Invitations and excuses that are not invitations and excuses: Gossip in Luke 14:18–20

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Ernest van Eck

2012-08-01

Full Text Available In modern Western culture, gossip is seen as a malicious activity that should be avoided. In ancient oral-cultures, gossip as a cultural form did not have this negative connotation. Gossip was a necessary social game that enabled the flow of information. This information was used in the gossip network of communities to clarify, maintain and enforce group values, facilitate group formation and boundary maintenance and assess the morality of individuals. Gossip was a natural and spontaneous recurring form of social organisation. This understanding of gossip is used to interpret the two invitations and three excuses in the parable of the Feast (Lk 14:16a–23. The conclusion reached is that gossip, when understood as a social game, can be a useful tool to curb anachronistic and ethnocentristic readings of texts produced by cultures different from that of modern interpreters analysing these texts.

The excuse principle can maintain cooperation through forgivable defection in the Prisoner's Dilemma game

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Krams, Indrikis; Kokko, Hanna; Vrublevska, Jolanta; Āboliņš-Ābols, Mikus; Krama, Tatjana; Rantala, Markus J.

2013-01-01

Reciprocal altruism describes a situation in which an organism acts in a manner that temporarily reduces its fitness while increasing another organism's fitness, but there is an ultimate fitness benefit based on an expectation that the other organism will act in a similar manner at a later time. It creates the obvious dilemma in which there is always a short-term benefit to cheating, therefore cooperating individuals must avoid being exploited by non-cooperating cheaters. This is achieved by following various decision rules, usually variants of the tit-for-tat (TFT) strategy. The strength of TFT, however, is also its weakness—mistakes in implementation or interpretation of moves, or the inability to cooperate, lead to a permanent breakdown in cooperation. We show that pied flycatchers (Ficedula hypoleuca) use a TFT with an embedded ‘excuse principle’ to forgive the neighbours that were perceived as unable to cooperate during mobbing of predators. The excuse principle dramatically increases the stability of TFT-like behavioural strategies within the Prisoner's Dilemma game. PMID:23864603

Evaluation of the "Lose Your Excuse" Public Service Advertising Campaign for Tweens to Save Energy

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Bertrand, Jane T.; Goldman, Patty; Zhivan, Natalia; Agyeman, Yaw; Barber, Erin

2011-01-01

This study evaluates the 2008-2009 "Lose your Excuse" public service advertising (PSA) campaign on energy efficiency targeting 8- to 12-year-olds, intended to increase knowledge, foster proactive attitudes, and change energy usage behaviors. Baseline and two follow-up surveys were conducted with online samples representative of the national…

Excuse me, your participle's dangling how to use grammar to make your writing powers soar

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DePino, Catherine

2013-01-01

Excuse Me, Your Participle's Dangling will give you all the bare essentials of grammar that you need to write like a pro. If you're a businessperson, college student, or ESL student seeking a user-friendly grammar book that aims to make you a better writer, this book is for you!

A figurative proverb test for dementia: rapid detection of disinhibition, excuse and confabulation, causing discommunication.

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Yamaguchi, Haruyasu; Maki, Yohko; Yamaguchi, Tomoharu

2011-12-01

Communicative disability is regarded as a prominent symptom of demented patients, and many studies have been devoted to analyze deficits of lexical-semantic operations in demented patients. However, it is often observed that even patients with preserved lexical-semantic skills might fail in interactive social communication. Whereas social interaction requires pragmatic language skills, pragmatic language competencies in demented subjects have not been well understood. We propose here a brief stress-free test to detect pragmatic language deficits, focusing on non-literal understanding of figurative expression. We hypothesized that suppression of the literal interpretation was required for figurative language interpretation.  We examined 69 demented subjects, 13 subjects with mild cognitive impairment and 61 healthy controls aged 65 years or more. The subjects were asked the meaning of a familiar proverb categorized as a figurative expression. The answers were analyzed based on five factors, and scored from 0 to 5. To consider the influence of cognitive inhibition on proverb comprehension, the scores of the Stroop Colour-Word Test were compared concerning correct and incorrect answers for each factor, respectively. Furthermore, the characteristics of answers were considered in the light of excuse and confabulation qualitatively. The proverb comprehension scores gradually decreased significantly as dementia progressed. The literal interpretation of the proverb, which showed difficulties in figurative language comprehension, was related to disinhibition. The qualitative analysis showed that excuse and confabulation increased as the dementia stage progressed. Deficits in cognitive inhibition partly explains the difficulties in interactive social communication in dementia. With qualitative analysis, asking the meaning of a proverb can be a brief test applied in a clinical setting to evaluate the stage of dementia, and to illustrate disinhibition, confabulation and

The impact of husband physical aggression and alcohol use on marital functioning: does alcohol "excuse" the violence?

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Testa, M; Leonard, K E

2001-10-01

Alcohol has been posited to serve as an "excuse" for deviant behavior, including domestic violence. A recent study suggested that wives hold husbands less responsible for their aggressive behavior when husbands are problem drinkers. To replicate and extend this study, the independent and interactive effects of husband physical aggression and husband alcohol use on wives' marital satisfaction and thoughts of divorce were examined among newlywed couples (n = 387). Husband physical aggression had a significant negative effect on marital satisfaction and a significant positive effect on divorce ideation regardless of the measure of husband alcohol use employed. Alcohol dependence had a negative effect on satisfaction; however, in no case was there an interaction between alcohol and aggression. Results fail to replicate an earlier study supporting an excuse function of alcohol and suggest that alcohol does not mitigate the negative effects of domestic violence on marital functioning.

Content Validity of a Tool Measuring Medication Errors.

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Tabassum, Nishat; Allana, Saleema; Saeed, Tanveer; Dias, Jacqueline Maria

2015-08-01

The objective of this study was to determine content and face validity of a tool measuring medication errors among nursing students in baccalaureate nursing education. Data was collected from the Aga Khan University School of Nursing and Midwifery (AKUSoNaM), Karachi, from March to August 2014. The tool was developed utilizing literature and the expertise of the team members, expert in different areas. The developed tool was then sent to five experts from all over Karachi for ensuring the content validity of the tool, which was measured on relevance and clarity of the questions. The Scale Content Validity Index (S-CVI) for clarity and relevance of the questions was found to be 0.94 and 0.98, respectively. The tool measuring medication errors has an excellent content validity. This tool should be used for future studies on medication errors, with different study populations such as medical students, doctors, and nurses.

Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic.

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Petersson, Frida J M

2013-11-01

Methadone maintenance treatment has been subjected to much debate and controversy in Sweden during the last decades. Thresholds for getting access are high and control policies strict within the programmes. This article analyses how professionals working in a Swedish methadone clinic discuss and decide on appropriate responses to clients' rule-breaking behaviour. The research data consist of field notes from observations of three interprofessional team meetings where different clients' illicit drug use is discussed. A micro-sociological approach and accounts analysis was applied to the data. During their decision-oriented talk at the meetings, the professionals account for: (1) sanctions, (2) nonsanction, (3) mildness. In accounting for (2) and (3), they also account for clients' rule-breaking behaviour. Analysis shows how these ways of accounting are concerned with locating blame and responsibility for the act in question, as well as with constructing excuses and justifications for the clients and for the professionals themselves. In general, these results demonstrate that maintenance treatment in everyday professional decision-making, far from being a neutral evidence-based practice, involves a substantial amount of professional discretion and moral judgements. Sanctions are chosen according to the way in which a deviance from the rules is explained and, in doing so, a certain behaviour is deemed to be serious, dangerous and unacceptable - or excusable. Copyright © 2013 Elsevier B.V. All rights reserved.

Educational testing validity and reliability in pharmacy and medical education literature.

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Hoover, Matthew J; Jung, Rose; Jacobs, David M; Peeters, Michael J

2013-12-16

To evaluate and compare the reliability and validity of educational testing reported in pharmacy education journals to medical education literature. Descriptions of validity evidence sources (content, construct, criterion, and reliability) were extracted from articles that reported educational testing of learners' knowledge, skills, and/or abilities. Using educational testing, the findings of 108 pharmacy education articles were compared to the findings of 198 medical education articles. For pharmacy educational testing, 14 articles (13%) reported more than 1 validity evidence source while 83 articles (77%) reported 1 validity evidence source and 11 articles (10%) did not have evidence. Among validity evidence sources, content validity was reported most frequently. Compared with pharmacy education literature, more medical education articles reported both validity and reliability (59%; particles in pharmacy education compared to medical education, validity, and reliability reporting were limited in the pharmacy education literature.

Elaboration and Validation of the Medication Prescription Safety Checklist 1

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Pires, Aline de Oliveira Meireles; Ferreira, Maria Beatriz Guimarães; do Nascimento, Kleiton Gonçalves; Felix, Márcia Marques dos Santos; Pires, Patrícia da Silva; Barbosa, Maria Helena

2017-01-01

ABSTRACT Objective: to elaborate and validate a checklist to identify compliance with the recommendations for the structure of medication prescriptions, based on the Protocol of the Ministry of Health and the Brazilian Health Surveillance Agency. Method: methodological research, conducted through the validation and reliability analysis process, using a sample of 27 electronic prescriptions. Results: the analyses confirmed the content validity and reliability of the tool. The content validity, obtained by expert assessment, was considered satisfactory as it covered items that represent the compliance with the recommendations regarding the structure of the medication prescriptions. The reliability, assessed through interrater agreement, was excellent (ICC=1.00) and showed perfect agreement (K=1.00). Conclusion: the Medication Prescription Safety Checklist showed to be a valid and reliable tool for the group studied. We hope that this study can contribute to the prevention of adverse events, as well as to the improvement of care quality and safety in medication use. PMID:28793128

Development, Validation, and Implementation of a Medical Judgment Metric

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Rami A. Ahmed DO, MHPE

2017-06-01

Full Text Available Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM, a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987 as well as their evaluation of the expected patient outcome (Fleiss’s Kappa 0.791 to 0.906. For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen’s Kappa 0.851 to 0.880. Discussion : The MJM demonstrated preliminary evidence of reliability and validity.

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

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Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-03-01

Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

Four tenets of modern validity theory for medical education assessment and evaluation.

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Royal, Kenneth D

2017-01-01

Validity is considered by many to be the most important criterion for evaluating a set of scores, yet few agree on what exactly the term means. Since the mid-1800s, scholars have been concerned with the notion of validity, but over time, the term has developed a variety of meanings across academic disciplines and contexts. Accordingly, when scholars with different academic backgrounds, many of whom hold deeply entrenched perspectives about validity conceptualizations, converge in the field of medical education assessment, it is a recipe for confusion. Thus, it is important to work toward a consensus about validity in the context of medical education assessment. Thus, the purpose of this work was to present four fundamental tenets of modern validity theory in an effort to establish a framework for scholars in the field of medical education assessment to follow when conceptualizing validity, interpreting validity evidence, and reporting research findings.

Dosimetric studies for gamma radiation validation of medical devices

International Nuclear Information System (INIS)

Soliman, Y.S.; Beshir, W.B.; Abdel-Fattah, A.A.; Abdel-Rehim, F.

2013-01-01

The delivery and validation of a specified dose to medical devices are key concerns to operators of gamma radiation facilities. The objective of the present study was to characterize the industrial gamma radiation facility and map the dose distribution inside the product-loading pattern during the validation and routine control of the sterilization process using radiochromic films. Cardboard phantoms were designed to achieve the homogeneity of absorbed doses. The uncertainty of the dose delivered during validation of the sterilization process was assessed. - Highlights: ► Using γ-rays for sterilization of hollow fiber dialyzers and blood tubing sets according to ISO 11137, 2006. ► Dosimetry studies of validations of γ-irradiation facility and sterilized medical devices. ► Places of D min and D max have been determined using FWT-60 films. ► Determining the target minimum doses required to meet the desired SAL of 10 −6 for the two products.

[Attitudes of freshman medical students towards education in communication skills].

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Tóth, Ildikó; Bán, Ildikó; Füzesi, Zsuzsanna; Kesztyüs, Márk; Nagy, Lajos

2011-09-18

In their institute authors teach medical communication skills in three languages (Hungarian, English and German) for medical students in the first year of their studies. In order to improve teaching methods, authors wanted to explore the attitudes of students towards the communication skills learning. For this purpose authors applied the Communication Skills Attitudes Scale created by Rees et al., which is an internationally accepted and well adaptable instrument. In this survey authors wanted to validate the Hungarian and German version of the Communication Skills Attitudes Scale. In addition, their aim was to analyze possible differences between the attitudes of each of the three medical teaching programs. Questionnaires were filled anonymously at the beginning of the practices. Principal component analysis with varimax rotation was performed to evaluate the attitudes using the SPSS 10.5 version for analysis. Authors created a model consisting of 7 factors. Factors were the following: 1: respect and interpersonal skills; 2: learning; 3: importance of communication within medical profession; 4: excuse; 5: counter; 6: exam; 7: overconfidence. It was found that students had mainly positive attitudes. Except the learning factor, all other factors showed significant differences between the three medical teaching programs. although students had mainly positive attitudes toward learning communication skills, there were negative attitudes which can be partly modified by improving the teaching methods. However, results may create a proper base for further research to help improving communication skills teaching methods of the authors.

Sterilization validation for medical compresses at IRASM multipurpose irradiation facility

International Nuclear Information System (INIS)

Alexandru, Mioara; Ene, Mihaela

2007-01-01

In Romania, IRASM Radiation Processing Center is the unique supplier of radiation sterilization services-industrial scale (ISO 9001:2000 and ISO 13485:2003 certified). Its Laboratory of Microbiological Testing is the sole third party competent laboratory (GLPractice License, ISO 17025 certification in progress) for pharmaceutics and medical devices as well. We here refer to medical compresses as a distinct category of sterile products, made from different kind of hydrophilic materials (cotton, non-woven, polyurethane foam) with or without an impregnated ointment base (paraffin, plant extracts). These products are included in the class of medical devices, but for the sterilization validation, from microbiological point of view, there are important differences in testing method compared to the common medical devices (syringes, catheters, etc). In this paper, we present some results and practical solutions chosen to perform a sterilization validation, compliant with ISO 11137: 2006

Validity evidence for the measurement of the strength of motivation for medical school.

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Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

2011-05-01

The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as the sources of validity evidence. The SMMS questionnaire was filled out by 1,494 medical students in different years of medical curriculum. The validity evidence for the internal structure was analyzed by principal components analysis with promax rotation. Validity evidence for relations to other variables was tested by comparing the SMMS scores with scores on the Academic Motivation Scale (AMS) and the exhaustion scale of Maslach Burnout Inventory-Student Survey (MBI-SS) for measuring study stress. Evidence for internal consistency was determined through the Cronbach's alpha for reliability. The analysis showed that the SMMS had a 3-factor structure. The validity in relations to other variables was established as both, the subscales and full scale scores significantly correlated positively with the intrinsic motivation scores and with the more autonomous forms of extrinsic motivation, the correlation decreasing and finally becoming negative towards the extrinsic motivation end of the spectrum. They also had significant negative correlations with amotivation scale of the AMS and exhaustion scale of MBI-SS. The Cronbach's alpha for reliability of the three subscales and full SMMS scores was 0.70, 0.67, 0.55 and 0.79. The strength of motivation for medical school has a three factor structure and acceptable validity evidence was found in our study.

Medical staff organization in nursing homes: scale development and validation.

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Katz, Paul R; Karuza, Jurgis; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent; Caprio, Thomas; Caprio, Anthony; Dauenhauer, Jason; Lima, Julie

2009-09-01

To construct a multidimensional self-report scale to measure nursing home (NH) medical staff organization (NHMSO) dimensions and then pilot the scale using a national survey of medical directors to provide data on its psychometric properties. Instrument development process consisting of the proceedings from the Nursing Home Physician Workforce Conference and focus groups followed by cognitive interviews, which culminated in a survey of a random sample of American Medical Directors Association (AMDA) affiliated medical directors. Analyses were conducted on surveys matched to Online Survey Certification and Reporting (OSCAR) data from freestanding nonpediatric nursing homes. A total of 202 surveys were available for analysis and comprised the final sample. Dimensions were identified that measured the extent of medical staff organization in nursing homes and included staff composition, appointment process, commitment (physiciancohesion; leadership turnover/capability), departmentalization (physician supervision, autonomy and interdisciplinary involvement), documentation, and informal dynamics. The items developed to measure each dimension were reliable (Cronbach's alpha ranged from 0.81 to 0.65).Intercorrelations among the scale dimensions provided preliminary evidence of the construct validity of the scale. This report, for the first time ever, defines and validates NH medical staff organization dimensions, a critical first step in determining the relationship between physician practice and the quality of care delivered in the NH.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students.

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Shim, Eun-Jung; Jeon, Hong Jin; Kim, Hana; Lee, Kwang-Min; Jung, Dooyoung; Noh, Hae-Lim; Roh, Myoung-Sun; Hahm, Bong-Jin

2016-11-24

Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI). The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered. Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach's α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI's ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH. The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Medical negligence- Meaning and Scope in India

OpenAIRE

L Kumar; BK Bastia

2011-01-01

It is a principle recognized by our as well as by other legal systems that ignorance of the law is no excuse for violating it. The rule is also expressed in the form of a legal presumption that everyone knows the law. It is the duty of every man to know that part of it which concerns him. A doctor, in particular, is conclusively presumed to know the law, and is dealt with as if he did know it, because in general he can and ought to know it. In the matter of professional liability, the medical...

Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9 among patients on antihypertensive medications

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Desrosiers Marie-Pierre

2009-04-01

Full Text Available Abstract Background The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9, derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication. Methods A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA. Results A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

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Eun-Jung Shim

2016-11-01

Full Text Available Abstract Background Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI. Methods The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI and questions regarding quality of life (QOL and self-rated physical health (SPH were administered. Results Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach’s α = .78. Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI’s ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH. Conclusions The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Cross-cultural Adaptation and Validation of the Medication Regimen Complexity Index Adapted to Spanish.

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Saez de la Fuente, Javier; Such Diaz, Ana; Cañamares-Orbis, Irene; Ramila, Estela; Izquierdo-Garcia, Elsa; Esteban, Concepcion; Escobar-Rodríguez, Ismael

2016-11-01

The most widely used validated instrument to assess the complexity of medication regimens is the Medication Regimen Complexity Index (MRCI). This study aimed to translate, adapt, and validate a reliable version of the MRCI adapted to Spanish (MRCI-E). The cross-cultural adaptation process consisted of an independent translation by 3 clinical pharmacists and a backtranslation by 2 native English speakers. A reliability analysis was conducted on 20 elderly randomly selected patients. Two clinical pharmacists calculated the MRCI-E from discharge treatments and 2 months later. For the validity analysis, the sample was augmented to 60 patients. Convergent validity was assessed by analyzing the correlation between the number of medications; discriminant validity was stratified by gender; and predictive validity was determined by analyzing the ability to predict readmission and mortality at 3 and 6 months. The MRCI-E retained the original structure of 3 sections. The reliability analysis demonstrated an excellent internal consistency (Cronbach's α=0.83), and the intraclass correlation coefficient exceeded 0.9 in all cases. The correlation coefficient with the number of medications was 0.883 ( Pdifferences were found when stratified by gender (3.6; 95%CI=-2.9 to 10.2; P=0.27). Patients who were readmitted at 3 months had a higher MRCI-E score (10.7; 95%CI=4.4 to 17.2; P=0.001). The differences remained significant in patients readmitted at 6 months, but differences in mortality were not detected. The MRCI-E retains the reliability and validity of the original index and provides a suitable tool to assess the complexity of medication regimens in Spanish.

Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do

Science.gov (United States)

2018-01-01

Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

Connecting Technological Innovation in Artificial Intelligence to Real-world Medical Practice through Rigorous Clinical Validation: What Peer-reviewed Medical Journals Could Do.

Science.gov (United States)

Park, Seong Ho; Kressel, Herbert Y

2018-05-28

Artificial intelligence (AI) is projected to substantially influence clinical practice in the foreseeable future. However, despite the excitement around the technologies, it is yet rare to see examples of robust clinical validation of the technologies and, as a result, very few are currently in clinical use. A thorough, systematic validation of AI technologies using adequately designed clinical research studies before their integration into clinical practice is critical to ensure patient benefit and safety while avoiding any inadvertent harms. We would like to suggest several specific points regarding the role that peer-reviewed medical journals can play, in terms of study design, registration, and reporting, to help achieve proper and meaningful clinical validation of AI technologies designed to make medical diagnosis and prediction, focusing on the evaluation of diagnostic accuracy efficacy. Peer-reviewed medical journals can encourage investigators who wish to validate the performance of AI systems for medical diagnosis and prediction to pay closer attention to the factors listed in this article by emphasizing their importance. Thereby, peer-reviewed medical journals can ultimately facilitate translating the technological innovations into real-world practice while securing patient safety and benefit.

Validity of a hospital-based obstetric register using medical records as reference

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed

2015-01-01

BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....

Validation of the generic medical interview satisfaction scale: the G-MISS questionnaire.

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Maurice-Szamburski, Axel; Michel, Pierre; Loundou, Anderson; Auquier, Pascal

2017-02-14

Patients have about seven medical consultations a year. Despite the importance of medical interviews in the healthcare process, there is no generic instrument to assess patients' experiences in general practices, medical specialties, and surgical specialties. The main objective was to validate a questionnaire assessing patients' experiences with medical consultations in various practices. The G-MISS study was a prospective multi-center trial that enrolled patients from May to July 2016. A total of 2055 patients were included from general practices, medical specialties, and surgical specialties. Patients filled out a questionnaire assessing various aspects of their experience and satisfaction within 1 week after their medical interview. The validation process relied on item response theory. Internal validity was examined using exploratory factorial analysis. The statistical model used the root mean square error of approximation, confirmatory fit index, and standard root mean square residual as fit indices. Scalability and reliability were assessed with the Rasch model and Cronbach's alpha coefficients, respectively. Scale properties across the three subgroups were explored with differential item functioning. The G-MISS final questionnaire contained 16 items, structured in three dimensions of patients' experiences: "Relief", "Communication", and "Compliance". A global index of patients' experiences was computed as the mean of the dimension scores. All fit indices from the statistical model were satisfactory (RMSEA = 0.03, CFI = 0.98, SRMR = 0.06). The overall scalability had a good fit to the Rasch model. Each dimension was reliable, with Cronbach's alpha ranging from 0.73 to 0.86. Differential item functioning across the three consultation settings was negligible. Patients undergoing medical or surgical specialties reported higher scores in the "Relief" dimension compared with general practice (83.0 ± 11.6 or 82.4 ± 11.6 vs. 73.2 ± 16

Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

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Bing-You, Robert; Ramesh, Saradha; Hayes, Victoria; Varaklis, Kalli; Ward, Denham; Blanco, Maria

2018-01-01

Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture. Although guidelines for delivering effective feedback have existed for several decades, medical students and residents often indicate that they receive little feedback. A recent scoping review on feedback in medical education did not reveal any validity evidence on instruments to assess learner's perceptions of feedback. The purpose of our study was to gather validity evidence on two novel FEEDME (Feedback in Medical Education) instruments to assess medical students' and residents' perceptions of the feedback that they receive. After the authors developed an initial instrument with 54 items, cognitive interviews with medical students and residents suggested that 2 separate instruments were needed, one focused on the feedback culture (FEEDME-Culture) and the other on the provider of feedback (FEEDME-Provider). A Delphi study with 17 medical education experts and faculty members assessed content validity. The response process was explored involving 31 medical students and residents at 2 academic institutions. Exploratory factor analysis and reliability analyses were performed on completed instruments. Two Delphi consultation rounds refined the wording of items and eliminated several items. Learners found both instruments easy and quick to answer; it took them less than 5 minutes to complete. Learners preferred an electronic format of the instruments over paper. Factor analysis revealed a two- and three-factor solution for the FEEDME-Culture and FEEDME-Provider instruments, respectively. Cronbach's alpha was greater than 0.80 for all factors. Items on both instruments were moderately to highly correlated (range, r = .3-.7). Our

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

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Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline

2016-07-01

This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will

Self-handicapping, excuse making, and counterfactual thinking: consequences for self-esteem and future motivation.

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McCrea, Sean M

2008-08-01

Researchers interested in counterfactual thinking have often found that upward counterfactual thoughts lead to increased motivation to improve in the future, although at the cost of increased negative affect. The present studies suggest that because upward counterfactual thoughts indicate reasons for a poor performance, they can also serve as excuses. In this case, upward counterfactual thoughts should result in more positive self-esteem and reduced future motivation. Five studies demonstrated these effects in the context of self-handicapping. First, upward counterfactual thinking was increased in the presence of a self-handicap. Second, upward counterfactual thoughts indicating the presence of a self-handicap protected self-esteem following failure. Finally, upward counterfactual thoughts that protect self-esteem reduced preparation for a subsequent performance as well as performance itself. These findings suggest that the consequences of upward counterfactuals for affect and motivation are moderated by the goals of the individual as well as the content of the thoughts. (c) 2008 APA, all rights reserved

Validity Evidence for the Measurement of the Strength of Motivation for Medical School

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Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

2011-01-01

The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as…

Quantitative Validation of the Integrated Medical Model (IMM) for ISS Missions

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Young, Millennia; Arellano, J.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Goodenow, D. A.; Myers, J. G.

2016-01-01

Lifetime Surveillance of Astronaut Health (LSAH) provided observed medical event data on 33 ISS and 111 STS person-missions for use in further improving and validating the Integrated Medical Model (IMM). Using only the crew characteristics from these observed missions, the newest development version, IMM v4.0, will simulate these missions to predict medical events and outcomes. Comparing IMM predictions to the actual observed medical event counts will provide external validation and identify areas of possible improvement. In an effort to improve the power of detecting differences in this validation study, the total over each program ISS and STS will serve as the main quantitative comparison objective, specifically the following parameters: total medical events (TME), probability of loss of crew life (LOCL), and probability of evacuation (EVAC). Scatter plots of observed versus median predicted TMEs (with error bars reflecting the simulation intervals) will graphically display comparisons while linear regression will serve as the statistical test of agreement. Two scatter plots will be analyzed 1) where each point reflects a mission and 2) where each point reflects a condition-specific total number of occurrences. The coefficient of determination (R2) resulting from a linear regression with no intercept bias (intercept fixed at zero) will serve as an overall metric of agreement between IMM and the real world system (RWS). In an effort to identify as many possible discrepancies as possible for further inspection, the -level for all statistical tests comparing IMM predictions to observed data will be set to 0.1. This less stringent criterion, along with the multiple testing being conducted, should detect all perceived differences including many false positive signals resulting from random variation. The results of these analyses will reveal areas of the model requiring adjustment to improve overall IMM output, which will thereby provide better decision support for

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

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Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for

Development and validation of a new assessment tool for suturing skills in medical students.

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Sundhagen, Henriette Pisani; Almeland, Stian Kreken; Hansson, Emma

2018-01-01

In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students' suturing skills, measuring both micro- and macrosurgical qualities. A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery. The results show promising reliability and validity when assessing novice medical students' suturing skills. Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation.Level of Evidence: Not ratable.

The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance.

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Emery, Joanne L; Bell, John F

2009-06-01

Some medical courses in the UK have many more applicants than places and almost all applicants have the highest possible previous and predicted examination grades. The BioMedical Admissions Test (BMAT) was designed to assist in the student selection process specifically for a number of 'traditional' medical courses with clear pre-clinical and clinical phases and a strong focus on science teaching in the early years. It is intended to supplement the information provided by examination results, interviews and personal statements. This paper reports on the predictive validity of the BMAT and its predecessor, the Medical and Veterinary Admissions Test. Results from the earliest 4 years of the test (2000-2003) were matched to the pre-clinical examination results of those accepted onto the medical course at the University of Cambridge. Correlation and logistic regression analyses were performed for each cohort. Section 2 of the test ('Scientific Knowledge') correlated more strongly with examination marks than did Section 1 ('Aptitude and Skills'). It also had a stronger relationship with the probability of achieving the highest examination class. The BMAT and its predecessor demonstrate predictive validity for the pre-clinical years of the medical course at the University of Cambridge. The test identifies important differences in skills and knowledge between candidates, not shown by their previous attainment, which predict their examination performance. It is thus a valid source of additional admissions information for medical courses with a strong scientific emphasis when previous attainment is very high.

Development and Validation of the Motivations for Selection of Medical Study (MSMS Questionnaire in India.

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Sonu Goel

Full Text Available Understanding medical students' motivation to select medical studies is particularly salient to inform practice and policymaking in countries-such as India-where shortage of medical personnel poses crucial and chronical challenges to healthcare systems. This study aims to develop and validate a questionnaire to assess the motivation of medical students to select medical studies.A Motivation for Selection of Medical Study (MSMS questionnaire was developed using extensive literature review followed by Delphi technique. The scale consisted of 12 items, 5 measuring intrinsic dimensions of motivations and 7 measuring extrinsic dimensions. Exploratory factor analysis (EFA, confirmatory factor analysis (CFA, validity, reliability and data quality checks were conducted on a sample of 636 medical students from six medical colleges of three North Indian states.The MSMS questionnaire consisted of 3 factors (subscales and 8 items. The three principal factors that emerged after EFA were the scientific factor (e.g. research opportunities and the ability to use new cutting edge technologies, the societal factor (e.g. job security and the humanitarian factor (e.g. desire to help others. The CFA conducted showed goodness-of-fit indices supporting the 3-factor model.The three extracted factors cut across the traditional dichotomy between intrinsic and extrinsic motivation and uncover a novel three-faceted motivation construct based on scientific factors, societal expectations and humanitarian needs. This validated instrument can be used to evaluate the motivational factors of medical students to choose medical study in India and similar settings and constitutes a powerful tool for policymakers to design measures able to increase selection of medical curricula.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults.

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Bou Serhal, R; Salameh, P; Wakim, N; Issa, C; Kassem, B; Abou Jaoude, L; Saleh, N

2018-01-01

A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8). Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted nonadherence. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults

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R. Bou Serhal

2018-01-01

Full Text Available Background. A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8. Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. Methodology. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. Results. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743, and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003, unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001. Stress and smoking predicted nonadherence. Conclusion. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

Medical student quality-of-life in the clerkships: a scale validation study.

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Brannick, Michael T; Horn, Gregory T; Schnaus, Michael J; Wahi, Monika M; Goldin, Steven B

2015-04-01

Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.

[Reliability and validity of assessment of educational outcomes obtained by students of Medical Rescue at Medical University of Warsaw].

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Panczyk, Mariusz; Stachacz, Grzegorz; Gałązkowski, Robert; Gotlib, Joanna

2016-01-01

In the interest of preservation of high degree of objectivity of information about students' educational outcomes, a system of assessment needs to meet criteria of appropriate reliability and validity. Analysis of reliability and validity of the system of assessment of students' educational outcomes for courses followed by an examination and covered by a curriculum in Medical Rescue at Medical University of Warsaw (MU W). A retrospective study enrolling a group of 421 students of eight subsequent full education cycles. Detailed data concerning grades for fourteen courses followed by an examination in the entire course of studies were collected. Reliability (Cronbach's alpha coefficient) and criteria validity (Spearman's rank correlation) were assessed. Internal consistency was estimated using a multiple regression model. The levels of assessment reliability for the general university, pre-clinical, and clinical scopes amounted to alpha: 0.42, 0.53, and 0.70, respectively. The strongest positive correlations between the results of pre-clinical and clinical trainings were found for the Anatomy course (r ≈ 0.30). Only in the case of the Pharmacology course it was found that students' achievements in this field were significantly correlated with all other courses of clinical training. The influence of educational outcomes in particular areas of clinical training on the final grade for the entire course of studies was diverse (β regression between 0.04 and 0.11). While the Pharmacology course had the strongest impact on final results, the Surgery course had the least influence on students' final grades (β = 0.04). 1. Sufficient reliability of the system of assessment of educational outcomes in Medical Rescue showed good precision and repeatability of assessment. 2. A low level of validity was caused by a failure to keep the appropriateness of the assessment of educational outcomes in several clinical courses. 3. Prognostic and diagnostic validity of methods used for

An extended protocol for usability validation of medical devices : Research design and reference model

NARCIS (Netherlands)

Schmettow, M.; Schnittker, R.; Schraagen, J.M.

2017-01-01

This paper proposes and demonstrates an extended protocol for usability validation testing of medical devices. A review of currently used methods for the usability evaluation of medical devices revealed two main shortcomings. Firstly, the lack of methods to closely trace the interaction sequences

On the validity of language: speaking, knowing and understanding in medical geography.

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Scarpaci, J L

1993-09-01

This essay examines methodological problems concerning the conceptualization and operationalization of phenomena central to medical geography. Its main argument is that qualitative research can be strengthened if the differences between instrumental and apparent validity are better understood than the current research in medical geography suggests. Its premise is that our definitions of key terms and concepts must be reinforced throughout the design of research should our knowledge and understanding be enhanced. In doing so, the paper aims to move the methodological debate beyond the simple dichotomies of quantitative vs qualitative approaches and logical positivism vs phenomenology. Instead, the argument is couched in a postmodernist hermeneutic sense which questions the validity of one discourse of investigation over another. The paper begins by discussing methods used in conceptualizing and operationalizing variables in quantitative and qualitative research design. Examples derive from concepts central to a geography of health-care behavior and well-being. The latter half of the essay shows the uses and misuses of validity studies in selected health services research and the current debate on national health insurance.

An extended protocol for usability validation of medical devices: Research design and reference model.

