Assessment of self-reported physical activity in patients with chronic pain: development of an abbreviated Roland-Morris disability scale.

The Roland-Morris Disability Scale has been shown to be a reliable and valid measure of disability in persons with chronic pain. A short form with psychometric properties similar to the full scale would have numerous benefits, including decreased patient assessment burden and scoring time. On the basis of data obtained from 993 individuals with chronic pain screened for admission to a multidisciplinary pain management program, an 11-item short form of the Roland scale was developed using procedures and models from item response theory. This short form was found to be a good predictor of the 24-item parent scale and a previously published 18-item short form. The 11-item scale also demonstrated concurrent validity with measures of pain intensity and depression. Item content reflected limitations in specific functional behaviors. PERSPECTIVE: Brief measures of important pain-related variables can be created using item response theory (IRT). In this study, a reliable and valid 11-item version of the Roland-Morris Disability Scale was created using IRT. Clinicians and researchers might consider using this scale when patient or subject assessment burden is an issue.     

Prospective investigations into the safety of spinal manipulation

Spinal manipulation (SM) is a popular form of treatment of back and neck pain, as well as of other conditions. Uncertainty exists as to its safety. The aim of this systematic review was to summarize the data of all prospective investigations into the safety of SM. Five independent literature searches were carried out to identify all such studies. Data were extracted and validated according to pre-defined criteria. Five investigations met the inclusion criteria. The most valid studies suggest that about half of all patients will experience adverse events after chiropractic SM. These events are usually mild and transient. No reliable data exist about the incidence of serious adverse events. These data indicate that mild and transient adverse events seem to be frequent. Serious adverse events are probably rare but their incidence can only be estimated at present. Further prospective investigations are needed to define their incidence more closely.     

Reliability and validity of judgments concerning adverse events suffered by hospitalized patients

To evaluate a process for identifying adverse events through review of medical records, multiple reviews of 360 medical records from two teaching hospital were performed. The data from these multiple reviews provided information about the validity and reliability of our two-phase review process. In particular, it was found that the initial phase, involving review of the medical records by medical-record-room administrators using explicit criteria, was valid, with a sensitivity of 84% and negative predictive value of 92%. Results also showed that the second phase, involving judgments by physicians guided by an adverse event analysis form, was reliable (Spearman Brown Rm = 0.78, m = 2) and demonstrated construct validity when compared with a review by a set of senior physicians employing a different method of review (Kappa = 0.57). In addition, it was found that these cases classified as difficult to judge from causation were judged less reliable (Rm = 0.48, for difficult case, Rm = 0.65, for other cases, m = 1). These results indicate that a two-step review process of medical records can produce judgments about adverse events that are both reliable and valid.     

Automatic detection of detached and erroneous electrodes in electrical impedance tomography

One unfortunate occurrence in experimental measurements with electrical impedance tomography is electrodes which become detached or poorly connected, such that the measured data cannot be used. This paper presents an automatic approach to detect such erroneous electrodes. It is based on the assumption that all valid measurements are related by the image reconstruction model, while the measurements from erroneous electrodes are unrelated. The method estimates the data at an electrode based on the measurements from all other electrodes, and compares it to the measurements. If these data match adequately, the set of electrodes does not contain an erroneous electrode. In order to detect an erroneous electrode amongst N electrodes, all sets of N-1 electrodes are tested, and the set with the best match between measurements and estimate is identified as the one which excludes the erroneous electrode. The method was tested on simulated and experimental data and showed consistent identification of erroneous electrodes with those made by experts.     

Computerized analysis of isokinetic torque curves for muscle strengthening

Isokinetic exercise measurements are widely used in rehabilitation medicine for evaluation and treatment planning. Computerized peak torque, work, and power measurements in isokinetic exercise can be obtained reliably when testing muscles that cross the knee and elbow joints. Important technical considerations in torque curve analysis are axis alignment, instrument calibration, and damp and gravity correction factors. The usefulness of these measurements has been limited by the small number of accurate scientific studies providing valid normative data on healthy individuals.     

高原地区护理人员灾害救护核心能力体系的构建

目的构建高原地区护理人员灾害救护核心能力体系。方法通过文献资料法、理论分析法、质性研究法及德尔菲(Delphi)专家咨询法,拟订高原地区护理人员灾害救护核心能力体系。结果专家咨询的权威程度系数为0.83,判断系数为0.89,熟悉程度为0.76;最终确定的高原地区护理人员灾害救护核心能力体系包括一级指标3条、二级指标26条,其专家接受度均>80%;一、二级指标的协调系数分别为0.493、0.401,P<0.01,协调系数比较具有统计学意义。结论用Delphi法构建的高原地区护理人员灾害救护核心能力体系具有较高的科学性及可靠性,为编制应急预案、编写教材、更有针对性地培训以提高高原地区护理人员的应急救护保障能力提供依据。     

Virtual text and the growth of meaning in qualitative analysis

Qualitative researchers frequently analyze data in the form of narrative, such as responses to open-ended interview questions. Researchers acknowledge the validity of more than one interpretation of the same narratives but, to date, have offered little justification for multiple valid interpretations. A concept from literary theory, “the virtual text,” is presented to help explain the mechanism of multiple interpretations and provide a justification for their validity. An example from the first author's research is provided. © 1996 John Wiley & Sons, Inc.     

