Multidimensional Treatment Foster Care (MTFC) has been shown to be an evidence based alternative to residential rearing and an effective method to improve behavior and attachment of foster children ...in the US. This preliminary study investigated an application of MTFC for preschoolers (MTFC-P) in the Netherlands focusing on behavioral outcomes in course of the intervention. To examine the following hypothesis: "the time in the MTFC-P intervention predicts a decline in problem behavior", as this is the desired outcome for children assigned to MTFC-P, we assessed the daily occurrence of 38 problem behaviors via telephone interviews. Repeated measures revealed significant reduced problem behavior in course of the program. MTFC-P promises to be a treatment model suitable for high-risk foster children, that is transferable across centres and countries.
Netherlands Trial Register: 1747.
Purpose: Measuring exercise adherence is important in patients with chronic obstructive pulmonary disease (COPD). For this, the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems ...to be a promising instrument, and a Dutch version (RAdMAT-NL) is available. The aim of this study was to explore the dimensionality and construct validity of the RAdMAT-NL in patients with COPD. Secondly, we examined whether the items of the RAdMAT-NL could be summed to a single score. Patients and Methods: This prospective study included 193 patients with COPD from 53 primary physiotherapy practices in The Netherlands and Belgium. Patients and their physiotherapist provided data including the RAdMAT-NL, at one, two, and three months after inclusion. Horn's parallel analysis and exploratory factor analysis (EFA) were used to assess the dimensionality of the RAdMAT-NL. Fit to the dichotomous Rasch model for measurement was used to confirm the unidimensionality of the extracted RAdMAT-NL subscales and total scale. To evaluate construct validity, Spearman correlations with other indicators of adherence were calculated, including SIRAS score, percentage attendance and change in exercise skills. Results: EFA identified two dimensions of the RAdMAT-NL, "Participation" (13 items) and "Communication" (3 items), explaining 50.8% of the total variance. Rasch analysis confirmed the unidimensionality of the two dimensions. The unidimensional Rasch model was rejected for a summed score of all 16 RAdMAT-NL items. Medium to large significant positive correlations between the RAdMAT-NL subscale participation and different measures of adherence supported its convergent validity. Conclusion: The RAdMAT-NL exhibited two subscales that fitted the unidimensional Rasch model for objective measurement. Construct validity was supported by convergence with other established measures of adherence. Keywords: exercise adherence, chronic obstructive pulmonary disease, measurement instrument, dimensionality, construct validity
Aim
to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, ...researchers, Registered Nurses and policy makers.
Design
A multinational cross‐sectional study using Q‐methodology.
Methods
First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q‐set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q‐set using a web‐based system between May and August 2019. Lastly, the data were analysed using a by‐person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed.
Results
The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q‐sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post‐hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility.
Conclusions
Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC.
Impact
Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.
摘要
目的
确定: (1) 医院环境中FCC的护理能力; (2) 探讨荷兰和澳大利亚专业人员 (包括讲师、研究者、注册护士和决策者) 对这些能力的看法。
设计
采用Q方法的跨国横断面研究。
方法
首先进行综合评估, 以确定与FCC有关的已知能力, 并制定Q集 (检索截至2018年7月) 。第二, 采用目的性抽样来确保利益相关者参与度。第三, 参与者在2019年5月至8月期间使用基于网络 (web)的系统对Q集进行排序。最后, 采用个人因素分析法对数据进行分析。对排名最高和最低的5项能力的评注进行了专题分析。
结果
在综合评估中, 研究了43篇文章, 从中确定了72项能力。共有69名参与者完成了Q分类。我们提取了两个因素, 解释方差为24%。低解释方差阻碍了标签化。基于事后定性分析, 从被视为是最重要的能力中衍生出四个主题, 即: (a) 所信的FCC先决条件; (b) 促进护士、患者和家属之间的合作关系; (c) 成为护理工作的基本要素; (d) 代表一种必要的积极态度和对FCC附加价值的强烈信念。从被视为是最不重要的能力中衍生出三个主题, 因为它们: (a) 没有被视为是一种特定的护理能力; (b) 需要采用多学科方法; 或 (c) 要求患者和家属自行承担责任。
结论
在医疗保健专业人员中, 对于哪些护理能力被视为对FCC而言最重要, 存在很大的分歧。
影响
我们的一系列能力可以用来指导教育和评估医院的执业护士。在护理实践中实施新的FCC干预措施之前, 在考虑不同的FCC观点方面, 这些研究结果很有价值。
Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which ...have been developed to quantify functional status, as expressed by the ability to perform activities of daily life.
This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS) project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items.
Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item); low levels of variation in response pattern (28 items); significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items); or lack of model fit to the data at item level (26 items).