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Schmettow, Martin; Schnittker, Raphaela; Schraagen, Jan Maarten

2017-05-01

This paper proposes and demonstrates an extended protocol for usability validation testing of medical devices. A review of currently used methods for the usability evaluation of medical devices revealed two main shortcomings. Firstly, the lack of methods to closely trace the interaction sequences and derive performance measures. Secondly, a prevailing focus on cross-sectional validation studies, ignoring the issues of learnability and training. The U.S. Federal Drug and Food Administration's recent proposal for a validation testing protocol for medical devices is then extended to address these shortcomings: (1) a novel process measure 'normative path deviations' is introduced that is useful for both quantitative and qualitative usability studies and (2) a longitudinal, completely within-subject study design is presented that assesses learnability, training effects and allows analysis of diversity of users. A reference regression model is introduced to analyze data from this and similar studies, drawing upon generalized linear mixed-effects models and a Bayesian estimation approach. The extended protocol is implemented and demonstrated in a study comparing a novel syringe infusion pump prototype to an existing design with a sample of 25 healthcare professionals. Strong performance differences between designs were observed with a variety of usability measures, as well as varying training-on-the-job effects. We discuss our findings with regard to validation testing guidelines, reflect on the extensions and discuss the perspectives they add to the validation process. Copyright © 2017 Elsevier Inc. All rights reserved.

Creation and preliminary validation of the screening for self-medication safety post-stroke scale (S-5).

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Kaizer, Franceen; Kim, Angela; Van, My Tram; Korner-Bitensky, Nicol

2010-03-01

Patients with stroke should be screened for safety prior to starting a self-medication regime. An extensive literature review revealed no standardized self-medication tool tailored to the multi-faceted needs of the stroke population. The aim of this study was to create and validate a condition-specific tool to be used in screening for self-medication safety in individuals with stroke. Items were generated using expert consultation and review of the existing tools. The draft tool was pilot-tested on expert stroke clinicians to receive feedback on content, clarity, optimal cueing and domain omissions. The final version was piloted on patients with stroke using a structured interviewer-administered interview. The tool was progressively refined and validated according to feedback from the 11 expert reviewers. The subsequent version was piloted on patients with stroke. The final version includes 16 questions designed to elicit information on 5 domains: cognition, communication, motor, visual-perception and, judgement/executive function/self-efficacy. The Screening for Safe Self-medication post-Stroke Scale (S-5) has been created and validated for use by health professionals to screen self-medication safety readiness of patients after stroke. Its use should also help to guide clinicians' recommendations and interventions aimed at enhancing self-medication post-stroke.

Elaboration and Validation of the Medication Prescription Safety Checklist.

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Pires, Aline de Oliveira Meireles; Ferreira, Maria Beatriz Guimarães; Nascimento, Kleiton Gonçalves do; Felix, Márcia Marques Dos Santos; Pires, Patrícia da Silva; Barbosa, Maria Helena

2017-08-03

to elaborate and validate a checklist to identify compliance with the recommendations for the structure of medication prescriptions, based on the Protocol of the Ministry of Health and the Brazilian Health Surveillance Agency. methodological research, conducted through the validation and reliability analysis process, using a sample of 27 electronic prescriptions. the analyses confirmed the content validity and reliability of the tool. The content validity, obtained by expert assessment, was considered satisfactory as it covered items that represent the compliance with the recommendations regarding the structure of the medication prescriptions. The reliability, assessed through interrater agreement, was excellent (ICC=1.00) and showed perfect agreement (K=1.00). the Medication Prescription Safety Checklist showed to be a valid and reliable tool for the group studied. We hope that this study can contribute to the prevention of adverse events, as well as to the improvement of care quality and safety in medication use. elaborar e validar um instrumento tipo checklist para identificar a adesão às recomendações na estrutura das prescrições de medicamentos, a partir do Protocolo do Ministério da Saúde e Agência Nacional de Vigilância Sanitária. pesquisa metodológica, conduzida por meio do processo de validade e análise de confiabilidade, com amostra de 27 prescrições eletrônicas. análises realizadas confirmaram a validade de conteúdo e a confiabilidade da versão do instrumento. A validade de conteúdo, obtida por meio da avaliação de juízes, foi considerada satisfatória por contemplar itens que representam a adesão às recomendações na estrutura das prescrições de medicamentos. A confiabilidade, avaliada por interobservadores, apresentou-se excelente (ICC=1,00) e de concordância perfeita (K=1,00). o instrumento Lista de Verificação de Segurança na Prescrição de Medicamentos demonstrou-se válido e confiável para o grupo estudado. Espera

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

OpenAIRE

Eun-Jung Shim; Hong Jin Jeon; Hana Kim; Kwang-Min Lee; Dooyoung Jung; Hae-Lim Noh; Myoung-Sun Roh; Bong-Jin Hahm

2016-01-01

Abstract Background Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI). Methods The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical stud...

Development and validation of an instrument to assess the prescribing readiness of medical students in Malaysia.

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Lai, Pauline Siew Mei; Sim, Si Mui; Chua, Siew Siang; Tan, Choo Hock; Ng, Chirk Jenn; Achike, Francis Ifejika; Teng, Cheong Lieng

2015-09-21

Prescribing incompetence is an important factor that contributes to prescribing error, and this is often due to inadequate training during medical schools. We therefore aimed to develop and validate an instrument to assess the prescribing readiness of medical students (PROMS) in Malaysia. The PROMS comprised of 26 items with four domains: undergraduate learning opportunities; hands-on clinical skills practice; information gathering behaviour; and factors affecting the learning of prescribing skills. The first three domains were adapted from an existing questionnaire, while items from the last domain were formulated based on findings from a nominal group discussion. Face and content validity was determined by an expert panel, pilot tested in a class of final year (Year 5) medical students, and assessed using the Flesch reading ease. To assess the reliability of the PROMS, the internal consistency and test-retest (at baseline and 2 weeks later) were assessed using the Wilcoxon Signed Ranks test and Spearman's rho. The discriminative validity of the PROMS was assessed using the Mann-Whitney U-test (to assess if the PROMS could discriminate between final year medical students from a public and a private university). A total of 119 medical students were recruited. Flesch reading ease was 46.9, indicating that the instrument was suitable for use in participants undergoing tertiary education. The overall Cronbach alpha value of the PROMS was 0.695, which was satisfactory. Test-retest showed no difference for 25/26 items, indicating that our instrument was reliable. Responses from the public and private university final year medical students were significantly different in 10/26 items, indicating that the PROMS was able to discriminate between these two groups. Medical students from the private university reported fewer learning opportunities and hands-on practice compared to those from the public university. On the other hand, medical students from the private university

A Validation of the Group-Based Medical Mistrust Scale in Formerly Incarcerated Black and Latino Men.

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Valera, Pamela; Boyas, Javier F; Bernal, Camila; Chiongbian, Victoria Briones; Chang, Yvonne; Shelton, Rachel C

2016-05-04

While there is a growing body of literature on medical mistrust and its relevance to public health, research on formerly incarcerated Black and Latino men and their perception of mistrust toward medical providers and medical institutions remains scant. Very little is known about whether formerly incarcerated Black and Latino men mistrust medical and clinical providers given their previous experiences with the criminal justice system. It is important to determine whether medical mistrust play a key role in the health and health behaviors of released Black and Latino men. The purpose of this study is to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale for use among formerly incarcerated Black and Latino men in New York City. The findings of the exploratory and confirmatory factor analyses state that a two-factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor Group-Based Medical Mistrust Scale is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men. © The Author(s) 2016.

[Formal sample size calculation and its limited validity in animal studies of medical basic research].

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Mayer, B; Muche, R

2013-01-01

Animal studies are highly relevant for basic medical research, although their usage is discussed controversially in public. Thus, an optimal sample size for these projects should be aimed at from a biometrical point of view. Statistical sample size calculation is usually the appropriate methodology in planning medical research projects. However, required information is often not valid or only available during the course of an animal experiment. This article critically discusses the validity of formal sample size calculation for animal studies. Within the discussion, some requirements are formulated to fundamentally regulate the process of sample size determination for animal experiments.

Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education.

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Palmer, Brian A; Frye, Mark A; Vickers Douglas, Kristin S; Staab, Jeffrey P; Bright, Robert P; Schleck, Cathy D; Mandrekar, Jayawant N; Mahapatra, Saswati; Beckman, Thomas J; Wittich, Christopher M

2017-07-06

Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants. In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties.

Predictive validity of the comprehensive basic science examination mean score for assessment of medical students' performance

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Firouz Behboudi

2002-04-01

Full Text Available Background Medical education curriculum improvements can be achieved bye valuating students performance. Medical students have to pass two undergraduate comprehensive examinations, basic science and preinternship, in Iran. Purpose To measure validity of the students' mean score in comprehensive basic science exam (CBSE for predicting their performance in later curriculum phases. Methods This descriptive cross-sectional study was conducted on 95 (38 women and 55 men Guilan medical university students. Their admission to the university was 81% by regional quota and 12% by shaheed and other organizations' share. They first enrolled in 1994 and were able to pass CBS£ at first try. Data on gender, regional quota, and average grades of CBS£, PC, and CPIE were collected by a questionnaire. The calculations were done by SPSS package. Results The correlation coefficient between CBS£ and CPIE mean scores (0.65 was higher than correlation coefficient between CBS£ and PC mean scores (0.49. The predictive validity of CBS£ average grade was significant for students' performance in CPIE; however, the predictive validity of CBSE mean scores for students I pe1jormance in PC was lower. Conclusion he students' mean score in CBSE can be a good denominator for their further admission. We recommend further research to assess the predictive validity for each one of the basic courses. Keywords predictive validity, comprehensive basic exam

Ignorance is no excuse for directors minimizing information asymmetry affecting boards

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Eythor Ivar Jonsson

2006-11-01

Full Text Available This paper looks at information asymmetry at the board level and how lack of information has played a part in undermining the power of the board of directors. Information is power, and at board level, information is essential to keep the board knowledgeable about the failures and successes of the organization that it is supposed to govern. Although lack of information has become a popular excuse for boards, the mantra could –and should –be changing to, “Ignorance is no excuse” (Mueller, 1993. This paper explores some of these information system solutions that have the aim of resolving some of the problems of information asymmetry. Furthermore, three case studies are used to explore the problem of asymmetric information at board level and the how the boards are trying to solve the problem. The focus of the discussion is to a describe how directors experience the information asymmetry and if they find it troublesome, b how important information is for the control and strategy role of the board and c find out how boards can minimize the problem of asymmetric information. The research is conducted through semi-structured interviews with directors, managers and accountants. This paper offers an interesting exploration into information, or the lack of information, at board level. It describes both from a theoretical and practical viewpoint the problem of information asymmetry at board level and how companies are trying to solve this problem. It is an issue that has only been lightly touched upon in the corporate governance literature but is likely to attract more attention and research in the future.

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia.

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Ching, Siew Mooi; Yee, Anne; Ramachandran, Vasudevan; Sazlly Lim, Sazlyna Mohd; Wan Sulaiman, Wan Aliaa; Foo, Yoke Loong; Hoo, Fan Kee

2015-01-01

This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS) by translating and validating this scale into the Malay language (SAS-M), which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated. A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT) in the Malay language. There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1) included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett's test of sphericity was significant (p addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

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Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-02-01

The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after spine surgery. Statistical analysis using a prospective surgical spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had

Development of a questionnaire to assess medical competencies: Reliability and validity of the Questionnaire

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Giesler, Marianne; Forster, Johannes; Biller, Silke; Fabry, Götz

2011-01-01

Introduction: While preparing a graduate survey for medical education in 2008 we realized that no instrument existed that would be suitable to evaluate whether the learning outcomes outlined in the Medical Licensure Act (ÄAppO) would be met. Therefore we developed the Freiburg Questionnaire to Assess Competencies in Medicine (Freiburger Fragebogen zur Erfassung von Kompetenzen in der Medizin, FKM)1 which has been revised and extended several times since then. Currently the FKM includes 45 items which are assigned to nine domains that correspond to the CanMEDS roles: medical expertise, communication, team-work, health and prevention, management, professionalism, learning, scholarship, and personal competencies. Methods: In order to test the reliability and validity of the questionnaire we have repeatedly surveyed medical students and residents since May 2008. In this article we report on the results of a cross-sectional study with 698 medical students from the preclinical and clinical years. In addition, we report the results of a survey of 514 residents who were up to two years into their residency. Results and conclusions: In summary, results show that the scales of the FKM are reliable (Cronbach’s α between .68 and .97). Significant differences in means between selected groups of students support the measure’s construct validity. Furthermore, there is evidence that the FKM might be used as a screening tool e.g. in graduate surveys to identify weaknesses in the medical education curriculum. PMID:21818241

Examining assumptions regarding valid electronic monitoring of medication therapy: development of a validation framework and its application on a European sample of kidney transplant patients

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Steiger Jürg

2008-02-01

Full Text Available Abstract Background Electronic monitoring (EM is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1 EM equipment functioned correctly, (2 if all EM bottle openings corresponded to actual drug intake, and (3 if EM did not influence a patient's normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness. Methods We used data from the Supporting Medication Adherence in Renal Transplantation (SMART study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS. Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study, and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect. Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence. Results Our analysis revealed that some assumptions were not fulfilled: 1 one cap malfunctioned (0.4%, 2 self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155, and 3 adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect. Conclusion The validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence.

“It’s not my fault, it was my brain”. Could such a statement lead to an excuse for individuals with personality disorders and psychopaths?

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Custodia Jiménez Martínez

2017-07-01

Full Text Available In this paper we study both the criminal responsibility and the mental state as excuse for indivisuals with personality disorders and psychopaths, as well as the arguments offered by the neuroscience to deny a basic, central, main, nuclear stone of our modern criminal law, the idea of a free will. According to that idea, the human being is free to choose between the right and wrong (unlawful behavior. For neuroscience we don’t have such a freedom that would be merely an illusion, a mirage. Our brain would have decided and ordered formerly our behavior.

Construct Validity of Medical Clinical Competence Measures: A Multitrait-Multimethod Matrix Study Using Confirmatory Factor Analysis.

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Forsythe, George B.; And Others

1986-01-01

Construct validity was investigated for three tests of clinical competence in medicine: National Board of Medical Examiners examination (NBME), California Psychological Inventory (CPI), and Resident Evaluation Form (REF). Scores from 166 residents were analyzed. Results suggested low construct validity for CPI and REF scales, and moderate…

Medical negligence- meaning and scope in India.

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Kumar, L; Bastia, B K

2011-01-01

It is a principle recognized by our as well as by other legal systems that ignorance of the law is no excuse for violating it. The rule is also expressed in the form of a legal presumption that everyone knows the law. It is the duty of every man to know that part of it which concerns him. A doctor, in particular, is conclusively presumed to know the law, and is dealt with as if he did know it, because in general he can and ought to know it. In the matter of professional liability, the medical profession differs from other occupations for the reason that the former operates in spheres where success cannot be achieved in every case and very often success or failure depends upon factors beyond a medical man's control. Due to the increasing awareness of the rights of a patient in present day society, a medical man has become more vulnerable to being sued by a litigation suit of any kind, civil or criminal. The basis of a medical negligence suit is still alien to the majority of the practicing doctors in our country. Hence, the present article aims at discussing the various aspects of negligence, like the meaning and types of negligence, and the concept of duty of care, degree of care, and standard of care, as considered by the law.

Medical negligence- Meaning and Scope in India

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L Kumar

2011-03-01

Full Text Available It is a principle recognized by our as well as by other legal systems that ignorance of the law is no excuse for violating it. The rule is also expressed in the form of a legal presumption that everyone knows the law. It is the duty of every man to know that part of it which concerns him. A doctor, in particular, is conclusively presumed to know the law, and is dealt with as if he did know it, because in general he can and ought to know it. In the matter of professional liability, the medical profession differs from other occupations for the reason that the former operates in spheres where success cannot be achieved in every case and very often success or failure depends upon factors beyond a medical man’s control. Due to the increasing awareness of the rights of a patient in present day society, a medical man has become more vulnerable to being sued by a litigation suit of any kind, civil or criminal. The basis of a medical negligence suit is still alien to the majority of the practicing doctors in our country. Hence, the present article aims at discussing the various aspects of negligence, like the meaning and types of negligence, and the concept of duty of care, degree of care, and standard. Keywords: degree of care, duty of care, medical negligence, standard of care.

The Malaysian Medication Adherence Scale (MALMAS: Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia.

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Wen Wei Chung

Full Text Available Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8 to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C. Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565 and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412. The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715. Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032. The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37 of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.

Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: A systematic review

NARCIS (Netherlands)

A.N. Ringburg (Akkie); G. de Ronde (Gijs); S. Thomas (Siep); E.M.M. van Lieshout (Esther); P. Patka (Peter); I.B. Schipper (Inger)

2009-01-01

textabstractObjective. This review provides an overview of the validity of Helicopter Emergency Medical Services (HEMS) dispatch criteria for severely injured patients. Methods. A systematic literature search was performed. English written and peer-reviewed publications on HEMS dispatch criteria

COCOA: A New Validated Instrument to Assess Medical Students' Attitudes towards Older Adults

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Hollar, David; Roberts, Ellen; Busby-Whitehead, Jan

2011-01-01

This study tested the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n = 160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better…

Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

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Wetzel, Angela Payne

Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize

Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

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Sun Lee

2017-09-01

Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

Validation of a Delirium Risk Assessment Using Electronic Medical Record Information.