An Item Response Theory-Based Assessment of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC)

Pain is often undetected in older people with dementia partly due to a deterioration of cognitive functioning. Observational scales enable the measurement of pain by registering physiological changes, facial expressions, or behaviors. Previous research showed that the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) is especially useful to measure pain in older people with dementia. PACSLAC was recently translated into Dutch and refined, thus forming PACSLAC-D. The current study uses a different approach to refining PACSLAC by (1) selecting items on the basis of ratings of nursing personnel and (2) applying confirmatory robust maximum likelihood factor analysis and (3) item response theory to investigate the psychometric properties of the selected items. Of the items that nursing personnel frequently registered, 18 valid and reliable items remained. Fourteen of these 18 items were also selected for PACSLAC-D, which confirms that these items are valid and reliable indicators of pain in older people with dementia. Confirmatory factor analysis showed that a 3-factor model is most adequate to describe the data. Differential item functioning analyses indicated that 2 items were biased. Ultimately, a refined version of PACSLAC was created that nursing personnel with different educational backgrounds might use to assess pain in older people with varying degrees of dementia.PerspectiveThis article describes the selection of items of PACSLAC on the basis of ratings of nursing personnel. By comparing this item selection with the items selected for PACSLAC-D, one can confirm that certain items are sound indicators of pain, whereas others need some attention (eg, through the training of raters).     

Cognitive interviews to test and refine questionnaires

Survey data are compromised when respondents do not interpret questions in the way researchers expect. Cognitive interviews are used to detect problems respondents have in understanding survey instructions and items, and in formulating answers. This paper describes methods for conducting cognitive interviews and describes the processes and lessons learned with an illustrative case study. The case study used cognitive interviews to elicit respondents' understanding and perceptions of the format, instructions, items, and responses that make up the Diabetes Symptom Self-Care Inventory (DSSCI), a questionnaire designed to measure Mexican Americans' symptoms of type 2 diabetes and their symptom management strategies. Responses to cognitive interviews formed the basis for revisions in the format, instructions, items, and translation of the DSSCI. All those who develop and revise surveys are urged to incorporate cognitive interviews into their instrumentation methods so that they may produce more reliable and valid measurements.     

Adverse events in Jordanian hospitals: Types and causes

Hayajneh YA, AbuAlRub RF, Almakhzoomy IK. International Journal of Nursing Practice 2010; 16 : 374–380
Adverse events in Jordanian hospitals: Types and causes Adverse events in health care have become an important issue for health‐care professionals, administrators, health policy‐makers, public and patients. Literature on adverse events in Jordan is scarce. The purpose of the study was (i) to identify the common types and major causes of adverse events in Jordanian hospitals from the nurses' perspective; and (ii) to estimate the frequency of adverse events in Jordanian hospitals. Qualitative and quantitative data regarding the perceived types, causes and incidence of adverse events were collected using a web‐based questionnaire. A total of 75 valid responses with qualitative and quantitative data were obtained. The results indicated (i) that medication errors, wrong diagnosis, hospital acquired infections, bed sores and falls were the most common types of adverse events; and (ii) that workload and inadequate staffing, technical performance, negligence and poor ethics, poor management, psychosocial job demands and written guidelines were the most common causes of adverse events. On average, participants in the study believed that adverse events occurred in about 28% of all hospital admissions. Nurse and hospital administrators and health policy‐makers should develop and institute effective strategies and polices to prevent or minimize the occurrence of adverse events.     

Point Shear Wave Elastography for Grading Liver Fibrosis: Can the Number of Measurements Be Reduced?

The aim of this study was to assess whether the number of liver point shear wave elastography (pSWE) measurements could be reduced compared with the currently recommended 10 valid measurements. Three thousand four hundred one pSWE examinations in patients with liver disease were performed with 10 consecutive valid measurements in liver segment 8. Liver fibrosis grading using published cutoff values were compared retrospectively using the median of 10 versus the first 1–9 measurements with Kendall's τ coefficient. Overall and binary (clinically significant [≥F2] versus non-significant [F0/F1]) fibrosis grading highly correlated when using 5–9 versus 10 valid measurements (τ?=?0.96/0.95, p < 0.001). With the use of 5 valid measurements, a change in binary grading was observed in 87 of 3401 (2.6%) exams and only when velocities measured between 1.1 and 1.5 m/s. Therefore, using 5–9 valid measurements in pSWE of the liver results in a small portion of liver fibrosis grading misclassifications compared with use of 10 measurements and could help decrease scanning time, cost and discomfort in sonographers and patients.     