It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep ...and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1–12 years, admitted to a tertiary center, and compared this with home 6–8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital. Conclusion : Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.
Multidisciplinary teams treating patients with newly diagnosed Colorectal Cancer (CRC) often encounter the appearance of Indeterminate Pulmonary Nodules (IPNs) that warrants follow–up with repetitive ...medical imaging and anxiety for patients. We determined the incidence of IPNs in patients with newly diagnosed CRC and developed and validated a model for individualized risk prediction of IPNs being lung metastases.
Newly diagnosed CRC who underwent surgery between November 2011 to June 2014 were included to create the risk model, developed using both clinical experience and statistical selection. Discrimination and calibration slopes of the risk score were evaluated in an independent temporal validation sample. A nomogram is presented to assist clinicians in estimating an individual risk score.
Out of 2111 CRC patients staged with chest CT, 204 (9.6%) had IPNs and 54/204 (26%) had lung metastases. We identified 4 predictors: “location of primary tumour”, “pathological nodal stage”, “size of the largest nodule” and “extrapulmonary synchronous metastases at diagnosis”. Discrimination of the final model in the validation sample was demonstrated by the difference in mean predicted risk between progressed cases en non-progressed cases (49% versus 21%, p = <0.001).
A prediction model with 4 clinical risk factors can be used to assist multidisciplinary teams in the prediction of individualized risk of lung metastases and imaging strategy in patients with IPNs and newly diagnosed colorectal cancer. The model performed well in new patients not included in the model development.
•26 % of IPNs in our population turned out to be lung metastases•A nomogram can assist clinicians in predicting the risk of IPNs being lung metastases in patients with newly diagnosed CRC and IPNs•Extrapulmonary synchronous metastases at diagnosis in patients with newly diagnosed CRC and IPNs was the strongest predictor of the risk of IPNs being lung metastases
Responsiveness: a reinvention of the wheel? Lindeboom, Robert; Sprangers, Mirjam A; Zwinderman, Aeilko H
Health and quality of life outcomes,
02/2005, Letnik:
3, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Since the mid eighties, responsiveness is considered to be a separate property of health status questionnaires distinct from reliability and validity. The aim of the study was to assess the strength ...of the relationship between internal consistency reliability, referring to an instrument's sensitivity to differences in health status among subjects at one point in time, and responsiveness referring to sensitivity to health status changes over time.
We used three different datasets comprising the scores of patients on the Barthel, the SIP and the GO-QoL instruments at two points in time. The internal consistency was reduced stepwise by removing the item that contributed most to a scale's reliability. We calculated the responsiveness expressed by the Standardized Response Mean (SRM) on each set of remaining items. The strength of the relationship between the thus obtained internal consistency coefficients and SRMs was quantified by Spearman rank correlation coefficients.
Strong to perfect correlations (0.90-1.00) was found between internal consistency coefficients and SRMs for all instruments indicating, that the two can be used interchangeably.
The results contradict the conviction that responsiveness is a separate psychometric property. The internal consistency coefficient adequately reflects an instrument's potential sensitivity to changes over time.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim The aims of this study were to examine whether objective measurements of the 10‐minute drooling quotient (DQ10) and the 5‐minute drooling quotient (DQ5) are interchangeable; to assess agreement ...between the measurements and their accuracy in classifying drooling severity; and to develop a time‐efficient clinical assessment.
Method The study cohort included 162 children (61 females, 101 males; mean age 11y 6mo, SD 4y 5mo, range 3y 9mo–22y 1mo) suffering from moderate to profuse drooling. One hundred and twenty‐four had cerebral palsy and 38 had other developmental disabilities. Seventy‐four of the participants were ambulant and 88 non‐ambulant. The original DQ10 was recalculated into a 5‐minute score (DQ5). Assessments were undertaken while the participants were in a rest situation (DQR) and while they were active (DQA). Agreement in scores was quantified using intraclass correlations and Bland–Altman plots. To classify drooling, area under the receiver operating characteristic curve analysis was used to compare accuracy of the DQ10 and DQ5 at rest and during activity.
Results Agreement between DQ10A, and DQ5A, and between DQ10R and DQ5R was high (intraclass correlation coefficient >0.90). Moderate agreement existed between DQA and DQR. DQA scores were more accurate in classifying children’s drooling behaviour. For DQ5A, a cut‐off point of 18 or more (drooling episodes/observation time) might indicate ‘constant drooling’.
Interpretation The DQ10 and DQ5 can be used interchangeably. DQA is most discriminative for drooling severity. For evaluating treatment efficiency the cut‐off point can be used. For clinical and research purposes, the DQ5 is time efficient and cost saving while validity, and intrarater and interrater reliability are preserved.
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