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Rudolph, James L; Doherty, Kelly; Kelly, Brittany; Driver, Jane A; Archambault, Elizabeth

2016-03-01

Identifying patients at risk for delirium allows prompt application of prevention, diagnostic, and treatment strategies; but is rarely done. Once delirium develops, patients are more likely to need posthospitalization skilled care. This study developed an a priori electronic prediction rule using independent risk factors identified in a National Center of Clinical Excellence meta-analysis and validated the ability to predict delirium in 2 cohorts. Retrospective analysis followed by prospective validation. Tertiary VA Hospital in New England. A total of 27,625 medical records of hospitalized patients and 246 prospectively enrolled patients admitted to the hospital. The electronic delirium risk prediction rule was created using data obtained from the patient electronic medical record (EMR). The primary outcome, delirium, was identified 2 ways: (1) from the EMR (retrospective cohort) and (2) clinical assessment on enrollment and daily thereafter (prospective participants). We assessed discrimination of the delirium prediction rule with the C-statistic. Secondary outcomes were length of stay and discharge to rehabilitation. Retrospectively, delirium was identified in 8% of medical records (n = 2343); prospectively, delirium during hospitalization was present in 26% of participants (n = 64). In the retrospective cohort, medical record delirium was identified in 2%, 3%, 11%, and 38% of the low, intermediate, high, and very high-risk groups, respectively (C-statistic = 0.81; 95% confidence interval 0.80-0.82). Prospectively, the electronic prediction rule identified delirium in 15%, 18%, 31%, and 55% of these groups (C-statistic = 0.69; 95% confidence interval 0.61-0.77). Compared with low-risk patients, those at high- or very high delirium risk had increased length of stay (5.7 ± 5.6 vs 3.7 ± 2.7 days; P = .001) and higher rates of discharge to rehabilitation (8.9% vs 20.8%; P = .02). Automatic calculation of delirium risk using an EMR algorithm identifies patients at

Validation of the Chinese version of the Modified Caregivers Strain Index among Hong Kong caregivers: an initiative of medical social workers.

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Chan, Wallace Chi Ho; Chan, Christopher L F; Suen, Margaret

2013-11-01

Family caregivers may often experience caregiving stress and burden. To systematically assess this issue, medical social workers may need to use a brief and valid measurement in their practice. In the Hong Kong Chinese context, one additional challenge is to examine whether a measurement developed in the West is valid for Hong Kong Chinese caregivers. Thus, medical social workers in Hong Kong initiated this research study to validate the Chinese version of the Modified Caregiver Strain Index (C-M-CSI). A total of 223 Chinese caregivers of patients with various chronic illnesses were recruited for this validation study. C-M-CSI demonstrated good reliability (Cronbach's alpha coefficient = .91), concurrent validity with the Chinese version of the Caregiver Burden Inventory, and discriminant validity with the Chinese version of the Meaning in Life Questionnaire. Factor analysis yielded a single factor as the original M-CSI, which explained 49 percent of variance. Construct validity was shown by differentiating spousal and nonspousal caregivers, as well as caregivers of patients with and without behavioral problems. C-M-CSI is recommended as a brief and valid measurement that can be used by medical social workers in assessing the caregiving strain of Chinese caregivers of patients in Hong Kong.

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

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Greiffenstein, Manfred F.

2010-01-01

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory-2-FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of…

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

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McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

2015-01-01

Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools.

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Edwards, Daniel; Friedman, Tim; Pearce, Jacob

2013-12-27

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted. Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables. The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised.

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia.

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Siew Mooi Ching

Full Text Available This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS by translating and validating this scale into the Malay language (SAS-M, which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated.A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT in the Malay language.There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1 included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett's test of sphericity was significant (p <0.01, and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach's alpha = 0.94. All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT.This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

A medical school's organizational readiness for curriculum change (MORC): development and validation of a questionnaire.

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Jippes, Mariëlle; Driessen, Erik W; Broers, Nick J; Majoor, Gerard D; Gijselaers, Wim H; van der Vleuten, Cees P M

2013-09-01

Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's organizational readiness for curriculum change (MORC). In 2012, a panel of medical education experts judged and adapted a preliminary MORC questionnaire through a modified Delphi procedure. The authors administered the resulting questionnaire to medical school faculty involved in curriculum change and tested the psychometric properties using exploratory and confirmatory factor analysis, and generalizability analysis. The mean relevance score of the Delphi panel (n = 19) reached 4.2 on a five-point Likert-type scale (1 = not relevant and 5 = highly relevant) in the second round, meeting predefined criteria for completing the Delphi procedure. Faculty (n = 991) from 131 medical schools in 56 countries completed MORC. Exploratory factor analysis yielded three underlying factors-motivation, capability, and external pressure-in 12 subscales with 53 items. The scale structure suggested by exploratory factor analysis was confirmed by confirmatory factor analysis. Cronbach alpha ranged from 0.67 to 0.92 for the subscales. Generalizability analysis showed that the MORC results of 5 to 16 faculty members can reliably evaluate a school's organizational readiness for change. MORC is a valid, reliable questionnaire for measuring organizational readiness for curriculum change in medical schools. It can identify which elements in a change process require special attention so as to increase the chance of successful implementation.

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

Science.gov (United States)

Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

2017-09-08

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

A Medical School's Organizational Readiness for Curriculum Change (MORC): Development and Validation of a Questionnaire

NARCIS (Netherlands)

Jippes, M.; Driessen, E.W.; Broers, N.J.; Majoor, G.D.; Gijselaers, W.H.; Vleuten, C.P.M. van der

2013-01-01

PURPOSE: Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's

Predictive validity of the personal qualities assessment for selection of medical students in Scotland.

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Dowell, Jon; Lumsden, Mary Ann; Powis, David; Munro, Don; Bore, Miles; Makubate, Boikanyo; Kumwenda, Ben

2011-01-01

The Personal Qualities Assessment (PQA) was developed to enhance medical student selection by measuring a range of non-cognitive attributes in the applicants to medical school. Applicants to the five Scottish medical schools were invited to pilot the test in 2001 and 2002. To evaluate the predictive validity of PQA for selecting medical students. A longitudinal cohort study was conducted in which PQA scores were compared with senior year medical school performance. Consent to access performance markers was obtained from 626 students (61.6% of 1017 entrants in 2002-2003). Linkable Foundation Year (4th) rankings were available for 411 (66%) students and objective structured clinical examination (OSCE) rankings for 335 (54%) of those consenting. Both samples were representative of the original cohort. No significant correlations were detected between separate elements of the PQA assessment and student performance. However, using the algorithm advocated by Powis et al. those defined as 'non-extreme' (libertarian-communitarian moral orientation scales were ranked higher in OSCEs (average of 7.5% or 25 out of 335, p = 0.049). This study was limited by high attrition and basic outcome markers which are insensitive to relevant non-cognitive characteristics. However, it is the largest currently available study of predictive validity for the PQA assessment. There was one finding of significance: that those students who were identified by PQA as 'not extreme' on the two personal characteristics scales performed better in an OSCE measure of professionalism. Futures studies are required since psychometric testing for both cognitive and non-cognitive attributes are increasingly used in admission process and these should include more and better measures of professionalism against which to correlate non-cognitive traits.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

Science.gov (United States)

Wright, A.; Krousel-Wood, M.; Thomas, E. J.; McCoy, J. A.; Sittig, D. F.

2015-01-01

Summary Background Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. Objective We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. Methods We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. Results The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. Conclusions We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes. PMID:26171079

[Development and validation of a questionnaire on perception of portfolio by undergraduate medical students].

Science.gov (United States)

Riquelme, Arnoldo; Méndez, Benjamín; de la Fuente, Paloma; Padilla, Oslando; Benaglio, Carla; Sirhan, Marisol; Labarca, Jaime

2011-01-01

Portfolio is an innovative instrument that promotes reflection, creativity and professionalism among students. To describe the development and validation process of a questionnaire to evaluate the use of portfolio in undergraduate medical students. Focus groups with students and teachers were employed to identify aspects related with portfolio in undergraduate teaching. The Delphi technique was used to prioritize relevant aspects and construct the questionnaire. The validated questionnaire, consisting of 43 items and 6 factors, was applied to 97 students (response rote of 99.9%) in 2007 and 100 students (99.2%) in 2008. Each question had to be answered using a Likert scale, from 0 (completely disagree) to 4 (completely agree) The validity and reliability of the questionnaire was evaluated. The questionnaire showed a high reliability (Cronbach alpha = 0.9). The mean total scores obtained in 2007 and 2008 were 106.2 ± 21.2 (61.7% of the maximal obtainable score) and 104.6 ± 34.0 (60.8% of the maximal obtainable score), respectively No significant differences were seen in the analysis by factors. Changes in portfolio during 2008 showed differences in items related with organization, evaluation and regulation. The questionnaire is a valid and highly reliable instrument, measuring perceptions about the portfolio by undergraduate medical students. The students perceived an improvement in their creativity and professionalism as one of the strengths of portfolio. The weaknesses identified during the implementation process helped us to focus changes in organization and evaluation to improve the portfolio as a dynamic process.

Predictive validity of pre-admission assessments on medical student performance.

Science.gov (United States)

Dabaliz, Al-Awwab; Kaadan, Samy; Dabbagh, M Marwan; Barakat, Abdulaziz; Shareef, Mohammad Abrar; Al-Tannir, Mohamad; Obeidat, Akef; Mohamed, Ayman

2017-11-24

To examine the predictive validity of pre-admission variables on students' performance in a medical school in Saudi Arabia. In this retrospective study, we collected admission and college performance data for 737 students in preclinical and clinical years. Data included high school scores and other standardized test scores, such as those of the National Achievement Test and the General Aptitude Test. Additionally, we included the scores of the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS) exams. Those datasets were then compared with college performance indicators, namely the cumulative Grade Point Average (cGPA) and progress test, using multivariate linear regression analysis. In preclinical years, both the National Achievement Test (p=0.04, B=0.08) and TOEFL (p=0.017, B=0.01) scores were positive predictors of cGPA, whereas the General Aptitude Test (p=0.048, B=-0.05) negatively predicted cGPA. Moreover, none of the pre-admission variables were predictive of progress test performance in the same group. On the other hand, none of the pre-admission variables were predictive of cGPA in clinical years. Overall, cGPA strongly predict-ed students' progress test performance (p<0.001 and B=19.02). Only the National Achievement Test and TOEFL significantly predicted performance in preclinical years. However, these variables do not predict progress test performance, meaning that they do not predict the functional knowledge reflected in the progress test. We report various strengths and deficiencies in the current medical college admission criteria, and call for employing more sensitive and valid ones that predict student performance and functional knowledge, especially in the clinical years.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

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Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati

2018-05-18

Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death

Challenges to validation of a complex nonsterile medical device tray.

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Prince, Daniel; Mastej, Jozef; Hoverman, Isabel; Chatterjee, Raja; Easton, Diana; Behzad, Daniela

2014-01-01

Validation by steam sterilization of reusable medical devices requires careful attention to many parameters that directly influence whether or not complete sterilization occurs. Complex implant/instrument tray systems have a variety of configurations and components. Geobacillus stearothermophilus biological indicators (BIs) are used in overkill cycles to to simulate worst case conditions and are intended to provide substantial sterilization assurance. Survival of G. stearothermophilus spores was linked to steam access and size of load in the chamber. By a small and reproducible margin, it was determined that placement of the trays in a rigid container into minimally loaded chambers were more difficult to completely sterilize than maximally loaded chambers.

The validation of the Utrecht work engagement scale for emergency medical technicians in Gauteng

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JLP Naudé

2004-04-01

Full Text Available The objectives of this study were to validate the Utrecht Work Engagement Scale (UWES for emergency medical technicians in the Gauteng Province of South Africa and to determine its construct equivalence and bias for different language groups. A cross-sectional survey design was used with a convenient sample (N = 318 of emergency medical technicians in Gauteng. The UWES and a biographical questionnaire were administered. A two-factor model of work engagement, consisting of Vigour/Dedication and Absorption was found. Exploratory factor analysis with target rotations confirmed the construct equivalence of the work engagement construct for white and black employees.

The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

DEFF Research Database (Denmark)

Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring

2009-01-01

into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale......OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated...

Validation of questionnaire-reported hearing with medical records: A report from the Swiss Childhood Cancer Survivor Study.

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Annette Weiss

Full Text Available Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference.In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent, sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss.Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62, normal hearing was correctly assessed in 92% of those with normal hearing (n = 249, and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112. Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid.Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results.

Validation of questionnaire-reported hearing with medical records: A report from the Swiss Childhood Cancer Survivor Study

Science.gov (United States)

Scheinemann, Katrin; Grotzer, Michael; Kompis, Martin; Kuehni, Claudia E.

2017-01-01

Background Hearing loss is a potential late effect after childhood cancer. Questionnaires are often used to assess hearing in large cohorts of childhood cancer survivors and it is important to know if they can provide valid measures of hearing loss. We therefore assessed agreement and validity of questionnaire-reported hearing in childhood cancer survivors using medical records as reference. Procedure In this validation study, we studied 361 survivors of childhood cancer from the Swiss Childhood Cancer Survivor Study (SCCSS) who had been diagnosed after 1989 and had been exposed to ototoxic cancer treatment. Questionnaire-reported hearing was compared to the information in medical records. Hearing loss was defined as ≥ grade 1 according to the SIOP Boston Ototoxicity Scale. We assessed agreement and validity of questionnaire-reported hearing overall and stratified by questionnaire respondents (survivor or parent), sociodemographic characteristics, time between follow-up and questionnaire and severity of hearing loss. Results Questionnaire reports agreed with medical records in 85% of respondents (kappa 0.62), normal hearing was correctly assessed in 92% of those with normal hearing (n = 249), and hearing loss was correctly assessed in 69% of those with hearing loss (n = 112). Sensitivity of the questionnaires was 92%, 74%, and 39% for assessment of severe, moderate and mild bilateral hearing loss; and 50%, 33% and 10% for severe, moderate and mild unilateral hearing loss, respectively. Results did not differ by sociodemographic characteristics of the respondents, and survivor- and parent-reports were equally valid. Conclusions Questionnaires are a useful tool to assess hearing in large cohorts of childhood cancer survivors, but underestimate mild and unilateral hearing loss. Further research should investigate whether the addition of questions with higher sensitivity for mild degrees of hearing loss could improve the results. PMID:28333999

Utilization of never-medicated bipolar disorder patients towards development and validation of a peripheral biomarker profile.

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Catherine L Clelland

Full Text Available There are currently no biological tests that differentiate patients with bipolar disorder (BPD from healthy controls. While there is evidence that peripheral gene expression differences between patients and controls can be utilized as biomarkers for psychiatric illness, it is unclear whether current use or residual effects of antipsychotic and mood stabilizer medication drives much of the differential transcription. We therefore tested whether expression changes in first-episode, never-medicated BPD patients, can contribute to a biological classifier that is less influenced by medication and could potentially form a practicable biomarker assay for BPD. We employed microarray technology to measure global leukocyte gene expression in first-episode (n=3 and currently medicated BPD patients (n=26, and matched healthy controls (n=25. Following an initial feature selection of the microarray data, we developed a cross-validated 10-gene model that was able to correctly predict the diagnostic group of the training sample (26 medicated patients and 12 controls, with 89% sensitivity and 75% specificity (p<0.001. The 10-gene predictor was further explored via testing on an independent cohort consisting of three pairs of monozygotic twins discordant for BPD, plus the original enrichment sample cohort (the three never-medicated BPD patients and 13 matched control subjects, and a sample of experimental replicates (n=34. 83% of the independent test sample was correctly predicted, with a sensitivity of 67% and specificity of 100% (although this result did not reach statistical significance. Additionally, 88% of sample diagnostic classes were classified correctly for both the enrichment (p=0.015 and the replicate samples (p<0.001. We have developed a peripheral gene expression biomarker profile, that can classify healthy controls from patients with BPD receiving antipsychotic or mood stabilizing medication, which has both high sensitivity and specificity

Validation of the self-assessment teamwork tool (SATT) in a cohort of nursing and medical students.

Science.gov (United States)

Roper, Lucinda; Shulruf, Boaz; Jorm, Christine; Currie, Jane; Gordon, Christopher J

2018-02-09

Poor teamwork has been implicated in medical error and teamwork training has been shown to improve patient care. Simulation is an effective educational method for teamwork training. Post-simulation reflection aims to promote learning and we have previously developed a self-assessment teamwork tool (SATT) for health students to measure teamwork performance. This study aimed to evaluate the psychometric properties of a revised self-assessment teamwork tool. The tool was tested in 257 medical and nursing students after their participation in one of several mass casualty simulations. Using exploratory and confirmatory factor analysis, the revised self-assessment teamwork tool was shown to have strong construct validity, high reliability, and the construct demonstrated invariance across groups (Medicine & Nursing). The modified SATT was shown to be a reliable and valid student self-assessment tool. The SATT is a quick and practical method of guiding students' reflection on important teamwork skills.

28 CFR 32.14 - PSOB Office determination.

Science.gov (United States)

2010-07-01

...'s failure (without reasonable justification or excuse) to pursue in timely fashion the determination..., or other non-physical evidence (such as medical-history records, as appropriate) and legal arguments...