Using self-efficacy theory to educate a patient with chronic obstructive pulmonary disease: A case study of 1-year follow-up

Self-efficacy is important in determining which activities or situations an individual will perform or avoid. This is a case study report to explore the utility of structured education programme on strengthening self-efficacy in an older adult with chronic obstructive pulmonary disease (COPD). To comprehensively evaluate this intervention, a combined qualitative and quantitative approach was used. Although qualitative data were collected following the interview guide, quantitative data were collected by the demographic data form and the COPD Self-Efficacy Scale (CSES) at the preprogramme and postprogramme stage. The patient's self-efficacy scores improved after 8 weeks of the structured education programme and remained relatively constant on all the repeated measurements after education. Qualitative data were identified as 'difficulties' and 'facilities'. This study indicates that, by applying a self-efficacy theory, a planned education programme could be useful in improving both short-term and long-term self-efficacy in patients with COPD.     

An alternative to body mass index for standardizing body weight for stature

Although body mass index (BMI) has been adopted by WHO as an international measure of obesity, it lacks a theoretical basis, and empirical evidence suggests it is not valid for all populations. We determined standard weight-for-height using a model calibrated by multivariate analysis of observational data on body dimensions and health status in the USA (NHANES III). A multiple linear regression model based on a simple mathematical formulation accurately described the observed weight variations in this normal adult population. A standardized reference model using just two measurements (upper arm length and sitting height), readily applied in both clinical and research settings using lookup tables, improved explanatory power substantially compared to the best BMI formulation (r(2) increased 16.3% for males, 21.1% for females). Physical dysfunction and self-reported poor health showed strong trends with excess body weight. These findings need confirmation from larger population samples.     

Nursing praxis within Margaret Newman's theory of health as expanding consciousness

Nursing praxis was explored from the perspective of one Newman scholar. She shared her evolving perspectives on research as a doctoral candidate and as a member of a hospital-based praxis team she went on to develop with colleagues focusing on women with cancer. Using Newman's research method, the team interviewed families regarding meaningful persons and events in their lives. They then conducted another study in the form of action research. The praxis team found that Newman's theory resonated throughout nursing practice. Newman nursing praxis integrates theory, practice, and research.     

The role of theory for understanding and preventing suicide (but not predicting it): A commentary on Hjelmeland and Knizek

Abstract

Hjelmeland and Knizek suggest that parsimonious theory is inappropriate for explaining a highly complex and contextual phenomenon like suicide. Similar suggestions have been made by others. In this commentary, I counter that the pursuit of parsimonious theory is at the core of any scientific enterprise, including health sciences and suicide science. Using examples from physics and psychology, I illustrate that parsimonious theories have been essential for understanding highly complex and contextual phenomena like the motion of objects and the behavior of people. I further illustrate that these theories, despite their undeniable validity and enormous utility, have limited value for predicting future real-world events; thus, it is important not to conflate valid theory with highly accurate prediction of the future. To conclude, I offer suggestions for better evaluating and advancing suicide theory, and I affirm that the pursuit of parsimonious suicide theory is important and worthwhile, and must continue.     

Meta-analysis research.

Beginning with Florence Nightingale, nurses have attempted to base their practice on the best evidence. Research findings often form part of the evidence for practice. The proliferation of studies and the frequent contradictory findings between studies make it difficult to determine the scientific basis for practice. Increasingly, nurses are finding meta-analysis research reports on important practice topics. This article provides an overview of key features of meta-analyses to enable nurses to determine whether meta-analyses findings are valid and useful for their practice.     

An analysis of case mix complexity using information theory and diagnostic related grouping.

Case mix complexity measurements are essential to determine health care efficiency and effectiveness. Measures of patient care processes and outcomes must be adjusted for case mix before valid comparisons can be made. Hospital reimbursement, particularly prospective reimbursement, must take into account differences in case mix. In addition, a key variable for hospital classification is case mix. There are, however, no widely accepted easily computed case mix measures. Information theory measures of case mix have been developed but their acceptance has been limited by a lack of verification of their basic assumption that concentration of disease is related to clinical complexity. We discuss the rationale underlying the mathematical computaton of information theory measures and demonstrate a statistically significant relationship between clinical measures of case mix complexity and information theory measures of case mix complexity.