous research, girls reported more stress than boys. Overall, the Greek ASQ is a valid and reliable instrument for evaluating adolescent stress.