Evaluation of tumor registry validity in Samsung medical center radiation oncology department

International Nuclear Information System (INIS)

Park, Won; Huh, Seung Jae; Kim, Dae Yong; Shin, Seong Soo; Ahn, Yong Chan; Lim, Do Hoon; Kim, Seon Woo

2004-01-01

A tumor registry system for the patients treated by radiotherapy at Samsung Medical Center since the opening of a hospital at 1994 was employed. In this study, the tumor registry system was introduced and the validity of the tumor registration was analyzed. The tumor registry system was composed of three parts: patient demographic, diagnostic, and treatment information. All data were input in a screen using a mouse only. Among the 10,000 registered cases in the tumor registry system until Aug, 2002, 199 were randomly selected and their registration data were compared with the patients' medical records. Total input errors were detected in 15 cases (7.5%). There were 8 error items in the part relating to diagnostic information: tumor site 3, pathology 2, AJCC staging 2 and performance status 1. In the part relating to treatment information there were 9 mistaken items: combination treatment 4, the date of initial treatment 3 and radiation completeness 2. According to the assignment doctor, the error ratio was consequently variable. The doctors who did no double-checks showed higher errors than those that did (15.6%: 3.7%). Our tumor registry had errors within 2% for each item. Although the overall data quality was high, further improvement might be achieved through promoting sincerity, continuing training periodic validity tests and keeping double-checks. Also, some items associated with the hospital information system will be input automatically in the next step

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients.

Science.gov (United States)

Ashur, S T; Shamsuddin, K; Shah, S A; Bosseri, S; Morisky, D E

2015-12-13

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.

Medication reconciliation is a prerequisite for obtaining a valid medication review

DEFF Research Database (Denmark)

Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

2013-01-01

The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors.......The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors....

Medical students' attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study.

Science.gov (United States)

Rees, Charlotte E; Wearn, Andy M; Dennis, Ian; Amri, Hakima; Greenfield, Sheila M

2009-02-01

Current research mainly employs cross-sectional designs to examine changes in medical students' attitudes towards complementary and alternative medicine (CAM). This paper reports the findings of a longitudinal study to further validate the Integrative Medicine Attitude Questionnaire (IMAQ) and examine changes in medical students' attitudes over 3 years. A total of 154 medical students from four schools in three countries completed a modified version of the IMAQ during their first (T1) and fourth year (T2). We established the validity of a three-factor model for the IMAQ: (1) attitudes towards holism; (2) attitudes towards the effectiveness of CAM therapies, and (3) attitudes towards introspection and the doctor-patient relationship. We found that IMAQ factor scores did not differ significantly from T1 to T2, emphasizing the relative stability in attitudes across time. Various student characteristics were significantly associated with IMAQ factor scores at T2: age, gender, CAM use, CAM education and school; and two variables (gender and CAM use) predicted changes in medical students' attitudes between T1 and T2. We urge medical educators to continue exploring medical students' attitude changes towards CAM and we provide examples of what further research is needed.

Validation of the complex of measures of medical rehabilitation of children victims of Chernobyl accident

International Nuclear Information System (INIS)

Paramonov, Z.M.

1999-01-01

Special complex program including social medical, organizational and hygienic aspects of studying state of health of children and the characteristics of the system of medical service have been worked out. The peculiarities of changes in the state of health in children and its correlation with the level of the internal irradiation as well as the ways to form the latter in the chain 'soil-water complex - food stuffs - organism' have been determined. Special rehabilitation measures and their application in the network of therapeutic sanatorium centers for radiation protection are validated. The expediency and necessity of medico-hygienic protection of children was established

Design and validation of a questionnaire on nursing competence in the notification of medication incidents.

Science.gov (United States)

Salcedo-Diego, Isabel; de Andrés-Gimeno, Begoña; Ruiz-Antorán, Belén; Layunta, Rocío; Serrano-Gallardo, Pilar

To design and perform a face and content validation of a questionnaire to measure the competence of hospital RN to report medication incidents. Content and face questionnaire validation descriptive study. A review of the literature was performed for the creation of ítems. A panel of six experts assessed the relevance of the inclusion of each ítem in the questionnaire by calculating the position index; ítems with position index >0.70 were selected. The questionnaire was piloted by 59 RN. Finally, a meeting was convened with experts, in order to reduce the length of the piloted questionnaire through review, discussion and decision by consensus on each item. From the literature review, a battery of 151 ítems grouped into three elements of competence: attitudes, knowledge and skills was created. 52.9% (n=80) of the ítems received a position index > 0.70. The response rate in the pilot study was 40.65%. The median time to complete the questionnaire was 23:35minutes. After reduction by the experts, the final questionnaire comprised 45 ítems grouped into 32 questions. The NORMA questionnaire, designed to explore the competence of hospital RN to report medication incidents, has adequate face and content validity and is easy to administer, enabling its institutional implementation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care

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Eva Öhman

2016-12-01

Full Text Available Abstract Background Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES was originally developed for evaluation of nursing students’ clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students’ perceptions of their learning environment in primary health care. Methods In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. Results The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbach’s alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. Conclusion CLES, in its adapted form, appears

Integrated Medical Model (IMM) Project Verification, Validation, and Credibility (VVandC)

Science.gov (United States)

Walton, M.; Boley, L.; Keenan, L.; Kerstman, E.; Shah, R.; Young, M.; Saile, L.; Garcia, Y.; Meyers, J.; Reyes, D.

2015-01-01

The Integrated Medical Model (IMM) Project supports end user requests by employing the Integrated Medical Evidence Database (iMED) and IMM tools as well as subject matter expertise within the Project. The iMED houses data used by the IMM. The IMM is designed to forecast relative changes for a specified set of crew health and mission success risk metrics by using a probabilistic model based on historical data, cohort data, and subject matter expert opinion. A stochastic approach is taken because deterministic results would not appropriately reflect the uncertainty in the IMM inputs. Once the IMM was conceptualized, a plan was needed to rigorously assess input information, framework and code, and output results of the IMM, and ensure that end user requests and requirements were considered during all stages of model development and implementation, as well as lay the foundation for external review and application. METHODS: In 2008, the Project team developed a comprehensive verification and validation (VV) plan, which specified internal and external review criteria encompassing 1) verification of data and IMM structure to ensure proper implementation of the IMM, 2) several validation techniques to confirm that the simulation capability of the IMM appropriately represents occurrences and consequences of medical conditions during space missions, and 3) credibility processes to develop user confidence in the information derived from the IMM. When the NASA-STD-7009 (7009) [1] was published, the Project team updated their verification, validation, and credibility (VVC) project plan to meet 7009 requirements and include 7009 tools in reporting VVC status of the IMM. Construction of these tools included meeting documentation and evidence requirements sufficient to meet external review success criteria. RESULTS: IMM Project VVC updates are compiled recurrently and include updates to the 7009 Compliance and Credibility matrices. Reporting tools have evolved over the lifetime of

The validity of student tutors' judgments in early detection of struggling in medical school. A prospective cohort study.

Science.gov (United States)

O'Neill, Lotte Dyhrberg; Morcke, Anne Mette; Eika, Berit

2016-12-01

Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.

Development and validation of a generic questionnaire for the implementation of complex medical interventions

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Kramer, Lena

2014-04-01

Full Text Available [english] Introduction: The implementation of complex medical interventions in daily practice is often fraught with difficulties. According to the iterative phase model proposed by the British Medical Research Council (MRC, the development, implementation and evaluation of complex interventions should be theory-driven. A conceptual model that seems to be a promising framework is the Theory of planned behaviour (TPB. In our study we aimed to develop and validate a generic and multifaceted questionnaire based on the TPB to detect physicians’ willingness to implement complex medical interventions and the factors influencing this willingness.Methods: The questionnaire was developed according to the literature and was informed by previous qualitative research of our department. It was validated on the example of an electronic library of decision aids, arriba-lib. The sample consisted of 181 General Practitioners (GPs who received a training regarding arriba-lib and subsequently filled in the questionnaire, assessing the TPB variables attitude, subjective norm, perceived behaviour control and intention. Follow-up assessments were conducted after two (assessing retest reliability and eight weeks (assessing target behaviour. We performed a confirmatory factor analysis investigating the factorial structure of our questionnaire according to the TPB. Beside the calculation of the questionnaire’s psychometric properties we conducted a structural equation model and an ordinal regression to predict actual behaviour regarding the installation and application of arriba-lib.Results: The postulated three factorial model (attitude, subjective norm, perceived behaviour control of our questionnaire based on the TPB was rejected. A two factorial model with a combined factor subjective norm/perceived behaviour control was accepted. The explained variance in the ordinal regression was low (Nagelkerke’s R=.12. Neither attitude nor intention were able to predict

Role and liabilities of the medical physicist in the validation of oncologic treatments in internal vectorized radiation therapy. S.F.P.M. report nr 31, June 2015

International Nuclear Information System (INIS)

Farman, Bardia; Defez, Didier; Martineau, Antoine; Vrigneaud, Jean-Marc; Dieudonne, Arnaud; Giraud, Fabienne; Divry, Guillaume; Bardies, Manuel; Laffont, Sophie; Santoro, Lore; Ferrer, Ludovic; Guilhem, Marie-Therese; Meyer, Philippe; Simon, Luc

2015-06-01

According to legal arrangements and decrees, the medical physicist must validate the preparation of each treatment based on the use of radio-elements in non-sealed sources. As the medical physicist is therefore liable of this validation, this report addresses the approach to be followed to comply with the law. The authors first outline that this report only concerns oncologic internal vectorized radiation therapy, and does not address the dosimetric aspect of these treatments. After having recalled the principles of internal vectorized radiography, they describe the role of the different actors: nuclear physician, medical physicist, radio-pharmacist, radio-pharmacy dispenser, medical electro-radiology operator, state nurse. They address the various aspects of the process of validation of a treatment preparation: technical prerequisites, organisational prerequisite, validation process, traceability, dosimetry. Several examples are proposed in appendix regarding traceability, dosimetry software, examples of PRM files

The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

DEFF Research Database (Denmark)

O'Neill, Lotte; Mørcke, Anne Mette; Eika, Berit

2016-01-01

Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity...... of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted...... to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical...

A guide for radiological indications and major findings in medical practice

International Nuclear Information System (INIS)

Suwan, Z.

2009-01-01

If a clear cut diagnosis is reached by a simple modality such as adenoids by a nasopharynx radiograph; infection, sarcoidosis, or pneumothorax by a chest radiograph; stones in the gall-bladder, or cysts in a kidney by ultrasound; I cannot understand a need or an excuse for any further co sty, or invasive modalities. On the other hand, the single most valuable modality for epidural or subdural hematoma is CT and for multiple sclerosis or meniscal tear is MRI. Although the basic x rays for chest, bones and bowel loops in abdomen are still the most valuable standards, however the subject of modality of choice elsewhere in only applicable to instruments [X ray, US, CT and MR machines] manufactured at the same year and of latest generation. So the suggested modality of choice in this book is scientifically valid at year of publishing and can be subjected to any change in the future. (author)

Practical aspects during sterilization validation for medical devices at IRASM Microbiological Laboratory

International Nuclear Information System (INIS)

Trandafir, L.; Ene, M.; Alexandru, M.; Constantin, M.; Ionita, A.; Zorila, F.; Moise, I.V.

2011-01-01

Complete text of publication follows. The state of being free of living microorganisms is called sterility. The sterility state can be achieved by different means of sterilization. In practice the results of the process cannot be fully verified by tests, so the efficacy of the sterilization process must be validated. ISO 11137 established regulations for setting or substantiating the dose for achieving the desired sterility assurance level. The validation studies can be designed in particular for different types of product. Each product needs distinct protocol for bioburden determination and sterility testing. During time, the Microbiological Laboratories from Multipurpose Irradiation Center deals with different types of products, mainly for VD max 25 method. When it comes to microbiological evaluation the most challenging was cotton gauze. Special situation for establishing the sterilization validation method appears in cases of cotton, packed in large quantities. VD max 25 method can not be applied for items with average bioburden more than 1000 CFU / pack, no matter which is the weight of the package. This is a method limitation and implies increased costs for manufacturer, when choosing other method. For microbiological tests, culture condition should be selected in both cases the bioburden and sterility testing. These are time and money consuming. The costs can be reduced if taking into account some aspects. Reason for performing the bacteriostasis-fungistasis just for sterility testing will be given. The present study puts forward aspects during the validation studies for medical devices (cotton wool, cotton gauze, surgical sutures, dental screws), at IRASM Microbiological Laboratory.

The Transgenic RNAi Project at Harvard Medical School: Resources and Validation.

Science.gov (United States)

Perkins, Lizabeth A; Holderbaum, Laura; Tao, Rong; Hu, Yanhui; Sopko, Richelle; McCall, Kim; Yang-Zhou, Donghui; Flockhart, Ian; Binari, Richard; Shim, Hye-Seok; Miller, Audrey; Housden, Amy; Foos, Marianna; Randkelv, Sakara; Kelley, Colleen; Namgyal, Pema; Villalta, Christians; Liu, Lu-Ping; Jiang, Xia; Huan-Huan, Qiao; Wang, Xia; Fujiyama, Asao; Toyoda, Atsushi; Ayers, Kathleen; Blum, Allison; Czech, Benjamin; Neumuller, Ralph; Yan, Dong; Cavallaro, Amanda; Hibbard, Karen; Hall, Don; Cooley, Lynn; Hannon, Gregory J; Lehmann, Ruth; Parks, Annette; Mohr, Stephanie E; Ueda, Ryu; Kondo, Shu; Ni, Jian-Quan; Perrimon, Norbert

2015-11-01

To facilitate large-scale functional studies in Drosophila, the Drosophila Transgenic RNAi Project (TRiP) at Harvard Medical School (HMS) was established along with several goals: developing efficient vectors for RNAi that work in all tissues, generating a genome-scale collection of RNAi stocks with input from the community, distributing the lines as they are generated through existing stock centers, validating as many lines as possible using RT-qPCR and phenotypic analyses, and developing tools and web resources for identifying RNAi lines and retrieving existing information on their quality. With these goals in mind, here we describe in detail the various tools we developed and the status of the collection, which is currently composed of 11,491 lines and covering 71% of Drosophila genes. Data on the characterization of the lines either by RT-qPCR or phenotype is available on a dedicated website, the RNAi Stock Validation and Phenotypes Project (RSVP, http://www.flyrnai.org/RSVP.html), and stocks are available from three stock centers, the Bloomington Drosophila Stock Center (United States), National Institute of Genetics (Japan), and TsingHua Fly Center (China). Copyright © 2015 by the Genetics Society of America.

The Transgenic RNAi Project at Harvard Medical School: Resources and Validation

Science.gov (United States)

Perkins, Lizabeth A.; Holderbaum, Laura; Tao, Rong; Hu, Yanhui; Sopko, Richelle; McCall, Kim; Yang-Zhou, Donghui; Flockhart, Ian; Binari, Richard; Shim, Hye-Seok; Miller, Audrey; Housden, Amy; Foos, Marianna; Randkelv, Sakara; Kelley, Colleen; Namgyal, Pema; Villalta, Christians; Liu, Lu-Ping; Jiang, Xia; Huan-Huan, Qiao; Wang, Xia; Fujiyama, Asao; Toyoda, Atsushi; Ayers, Kathleen; Blum, Allison; Czech, Benjamin; Neumuller, Ralph; Yan, Dong; Cavallaro, Amanda; Hibbard, Karen; Hall, Don; Cooley, Lynn; Hannon, Gregory J.; Lehmann, Ruth; Parks, Annette; Mohr, Stephanie E.; Ueda, Ryu; Kondo, Shu; Ni, Jian-Quan; Perrimon, Norbert

2015-01-01

To facilitate large-scale functional studies in Drosophila, the Drosophila Transgenic RNAi Project (TRiP) at Harvard Medical School (HMS) was established along with several goals: developing efficient vectors for RNAi that work in all tissues, generating a genome-scale collection of RNAi stocks with input from the community, distributing the lines as they are generated through existing stock centers, validating as many lines as possible using RT–qPCR and phenotypic analyses, and developing tools and web resources for identifying RNAi lines and retrieving existing information on their quality. With these goals in mind, here we describe in detail the various tools we developed and the status of the collection, which is currently composed of 11,491 lines and covering 71% of Drosophila genes. Data on the characterization of the lines either by RT–qPCR or phenotype is available on a dedicated website, the RNAi Stock Validation and Phenotypes Project (RSVP, http://www.flyrnai.org/RSVP.html), and stocks are available from three stock centers, the Bloomington Drosophila Stock Center (United States), National Institute of Genetics (Japan), and TsingHua Fly Center (China). PMID:26320097

Validity of the Medication-based Disease Burden Index compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for geriatrics: a cohort study.

Science.gov (United States)

Beloosesky, Yichayaou; Weiss, Avraham; Mansur, Nariman

2011-12-01

Co-morbidity is common in older people. A co-morbidity index reduces coexisting illnesses and their severity to a single numerical score, allowing comparison with scores from other patients. Recently, the Medication-Based Disease Burden Index (MDBI) was developed. The aim of the study was to assess the MDBI's validity in hospitalized elderly patients. Clinical and demographic data and data on patients' medications on admission were obtained prospectively. Retrospectively, we applied the MDBI to the patients' medication regimens, determining their co-morbidity using the Charlson Comorbidity Index and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). The MDBI's criterion validity was assessed against the Charlson and CIRS-G indices. Convergent and discriminant validities were also assessed. The MDBI's predictive validity was assessed by its ability to predict 3-month post-discharge readmissions or mortality compared with the Charlson and CIRS-G indices. MDBI scores were correlated with the Charlson and CIRS-G indices' scores (r = 0.44 and r = 0.37, respectively [p indices had good predictive ability for mortality (OR 1.50 [95% CI 1.22, 1.84; p failed to differentiate between cognitive and functional patient groups. The MDBI should be investigated in larger studies to determine its validity in settings where medication data rather than diagnostic data are more readily available. In clinical practice with elderly patients, we recommend employing co-morbidity indices that are based on medical records, such as the Charlson Comorbidity Index and CIRS-G.

Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale.

Science.gov (United States)

Cabral, Ana C; Moura-Ramos, Mariana; Castel-Branco, Margarida; Fernandez-Llimos, Fernando; Figueiredo, Isabel V

2018-04-01

The 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8. A process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined. A total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, pPortuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

Science.gov (United States)

Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

2013-01-01

To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

49 CFR 219.203 - Responsibilities of railroads and employees.

Science.gov (United States)

2010-10-01

... duty tour. An employee who has been transported to receive medical care is not released from duty for... testing does not excuse such refusal by the employee timely to provide the required specimens. (c) Place...

Assessment of DoD Wounded Warrior Matters -- Fort Riley

Science.gov (United States)

2013-08-06

acceptable excuses included At Remote Care, Regular Leave, Maternity and Paternity Leave, Terminal Leave, Permanent Change of Station, and Transferred to...risk of negative medication interactions and reactions for Soldiers assigned to the Fort Riley WTB. B.2. Background The Joint Commission, an...reconciliation is to minimize medication errors such as omissions, duplications, dosing errors, and drug interactions . Medical reconciliation should

Physician Brain Drain from Sub-Saharan Africa: Exploring the Utility of an Eco-psychopolitical Validity Framework for Medical Migration Research

Directory of Open Access Journals (Sweden)

Benjamin Siankam

2011-11-01

Full Text Available In-depth understanding of any critical social issue requires investigators to use analytical tools that reflect the complexity of the social issue of interest. Toward this aim, I examine the medical brain drain from Sub-Saharan Africa to the United States through the lens of the eco-psychopolitical validity model (see, Christen and Perkins, 2008; Prilleltensky, 2008, an integrative approach that stresses the combined influences of structural factors, individual agency, and power at play in human dynamics and social systems. By adapting the eco-psychopolitical validity model to the study of medical skilled migration, I construe migration as a liberating venture articulated around the triadic process of oppression, empowerment, and wellness. If migrants yearn to breathe free, then émigré physicians are essentially in pursuit of liberation and wellbeing. However, in a world of profound health disparities, where the increasing emigration of medical doctors from resource-constrained countries ultimately leads to loss of lives in the communities left behind, migrant doctors´ individual agency and the multilevel contexts that enable or constrain them to emigrate require critical reflection. Some emerging themes and variations of an ongoing qualitative study are examined using the eco-psychopolitical validity paradigm.

Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claims.

Science.gov (United States)

Chastek, Benjamin J; Oleen-Burkey, Merrikay; Lopez-Bresnahan, Maria V

2010-01-01

Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data. A claims-based relapse detection algorithm was tested by comparing its detection rate over a 1-year period with relapses identified based on medical chart review. According to the algorithm, MS patients in a US healthcare claims database who had either (1) a primary claim for MS during hospitalization or (2) a corticosteroid claim following a MS-related outpatient visit were designated as having a relapse. Patient charts were examined for explicit indication of relapse or care suggestive of relapse. Positive and negative predictive values were calculated. Medical charts were reviewed for 300 MS patients, half of whom had a relapse according to the algorithm. The claims-based criteria correctly classified 67.3% of patients with relapses (positive predictive value) and 70.0% of patients without relapses (negative predictive value; kappa 0.373: p value of the operational algorithm. Limitations of the algorithm include lack of differentiation between relapsing-remitting MS and other types, and that it does not incorporate measures of function and disability. The claims-based algorithm appeared to successfully detect moderate-to-severe MS relapse. This validated definition can be applied to future claims-based MS studies.

[Ethic review on clinical experiments of medical devices in medical institutions].

Science.gov (United States)

Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

2011-07-01

Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

Validation of metabolic syndrome using medical records in the SUN cohort

Directory of Open Access Journals (Sweden)

Barrio-Lopez Maria

2011-11-01

Full Text Available Abstract Background The objective of this study was to evaluate the validity of self reported criteria of Metabolic Syndrome (MS in the SUN (Seguimiento Universidad de Navarra cohort using their medical records as the gold standard. Methods We selected 336 participants and we obtained MS related data according to Adult Treatment Panel III (ATP III and International Diabetes Federation (IDF. Then we compared information on the self reported diagnosis of MS and MS diagnosed in their medical records. We calculated the proportion of confirmed MS, the proportion of confirmed non-MS and the intraclass correlation coefficients for each component of the MS. Results From those 336 selected participants, we obtained sufficient data in 172 participants to confirm or reject MS using ATP III criteria. The proportion of confirmed MS was 91.2% (95% CI: 80.7- 97.1 and the proportion of confirmed non-MS was 92.2% (95% CI: 85.7-96.4 using ATP III criteria. The proportion of confirmed MS using IDF criteria was 100% (95% CI: 87.2-100 and the proportion of confirmed non-MS was 97.1% (95% CI: 85.1-99.9. Kappa Index was 0.82 in the group diagnosed by ATP III criteria and 0.97 in the group diagnosed by IDF criteria. Intraclass correlation coefficients for the different component of MS were: 0.93 (IC 95%:0.91- 0.95 for BMI; 0.96 (IC 95%: 0.93-0.98 for waist circumference; 0.75 (IC 95%: 0.66-0.82 for fasting glucose; 0.50 (IC 95%:0.35-0.639 for HDL cholesterol; 0.78 (IC 95%: 0.70-0.84 for triglycerides; 0.49 (IC 95%:0.34-0.61 for systolic blood pressure and 0.55 (IC 95%: 0.41-0.65 for diastolic blood pressure. Conclusions Self-reported MS based on self reported components of the SM in a Spanish cohort of university graduates was sufficiently valid as to be used in epidemiological studies.

Risk management in technovigilance: construction and validation of a medical-hospital product evaluation instrument.

Science.gov (United States)

Kuwabara, Cleuza Catsue Takeda; Evora, Yolanda Dora Martinez; de Oliveira, Márcio Mattos Borges

2010-01-01

With the continuous incorporation of health technologies, hospital risk management should be implemented to systemize the monitoring of adverse effects, performing actions to control and eliminate their damage. As part of these actions, Technovigilance is active in the procedures of acquisition, use and quality control of health products and equipment. This study aimed to construct and validate an instrument to evaluate medical-hospital products. This is a quantitative, exploratory, longitudinal and methodological development study, based on the Six Sigma quality management model, which has as its principle basis the component stages of the DMAIC Cycle. For data collection and content validation, the Delphi technique was used with professionals from the Brazilian Sentinel Hospital Network. It was concluded that the instrument developed permitted the evaluation of the product, differentiating between the results of the tested brands, in line with the initial study goal of qualifying the evaluations performed.

Validity of self-reported periodontal measures, demographic characteristics and systemic medical conditions.

Science.gov (United States)

Chatzopoulos, Georgios S; Cisneros, Alejandro; Sanchez, Miguel; Lunos, Scott; Wolff, Larry F

2018-04-06

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic. In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were utilized to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included with the range of answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors. The sample mean age was 54.1 years and included 52.6% males and 14.9% smokers with a mean number of missing teeth of 3.5. Self-reported tooth mobility, history of "gum treatment" and the importance to keep the teeth as well as age, tobacco use and cancer were statistically significant (p brushing", gender, diabetes, anxiety and arthritis. Self-reported periodontal screening questions as well as demographic characteristics, smoking and systemic medical conditions were significant predictors of periodontal disease and they could be used as valid, economical and practical measures. This article is protected by copyright. All rights reserved. © 2018 American Academy of Periodontology.

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.

Science.gov (United States)

Garibaldi, Brian T; Reimers, Mallory; Ernst, Neysa; Bova, Gregory; Nowakowski, Elaine; Bukowski, James; Ellis, Brandon C; Smith, Chris; Sauer, Lauren; Dionne, Kim; Carroll, Karen C; Maragakis, Lisa L; Parrish, Nicole M

2017-02-01

In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste. Copyright © 2017 American Society for Microbiology.

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review

Science.gov (United States)

2018-01-11

Background: This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. Methods: A systematic review study design wa...

How valid are commercially available medical simulators?

NARCIS (Netherlands)

Stunt, J.J.; Wulms, P.H.; Kerkhoffs, G.M.; Dankelman, J.; Van Dijk, C.N.; Tuijthof, G.J.M.

2014-01-01

Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on

Specificity of the tomography implementation in electric arc domain - Validity in medical imaging

International Nuclear Information System (INIS)

Benech, Julie

2008-01-01

The aim of these works was to implement a new experimental method to characterize 3D thermal plasmas by emission spectroscopy. The method used is based on tomographic technique which is widely used in medical imaging nowadays. However, tomography that we have developed and applied to electric arc is specific as the number of accessible projections angles is strongly limited: 4 projections our case against basically 64 in medical imaging. The particularity of our experimental tomographic system is that measurements are resolved both spectrally and spatially. The spectral resolution is necessary to determine the temperature values from method based on atomic line intensity. The spatial resolution is needed to simultaneously acquire the whole width of the plasma and so to reconstruct a whole cross-section in only one acquisition. One of the principal objective was to realize the experimental system of four-view tomography for thermal plasmas. Thanks to this device, we showed that the characterization of non-axisymmetric plasma is possible and that it enables to reconstruct 3D temperature maps. Finally, our tomographic method is applied with medical imaging data acquired in SPECT (Single Photon Emission Computed Tomography). These tests allowed validating the use of our tomographic reconstruction technique in SPECT, particularly the used iterative algebraic algorithm and the limited-view configuration. (author) [fr

Validity of Simulation-Based Assessment for Accreditation Council for Graduate Medical Education Milestone Achievement.

Science.gov (United States)

Isaak, Robert S; Chen, Fei; Martinelli, Susan M; Arora, Harendra; Zvara, David A; Hobbs, Gene; Stiegler, Marjorie P

2018-01-25

The Accreditation Council for Graduate Medical Education requires biannual evaluation of anesthesiology residents on 25 subcompetency milestones. Some milestone domains are particularly challenging to repeatedly and reliably observe during clinical care. Simulation-Based Milestones Assessment (SBMA) may help overcome these challenges. However, few studies have examined the external validation of simulation assessment scores (ie, the relationships between simulation-based assessment scores and other standard measures of ability) for milestones. This study analyzed whether SBMA scores (1) discriminate by postgraduate year, (2) improve over time, and (3) correlate with traditional measures of performance. This is a retrospective analysis of 55 residents' SBMA data from 30 scenarios for two academic years. Each scenario was evaluated for time-in-training discrimination. Scenarios were then analyzed for SBMA scoring trends over time, and SBMA scores were compared with residents' clinical evaluations. Twenty-four SBMA scenarios discriminated by postgraduate year. Repeated measure analysis of variance showed statistically significant between-session score improvements (F (3, 54) = 17.79, P Medical Education milestone competencies.

Aeromedical Hazard Comparison of FAA Medically Certified Third-Class and Medically Uncertified Pilots.

Science.gov (United States)

Ricaurte, Eduard M; Mills, William D; DeJohn, Charles A; Laverde-Lopez, Maria C; Porras-Sanchez, Daniel F

2016-07-01

Since 2004, in the United States, light sport aircraft (LSA) and some aircraft with standard airworthiness certificates can be operated for recreational purposes with a valid state driver's license rather than a Federal Aviation Administration (FAA)-issued aeromedical certificate. There have been recent efforts to allow operation of much larger, heavier, faster, and more complex aircraft without requiring a medical certificate. The primary objective of this research was to compare hazards to flight safety identified in fatally injured pilots required to possess a valid FAA third-class medical certificate to hazards in fatally injured pilots who were not required to possess a valid medical certificate. A search of all fatal U.S. aircraft accidents in the FAA Medical ANalysis and TRAcking (MANTRA) registry between January 1, 2011, and April 30, 2014, identified 1084 individuals. A review of accident pilots' medical, autopsy, and toxicological data was conducted. After applying exclusion criteria, 467 pilots remained, including 403 medically certified and 64 medically uncertified pilots. A significant difference was found in a surrogate measure for risk between medically certified and uncertified pilots (25% vs. 59%). This difference remained significant after adjustment for age. No significant difference was found in the proportions of hazards identified on toxicological review. The results of this study suggest that the risk of an adverse medical event is reduced in pilots required to possess a valid medical certificate. Ricaurte EM, Mills WD, DeJohn CA, Laverde-Lopez MC, Porras-Sanchez DF. Aeromedical hazard comparison of FAA medically certified third-class and medically uncertified pilots. Aerosp Med Hum Perform. 2016; 87(7):618-621.

The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia

OpenAIRE

Chung, Wen Wei; Chua, Siew Siang; Lai, Pauline Siew Mei; Morisky, Donald E.

2015-01-01

Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The ...

Validation of an improved abnormality insertion method for medical image perception investigations

Science.gov (United States)

Madsen, Mark T.; Durst, Gregory R.; Caldwell, Robert T.; Schartz, Kevin M.; Thompson, Brad H.; Berbaum, Kevin S.

2009-02-01

The ability to insert abnormalities in clinical tomographic images makes image perception studies with medical images practical. We describe a new insertion technique and its experimental validation that uses complementary image masks to select an abnormality from a library and place it at a desired location. The method was validated using a 4-alternative forced-choice experiment. For each case, four quadrants were simultaneously displayed consisting of 5 consecutive frames of a chest CT with a pulmonary nodule. One quadrant was unaltered, while the other 3 had the nodule from the unaltered quadrant artificially inserted. 26 different sets were generated and repeated with order scrambling for a total of 52 cases. The cases were viewed by radiology staff and residents who ranked each quadrant by realistic appearance. On average, the observers were able to correctly identify the unaltered quadrant in 42% of cases, and identify the unaltered quadrant both times it appeared in 25% of cases. Consensus, defined by a majority of readers, correctly identified the unaltered quadrant in only 29% of 52 cases. For repeats, the consensus observer successfully identified the unaltered quadrant only once. We conclude that the insertion method can be used to reliably place abnormalities in perception experiments.

Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS).

Science.gov (United States)

Kudesia, Rashmi; Chernyak, Elizabeth; McAvey, Beth

2017-10-01

To create, validate, and use a fertility awareness survey based on current U.S. Cross-sectional study. Not applicable. Phase 1 included U.S. women ages 18-45; phase 2 included female medical students and obstetrics and gynecology trainees at two urban academic programs. Survey including demographics, the Fertility & Infertility Treatment Knowledge Score (FIT-KS) instrument, and General Nutrition Knowledge Questionnaire. Knowledge of natural fertility and infertility treatments. The FIT-KS was validated through detailed item and validity analyses. In phase 1, 127 women participated; their median age was 31 years, and 43.7% had children. Their mean FIT-KS score was 16.2 ± 3.5 (55.9% correct). In phase 2, 118 medical trainees participated; their median age was 25 years, and 12.4% had children. Their mean FIT-KS score was 18.8 ± 2.1 (64.9% correct), with year of training correlating to a higher score (r=0.40). Participant awareness regarding lifestyle factors varied, but it was particularly low regarding the effects of lubricants. The majority underestimated the spontaneous miscarriage rate and overestimated the fecundability of 40-year-old women. There was general overestimation of success rates for assisted reproductive technologies, particularly among medical trainees. The FIT-KS is validated to current U.S. data for use in both general and medical populations as a quick assessment of fertility knowledge. The knowledge gaps demonstrated in this study correlate with national trends in delayed childbearing and time to initiate treatment. For medical trainees, these results raise concerns about the quality of fertility counseling they may be able to offer patients. Greater educational outreach must be undertaken to enhance fertility awareness. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Factorial Invariance and Convergent Validity of the Group-Based Medical Mistrust Scale across Gender and Ethnoracial Identity.

Science.gov (United States)

Wheldon, Christopher W; Kolar, Stephanie K; Hernandez, Natalie D; Daley, Ellen M

2017-01-01

The objective of this study was to assess the factorial invariance and convergent validity of the Group-Based Medical Mistrust Scale (GBMMS) across gender (male and female) and ethnoracial identity (Latino and Black). Minority students (N = 686) attending a southeastern university were surveyed in the fall of 2011. Psychometric analysis of the GBMMS was performed. A three-factor solution fit the data after the omission of two problematic items. This revised version of the GBMMS exhibited sufficient configural, metric, and scalar invariance. Convergence of the GBMMS with conceptually related measures provided further evidence of validity; however, there was variation across ethnoracial identity. The GBMMS has viable psychometric properties across gender and ethnoracial identity in Black and Latino populations.

Development and Validation of a Short-Form Safety Net Medical Home Scale.

Science.gov (United States)

Nocon, Robert S; Gunter, Kathryn E; Gao, Yue; Lee, Sang Mee; Chin, Marshall H

2017-12-01

To develop a short-form Safety Net Medical Home Scale (SNMHS) for assessing patient-centered medical home (PCMH) capability in safety net clinics. National surveys of federally qualified health centers (FQHCs). Interviews with FQHC directors. We constructed three short-form SNMHS versions and examined correlations with full SNMHS and related primary care assessments. We tested usability with FQHC directors and reviewed scale development with an advisory group. Federally qualified health center surveys were administered in 2009 and 2013, by mail and online. Usability testing was conducted through telephone interviews with FQHC directors in 2013. Six-, 12-, and 18-question short-form SNMHS versions had Pearson correlations with full scale of 0.84, 0.92, and 0.96, respectively. All versions showed a level of convergent validity with other primary care assessment scales comparable to the full SNMHS. User testers found short forms to be low-burden, though missing some PCMH concepts. Advisory group members expressed caution over missing concepts and appropriate use of short-form self-assessments. Short-form versions of SNMHS showed strong correlations with full scale and may be useful for brief assessment of safety net PCMH capability. Each short-form SNMHS version may be appropriate for different research, quality improvement, and assessment purposes. © Health Research and Educational Trust.

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission.

Science.gov (United States)

Hissbach, Johanna C; Klusmann, Dietrich; Hampe, Wolfgang

2011-10-14

Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission

Directory of Open Access Journals (Sweden)

Hissbach Johanna C

2011-10-01

Full Text Available Abstract Background Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. Methods 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Results Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. Conclusions A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of

From patient care to research: a validation study examining the factors contributing to data quality in a primary care electronic medical record database.

Science.gov (United States)

Coleman, Nathan; Halas, Gayle; Peeler, William; Casaclang, Natalie; Williamson, Tyler; Katz, Alan

2015-02-05

Electronic Medical Records (EMRs) are increasingly used in the provision of primary care and have been compiled into databases which can be utilized for surveillance, research and informing practice. The primary purpose of these records is for the provision of individual patient care; validation and examination of underlying limitations is crucial for use for research and data quality improvement. This study examines and describes the validity of chronic disease case definition algorithms and factors affecting data quality in a primary care EMR database. A retrospective chart audit of an age stratified random sample was used to validate and examine diagnostic algorithms applied to EMR data from the Manitoba Primary Care Research Network (MaPCReN), part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The presence of diabetes, hypertension, depression, osteoarthritis and chronic obstructive pulmonary disease (COPD) was determined by review of the medical record and compared to algorithm identified cases to identify discrepancies and describe the underlying contributing factors. The algorithm for diabetes had high sensitivity, specificity and positive predictive value (PPV) with all scores being over 90%. Specificities of the algorithms were greater than 90% for all conditions except for hypertension at 79.2%. The largest deficits in algorithm performance included poor PPV for COPD at 36.7% and limited sensitivity for COPD, depression and osteoarthritis at 72.0%, 73.3% and 63.2% respectively. Main sources of discrepancy included missing coding, alternative coding, inappropriate diagnosis detection based on medications used for alternate indications, inappropriate exclusion due to comorbidity and loss of data. Comparison to medical chart review shows that at MaPCReN the CPCSSN case finding algorithms are valid with a few limitations. This study provides the basis for the validated data to be utilized for research and informs users of its

Tradução e validação para o português do Medication Regimen Complexity Index Translation and validation into portuguese Language of the Medication Regimen Complexity Index

Directory of Open Access Journals (Sweden)

Ana Carolina Melchiors

2007-10-01

Full Text Available FUNDAMENTO: A complexidade da farmacoterapia consiste de múltiplas características do regime prescrito, incluindo o número de diferentes medicações no esquema, o número de unidades de dosagem por dose, o número total de doses por dia e os cuidados na administração dos medicamentos. O Medication Regimen Complexity Index (MRCI é um instrumento específico, validado e utilizado para medir a complexidade da farmacoterapia, desenvolvido originalmente em língua inglesa. OBJETIVO: Tradução transcultural e validação desse instrumento para o português do Brasil. MÉTODOS: Foi desenvolvido um estudo transversal envolvendo 95 pacientes com diabete do tipo 2 utilizando múltiplas medicações. O processo de validação teve início pela tradução, retrotradução e pré-teste do instrumento, gerando uma versão adaptada chamada Índice de Complexidade da Farmacoterapia (ICFT. Em seguida foram analisados parâmetros psicométricos, incluindo validade convergente, validade divergente, confiabilidade entre avaliadores e teste-reteste. RESULTADOS: A complexidade da farmacoterapia medida pelo ICFT obteve média de 15,7 pontos (desvio padrão = 8,36. O ICFT mostrou correlação significativa com o número de medicamentos em uso (r = 0,86; p BACKGROUND: The complexity of pharmacotherapy is a result of a multiplicity of prescribed regimen factors, including the number of different drugs in the regimen, the number of dosage units per dose, the total number of prescribed doses per day and administration instructions. The Medication Regimen Complexity Index (MRCI is a specific, reliable and valid tool used to measure the complexity of pharmacotherapy, originally developed in English language. OBJECTIVE: Transcultural translation and validation of this tool into Brazilian Portuguese. METHODS: A cross-sectional study was developed with 95 type-2 diabetes patients, receiving multiple medications. The validation process included translation into

Amphenicols stability in medicated feed – development and validation of liquid chromatography method

Directory of Open Access Journals (Sweden)

Pietro Wojciech Jerzy

2014-12-01

Full Text Available A liquid chromatography-ultraviolet detection method for the determination of florfenicol (FF and thiamphenicol (TAP in feeds is presented. The method comprises the extraction of analytes from the matrix with a mixture of methanol and acetonitrile, drying of the extract, and its dissolution in phosphate buffer. The analysis was performed with a gradient programme of the mobile phase composed of acetonitrile and buffer (pH = 7.3 on a Zorbax Eclipse Plus C18 (150 × 4.6 mm, 5 μm analytical column with UV (λ = 220 nm detection. The analytical procedure has been successfully adopted and validated for quantitative determination of florfenicol and thiamphenicol in feed samples. Sensitivity, specificity, linearity, repeatability, and intralaboratory reproducibility were included in the validation. The mean recovery of amphenicols was 93.5% within the working range of 50-4000 mg/kg. Simultaneous determination of chloramphenicol, which is banned in the feed, was also included within the same procedure of FF and TAP stability studies. Storing the medicated feed at room temperature for up to one month decreased concentration in the investigated drugs even by 45%. These findings are relevant to successful provision of therapy to animals.

Validation of a scenario-based assessment of critical thinking using an externally validated tool.

Science.gov (United States)

Buur, Jennifer L; Schmidt, Peggy; Smylie, Dean; Irizarry, Kris; Crocker, Carlos; Tyler, John; Barr, Margaret

2012-01-01

With medical education transitioning from knowledge-based curricula to competency-based curricula, critical thinking skills have emerged as a major competency. While there are validated external instruments for assessing critical thinking, many educators have created their own custom assessments of critical thinking. However, the face validity of these assessments has not been challenged. The purpose of this study was to compare results from a custom assessment of critical thinking with the results from a validated external instrument of critical thinking. Students from the College of Veterinary Medicine at Western University of Health Sciences were administered a custom assessment of critical thinking (ACT) examination and the externally validated instrument, California Critical Thinking Skills Test (CCTST), in the spring of 2011. Total scores and sub-scores from each exam were analyzed for significant correlations using Pearson correlation coefficients. Significant correlations between ACT Blooms 2 and deductive reasoning and total ACT score and deductive reasoning were demonstrated with correlation coefficients of 0.24 and 0.22, respectively. No other statistically significant correlations were found. The lack of significant correlation between the two examinations illustrates the need in medical education to externally validate internal custom assessments. Ultimately, the development and validation of custom assessments of non-knowledge-based competencies will produce higher quality medical professionals.

The economics of improving medication adherence in osteoporosis: validation and application of a simulation model.

Science.gov (United States)

Patrick, Amanda R; Schousboe, John T; Losina, Elena; Solomon, Daniel H

2011-09-01

Adherence to osteoporosis treatment is low. Although new therapies and behavioral interventions may improve medication adherence, questions are likely to arise regarding their cost-effectiveness. Our objectives were to develop and validate a model to simulate the clinical outcomes and costs arising from various osteoporosis medication adherence patterns among women initiating bisphosphonate treatment and to estimate the cost-effectiveness of a hypothetical intervention to improve medication adherence. We constructed a computer simulation using estimates of fracture rates, bisphosphonate treatment effects, costs, and utilities for health states drawn from the published literature. Probabilities of transitioning on and off treatment were estimated from administrative claims data. Patients were women initiating bisphosphonate therapy from the general community. We evaluated a hypothetical behavioral intervention to improve medication adherence. Changes in 10-yr fracture rates and incremental cost-effectiveness ratios were evaluated. A hypothetical intervention with a one-time cost of $250 and reducing bisphosphonate discontinuation by 30% had an incremental cost-effectiveness ratio (ICER) of $29,571 per quality-adjusted life year in 65-yr-old women initiating bisphosphonates. Although the ICER depended on patient age, intervention effectiveness, and intervention cost, the ICERs were less than $50,000 per quality-adjusted life year for the majority of intervention cost and effectiveness scenarios evaluated. Results were sensitive to bisphosphonate cost and effectiveness and assumptions about the rate at which intervention and treatment effects decline over time. Our results suggests that behavioral interventions to improve osteoporosis medication adherence will likely have favorable ICERs if their efficacy can be sustained.

Evaluation of the Cardiac Depression Visual Analogue Scale in a medical and non-medical sample.

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Di Benedetto, Mirella; Sheehan, Matthew

2014-01-01

Comorbid depression and medical illness is associated with a number of adverse health outcomes such as lower medication adherence and higher rates of subsequent mortality. Reliable and valid psychological measures capable of detecting a range of depressive symptoms found in medical settings are needed. The Cardiac Depression Visual Analogue Scale (CDVAS) is a recently developed, brief six-item measure originally designed to assess the range and severity of depressive symptoms within a cardiac population. The current study aimed to further investigate the psychometric properties of the CDVAS in a general and medical sample. The sample consisted of 117 participants, whose mean age was 40.0 years (SD = 19.0, range 18-84). Participants completed the CDVAS, the Cardiac Depression Scale (CDS), the Depression Anxiety Stress Scales (DASS) and a demographic and health questionnaire. The CDVAS was found to have adequate internal reliability (α = .76), strong concurrent validity with the CDS (r = .89) and the depression sub-scale of the DASS (r = .70), strong discriminant validity and strong predictive validity. The principal components analysis revealed that the CDVAS measured only one component, providing further support for the construct validity of the scale. Results of the current study indicate that the CDVAS is a short, simple, valid and reliable measure of depressive symptoms suitable for use in a general and medical sample.

Comparison of injury rates between cadets with limb length inequalities and matched control subjects over 1 year of military training and athletic participation.

Science.gov (United States)

Goss, Donald Lee; Moore, Josef H; Slivka, Erin M; Hatler, Brian S

2006-06-01

To compare lower-limb overuse injury and low back pain incidence among cadets with and without limb length inequality (LLI) over 1 year of military training and athletic participation. A total of 1,100 cadets were screened for LLIs; 126 of 1,100 were identified to have a LLI of > 0.5 cm and were assigned a matched control cadet. Injury rates, numbers of visits to sick call, and numbers of days spent on medical excusal during a 1-year period were then compared for the 252 cadets. There was no difference in prevalence of injury between the groups and no significant differences (p > 0.05) between the groups in injury rates, visits to sick call, or number of days spent on medical excusal. These findings do not support any increased incidence of injuries in a young, healthy, athletic, military population with mild LLIs, compared with matched control subjects without LLIs, over 1 year.

Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation.

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Shannon, C Ken; Jackson, Jodie

2015-01-01

The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice. © 2015 National Rural Health Association.

Validity of the Malay version of the Internet Addiction Test: a study on a group of medical students in Malaysia.

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Guan, Ng Chong; Isa, Saramah Mohammed; Hashim, Aili Hanim; Pillai, Subash Kumar; Harbajan Singh, Manveen Kaur

2015-03-01

The use of the Internet has been increasing dramatically over the decade in Malaysia. Excessive usage of the Internet has lead to a phenomenon called Internet addiction. There is a need for a reliable, valid, and simple-to-use scale to measure Internet addiction in the Malaysian population for clinical practice and research purposes. The aim of this study was to validate the Malay version of the Internet Addiction Test, using a sample of 162 medical students. The instrument displayed good internal consistency (Cronbach's α = .91), parallel reliability (intraclass coefficient = .88, P students with and without Internet dependence. Principal component analysis with varimax rotation identified a 5-factor model. The Malay version of the Internet Addiction Test appeared to be a valid instrument for assessing Internet addiction in Malaysian university students. © 2012 APJPH.

Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative

Science.gov (United States)

2007-06-01

AD_________________ Award Number: W81XWH-06-2-0045 TITLE: Mass Medication Clinic (MMC) Patient ...SUBTITLE 5a. CONTRACT NUMBER Mass Medication Clinic (MMC) Patient Medical Assistant (PMA) System Training Initiative 5b. GRANT NUMBER W81XWH-06-2...sections will describe the events, results, and accomplishments of this study. With validation through this project the Patient Medical Assistant

Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain

Science.gov (United States)

Hayes, Corey J.; Bhandari, Naleen Raj; Kathe, Niranjan; Payakachat, Nalin

2017-01-01

Limited evidence exists on how non-cancer pain (NCP) affects an individual’s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p reliable and valid measure of HRQoL for patients with NCP. PMID:28445438

Validation of the MedUseQ: A Self-Administered Screener for Older Adults to Assess Medication Use Problems.

Science.gov (United States)

Berman, Rebecca L; Iris, Madelyn; Conrad, Kendon J; Robinson, Carrie

2018-01-01

Older adults taking multiple prescription and nonprescription drugs are at risk for medication use problems, yet there are few brief, self-administered screening tools designed specifically for them. The study objective was to develop and validate a patient-centered screener for community-dwelling older adults. In phase 1, a convenience sample of 57 stakeholders (older adults, pharmacists, nurses, and physicians) participated in concept mapping, using Concept System® Global MAX TM , to identify items for a questionnaire. In phase 2, a 40-item questionnaire was tested with a convenience sample of 377 adults and a 24-item version was tested with 306 older adults, aged 55 and older, using Rasch methodology. In phase 3, stakeholder focus groups provided feedback on the format of questionnaire materials and recommended strategies for addressing problems. The concept map contained 72 statements organized into 6 conceptual clusters or domains. The 24-item screener was unidimensional. Cronbach's alpha was .87, person reliability was acceptable (.74), and item reliability was high (.96). The MedUseQ is a validated, patient-centered tool targeting older adults that can be used to assess a wide range of medication use problems in clinical and community settings and to identify areas for education, intervention, or further assessment.

Medical application and clinical validation for reliable and trustworthy physiological monitoring using functional textiles: experience from the HeartCycle and MyHeart project.

Science.gov (United States)

Reiter, Harald; Muehlsteff, Jens; Sipilä, Auli

2011-01-01

Functional textiles are seen as promising technology to enable healthcare services and medical care outside hospitals due to their ability to integrate textile-based sensing and monitoring technologies into the daily life. In the past much effort has been spent onto basic functional textile research already showing that reliable monitoring solutions can be realized. The challenge remains to find and develop suited medical application and to fulfil the boundary conditions for medical endorsement and exploitation. The HeartCycle vest described in this abstract will serve as an example for a functional textile carefully developed according to the requirements of a specific medical application, its clinical validation, the related certification aspects and the next improvement steps towards exploitation.

Experimental validation of neutron activation simulation of a varian medical linear accelerator.

Science.gov (United States)

Morato, S; Juste, B; Miro, R; Verdu, G; Diez, S

2016-08-01

This work presents a Monte Carlo simulation using the last version of MCNP, v. 6.1.1, of a Varian CLinAc emitting a 15MeV photon beam. The main objective of the work is to estimate the photoneutron production and activated products inside the medical linear accelerator head. To that, the Varian LinAc head was modelled in detail using the manufacturer information, and the model was generated with a CAD software and exported as a mesh to be included in the particle transport simulation. The model includes the transport of photoneutrons generated by primary photons and the (n, γ) reactions which can result in activation products. The validation of this study was done using experimental measures. Activation products have been identified by in situ gamma spectroscopy placed at the jaws exit of the LinAc shortly after termination of a high energy photon beam irradiation. Comparison between experimental and simulation results shows good agreement.

Medical device development.

Science.gov (United States)

Panescu, Dorin

2009-01-01

The development of a successful medical product requires not only engineering design efforts, but also clinical, regulatory, marketing and business expertise. This paper reviews items related to the process of designing medical devices. It discusses the steps required to take a medical product idea from concept, through development, verification and validation, regulatory approvals and market release.

SPECIFICITY OF MANIFACTURING PROCESS VALIDATION FOR DIAGNOSTIC SEROLOGICAL DEVICES

Directory of Open Access Journals (Sweden)

O. Yu. Galkin

2018-02-01

Full Text Available The aim of this research was to analyze recent scientific literature, as well as national and international legislature on manifacturing process validation of biopharmaceutical production, in particular devices for serological diagnostics. Technology validation in the field of medical devices for serological diagnostics is most influenced by the Technical Regulation for Medical Devices for in vitro Diagnostics State Standards of Ukraine – SSU EN ISO 13485:2015 “Medical devices. Quality management system. Requirements for regulation”, SSU EN ISO 14971:2015 “Medical devices. Instructions for risk management”, Instruction ST-N of the Ministry of Healthcare of Ukraine 42-4.0:2014 “Medications. Suitable industrial practice”, State Pharmacopoeia of Ukraine and Instruction ICH Q9 on risk management. Current recommendations for validations of drugs manufacturing process, including biotechnological manufacturing, can not be directly applied to medical devices for in vitro diagnostics. It was shown that the specifics of application and raw materials require individual validation parameters and process validations for serological diagnostics devices. Critical parameters to consider in validation plans were provided for every typical stage of production of in vitro diagnostics devices on the example of immunoassay kits, such as obtaining protein antigens, including recombinant ones, preparations of mono- and polyclonal antibodies, immunoenzyme conjugates and immunosorbents, chemical reagents etc. The bottlenecks of technologies for in vitro diagnostics devices were analyzed from the bioethical and biosafety points of view.

Andragogy and medical education: are medical students internally motivated to learn?

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Misch, Donald A

2002-01-01

Andragogy - the study of adult education - has been endorsed by many medical educators throughout North America. There remains, however, considerable controversy as to the validity and utility of adult education principles as espoused by the field's founder, Malcolm Knowles. Whatever the utility of andragogic doctrine in general education settings, there is reason to doubt its wholesale applicability to the training of medical professionals. Malcolm Knowles' last tenet of andragogy holds that adult learners are more motivated by internal than by external factors. The validity of this hypothesis in medical education is examined, and it is demonstrated that medical students' internal and external motivation are context-dependent, not easily distinguishable, and interrelate with one another in complex ways. Furthermore, the psychological motivation for medical student learning is determined by a variety of factors that range from internal to external, unconscious to conscious, and individual to societal. The andragogic hypothesis of increased internal motivation to learn on the part of adults in general, and medical trainees in particular, is rejected as simplistic, misleading, and counterproductive to developing a greater understanding of the forces that drive medical students to learn.

Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians.

Science.gov (United States)

Shibuya, Akiko; Misawa, Jimpei; Maeda, Yukihiro; Ichikawa, Rie; Kamata, Michiyo; Inoue, Ryusuke; Morimoto, Tetsuji; Nakayama, Masaharu; Hishiki, Teruyoshi; Kondo, Yoshiaki

2017-12-01

Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information. This study aimed to understand physicians' needs regarding time-oriented patient information in EMRs in clinical practice. The reliability and validity of the items in the questionnaire were evaluated in 87 physicians at a national university hospital. Internal consistency was satisfactory (Cronbach alpha coefficient, 0.87). Four dimensions were identified in exploratory factor analysis. Correlations between the 4 dimensions supported the construct validity of the items. Scores of time-oriented patients' medical history in the 4 dimensions showed a significant association with physician age. Based on confirmatory factor analysis, associations were significant and positive (P information in EMRs, both time-oriented treatment results followed by time-oriented team information had significant positive associations. Our study suggests that 4 specific time-oriented patient information factors in EMRs are needed by physicians. Exploring physicians' needs regarding patient-specific time-oriented information may provide a better understanding of the barriers facing the adoption and use of EMRs (eg, decision-making and practice safety concerns) and lead to better acceptance of EMRs in physicians' clinical practices. © 2017 John Wiley & Sons, Ltd.

Intelligent Medical Systems for Aerospace Emergency Medical Services

Science.gov (United States)

Epler, John; Zimmer, Gary

2004-01-01

The purpose of this project is to develop a portable, hands free device for emergency medical decision support to be used in remote or confined settings by non-physician providers. Phase I of the project will entail the development of a voice-activated device that will utilize an intelligent algorithm to provide guidance in establishing an airway in an emergency situation. The interactive, hands free software will process requests for assistance based on verbal prompts and algorithmic decision-making. The device will allow the CMO to attend to the patient while receiving verbal instruction. The software will also feature graphic representations where it is felt helpful in aiding in procedures. We will also develop a training program to orient users to the algorithmic approach, the use of the hardware and specific procedural considerations. We will validate the efficacy of this mode of technology application by testing in the Johns Hopkins Department of Emergency Medicine. Phase I of the project will focus on the validation of the proposed algorithm, testing and validation of the decision making tool and modifications of medical equipment. In Phase 11, we will produce the first generation software for hands-free, interactive medical decision making for use in acute care environments.

Sterilization of health care products - Radiation. Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

International Nuclear Information System (INIS)

2006-01-01

A sterile medical device is one that is free of viable microorganisms. International Standards, which specify requirements for validation and routine control of sterilization processes, require, when it is necessary to supply a sterile medical device, that adventitious microbiological contamination of a medical device prior to sterilization be minimized. Even so, medical devices produced under standard manufacturing conditions in accordance with the requirements for quality management systems (see, for example, ISO 13485) may, prior to sterilization, have microorganisms on them, albeit in low numbers. Such medical devices are non-sterile. The purpose of sterilization is to inactivate the microbiological contaminants and thereby transform the nonsterile medical devices into sterile ones. The kinetics of inactivation of a pure culture of microorganisms by physical and/or chemical agents used to sterilize medical devices can generally best be described by an exponential relationship between the numbers of microorganisms surviving and the extent of treatment with the sterilizing agent; inevitably this means that there is always a finite probability that a microorganism may survive regardless of the extent of treatment applied. For a given treatment, the probability of survival is determined by the number and resistance of microorganisms and by the environment in which the organisms exist during treatment. It follows that the sterility of any one medical device in a population subjected to sterilization processing cannot be guaranteed and the sterility of a processed population is defined in terms of the probability of there being a viable microorganism present on a medical device. This part of ISO 11137 describes requirements that, if met, will provide a radiation sterilization process intended to sterilize medical devices, that has appropriate microbicidal activity. Furthermore, compliance with the requirements ensures that this activity is both reliable and

Reliability and Validity of Objective Structured Clinical Examination for Residents of Obstetrics and Gynecology at Kermanshah University of Medical Sciences

Directory of Open Access Journals (Sweden)

Nasrin Jalilian

2012-11-01

Full Text Available Introduction: Objective structured clinical examination (OSCE is used for the evaluation of the clinical competence in medicine for which it is essential to measure validity and reliability. This study aimed to investigate the validity and reliability of OSCE for residents of obstetrics and gynecology at Kermanshah University of Medical Sciences in 2011.Methods: A descriptive-correlation study was designed and the data of OSCE for obstetrics and gynecology were collected via learning behavior checklists in method stations and multiple choice questions in question stations. The data were analyzed through Pearson correlation coefficient and Cronbach's alpha, using SPSS software (version 16. To determine the criterion validity, correlation of OSCE scores with scores of resident promotion test, direct observation of procedural skills, and theoretical knowledge was determined; for reliability, however, Cronbach's alpha was used. Total sample consisted of 25 participants taking part in 14 stations. P value of less than 0.05 was considered as significant.Results: The mean OSCE scores was 22.66 (±6.85. Criterion validity of the stations with resident promotion theoretical test, first theoretical knowledge test, second theoretical knowledge, and direct observation of procedural skills (DOPS was 0.97, 0.74, 0.49, and 0.79, respectively. In question stations, criterion validity was 0.15, and total validity of OSCE was 0.77.Conclusion: Findings of the present study indicated acceptable validity and reliability of OSCE for residents of obstetrics and gynecology.

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context.

Science.gov (United States)

Torres, Heloísa de Carvalho; Chaves, Fernanda Figueredo; Silva, Daniel Dutra Romualdo da; Bosco, Adriana Aparecida; Gabriel, Beatriz Diniz; Reis, Ilka Afonso; Rodrigues, Júlia Santos Nunes; Pagano, Adriana Silvina

2016-08-08

to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis. the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola. traduzir, adaptar e validar o conteúdo do Diabetes Medical Management Plan para o contexto brasileiro, protocolo elaborado pela Associação Americana de Diabetes, que orienta a conduta dos educadores para o cuidado das crianças e adolescentes com diabetes mellitus nas escolas. trata-se de estudo metodológico, realizado em quatro etapas: tradução inicial, síntese da tradução inicial, retrotradução e validação de conteúdo por um Comitê de Juízes, composto por 94 especialistas (29 linguistas aplicados e 65 profissionais da área da Saúde), para avaliação da versão traduzida por meio de um questionário online. O nível de concordância dos juízes foi

Qualitative Validation of the IMM Model for ISS and STS Programs

Science.gov (United States)

Kerstman, E.; Walton, M.; Reyes, D.; Boley, L.; Saile, L.; Young, M.; Arellano, J.; Garcia, Y.; Myers, J. G.

2016-01-01

To validate and further improve the Integrated Medical Model (IMM), medical event data were obtained from 32 ISS and 122 STS person-missions. Using the crew characteristics from these observed missions, IMM v4.0 was used to forecast medical events and medical resource utilization. The IMM medical condition incidence values were compared to the actual observed medical event incidence values, and the IMM forecasted medical resource utilization was compared to actual observed medical resource utilization. Qualitative comparisons of these parameters were conducted for both the ISS and STS programs. The results of these analyses will provide validation of IMM v4.0 and reveal areas of the model requiring adjustments to improve the overall accuracy of IMM outputs. This validation effort should result in enhanced credibility of the IMM and improved confidence in the use of IMM as a decision support tool for human space flight.

Readmissions of medical patients

DEFF Research Database (Denmark)

Cooksley, T.; Nanayakkara, P. W. B.; Nickel, C. H.

2016-01-01

of readmission but have not been validated in international populations. AIM: To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN: An unplanned secondary cohort study. METHODS: Patients admitted to the medical admission unit at the Hospital of South West Jutland (10...... power of both scores decreased with increasing age. CONCLUSION: Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health...

Validation of core medical knowledge by postgraduates and specialists.

NARCIS (Netherlands)

Koens, F.; Rademakers, J.J.; Cate, O.T.J. ten

2005-01-01

BACKGROUND: Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress

What are validated self-report adherence scales really measuring?: a systematic review.

Science.gov (United States)

Nguyen, Thi-My-Uyen; La Caze, Adam; Cottrell, Neil

2014-03-01

Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated. Cinahl and PubMed databases were used to search articles written in English on the development or validation of medication adherence scales dating to August 2012. The search terms used were medication adherence, medication non-adherence, medication compliance and names of each scale. Data such as barriers identified and validation comparison measures were extracted and compared. Sixty articles were included in the review, which consisted of 43 adherence scales. Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence. The validation strategies employed depended on whether the focus of the scale was to measure medication-taking behaviour or identify barriers or beliefs. Supporting patients to be adherent requires information on their medication-taking behaviour, barriers to adherence and beliefs about medicines. Adherence scales have the potential to explore these aspects of adherence, but currently there has been a greater focus on measuring medication-taking behaviour. Selecting the 'right' adherence scale(s) requires consideration of what needs to be measured and how (and in whom) the scale has been validated. © 2013 The British Pharmacological Society.

Gender and Dishonesty.

Science.gov (United States)

Ward, David A.; Beck, Wendy L.

1990-01-01

Examines the sex-role socialization theory showing women less likely to cheat. Presents findings of a 1984 study, involving 165 college students, that examined the relationship between excuse making and actual cheating. Reports women were significantly more likely to make excuses before cheating. Suggests excuse making deflects restraining…

Self-Handicapping and Interpersonal Trade-Offs: The Effects of Claimed Self-Handicaps on Observers' Performance Evaluations and Feedback.

Science.gov (United States)

Rhodewalt, Frederick; And Others

1995-01-01

Male subjects (n=130) evaluated performance of targets who, prior to and during the performance, offered no excuse, claimed intended low effort, claimed anxiety, or claimed drug impairment. Subjects evaluated objectively equivalent performances more negatively if they came from an excuse-making target than a no-excuse target. (JBJ)

Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools.

Science.gov (United States)

Park, Yoon Soo; Hyderi, Abbas; Heine, Nancy; May, Win; Nevins, Andrew; Lee, Ming; Bordage, Georges; Yudkowsky, Rachel

2017-11-01

To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlations), and consequences (composite score). Student performance varied by case and task. In the PNs, justification of differential diagnosis was the most discriminating task. G-studies showed that schools accounted for less than 1% of total variance; however, for the PNs, there were differences in scores for varying cases and tasks across schools, indicating a school effect. Composite score reliability was maximized when the PN was weighted between 30% and 40%. Raters preferred using case-specific scoring guidelines with clear point-scoring systems. This multisite study presents validity evidence for PN scores based on scoring rubric and case-specific scoring guidelines that offer rigor and feedback for learners. Variability in PN scores across participating sites may signal different approaches to teaching clinical reasoning among medical schools.

Validation of an Improved Computer-Assisted Technique for Mining Free-Text Electronic Medical Records.

Science.gov (United States)

Duz, Marco; Marshall, John F; Parkin, Tim

2017-06-29

The use of electronic medical records (EMRs) offers opportunity for clinical epidemiological research. With large EMR databases, automated analysis processes are necessary but require thorough validation before they can be routinely used. The aim of this study was to validate a computer-assisted technique using commercially available content analysis software (SimStat-WordStat v.6 (SS/WS), Provalis Research) for mining free-text EMRs. The dataset used for the validation process included life-long EMRs from 335 patients (17,563 rows of data), selected at random from a larger dataset (141,543 patients, ~2.6 million rows of data) and obtained from 10 equine veterinary practices in the United Kingdom. The ability of the computer-assisted technique to detect rows of data (cases) of colic, renal failure, right dorsal colitis, and non-steroidal anti-inflammatory drug (NSAID) use in the population was compared with manual classification. The first step of the computer-assisted analysis process was the definition of inclusion dictionaries to identify cases, including terms identifying a condition of interest. Words in inclusion dictionaries were selected from the list of all words in the dataset obtained in SS/WS. The second step consisted of defining an exclusion dictionary, including combinations of words to remove cases erroneously classified by the inclusion dictionary alone. The third step was the definition of a reinclusion dictionary to reinclude cases that had been erroneously classified by the exclusion dictionary. Finally, cases obtained by the exclusion dictionary were removed from cases obtained by the inclusion dictionary, and cases from the reinclusion dictionary were subsequently reincluded using Rv3.0.2 (R Foundation for Statistical Computing, Vienna, Austria). Manual analysis was performed as a separate process by a single experienced clinician reading through the dataset once and classifying each row of data based on the interpretation of the free

Evaluating the validity of an integrity-based situational judgement test for medical school admissions.

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Husbands, Adrian; Rodgerson, Mark J; Dowell, Jon; Patterson, Fiona

2015-09-02

While the construct of integrity has emerged as a front-runner amongst the desirable attributes to select for in medical school admissions, it is less clear how best to assess this characteristic. A potential solution lies in the use of Situational Judgement Tests (SJTs) which have gained popularity due to robust psychometric evidence and potential for large-scale administration. This study aims to explore the psychometric properties of an SJT designed to measure the construct of integrity. Ten SJT scenarios, each with five response stems were developed from critical incident interviews with academic and clinical staff. 200 of 520 (38.5 %) Multiple Mini Interview candidates at Dundee Medical School participated in the study during the 2012-2013 admissions cycle. Participants were asked to rate the appropriateness of each SJT response on a 4-point likert scale as well as complete the HEXACO personality inventory and a face validity questionnaire. Pearson's correlations and descriptive statistics were used to examine the associations between SJT score, HEXACO personality traits, pre-admissions measures namely academic and United Kingdom Clinical Aptitude Test (UKCAT) scores, as well as acceptability. Cronbach's alpha reliability for the SJT was .64. Statistically significant correlations ranging from .16 to .36 (.22 to .53 disattenuated) were observed between SJT score and the honesty-humility (integrity), conscientiousness, extraversion and agreeableness dimensions of the HEXACO inventory. A significant correlation of .32 (.47 disattenuated) was observed between SJT and MMI scores and no significant relationship with the UKCAT. Participant reactions to the SJTs were generally positive. Initial findings are encouraging regarding the psychometric robustness of an integrity-based SJT for medical student selection, with significant associations found between the SJTs, integrity, other desirable personality traits and the MMI. The SJTs showed little or no redundancy with

Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity.

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Dumas, Helene M; Fragala-Pinkham, Maria A; Rosen, Elaine L; O'Brien, Jane E

2017-11-01

To assess construct (convergent and divergent) validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in a sample of children with complex medical conditions. Demographics, clinical information, PEDI-CAT normative score, and the Post-Acute Acuity Rating for Children (PAARC) level were collected for all post-acute hospital admissions (n = 110) from 1 April 2015 to 1 March 2016. Correlations between the PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domain scores for the total sample and across three age groups (infant, preschool, and school-age) were calculated. Differences in mean PEDI-CAT scores for each domain across two groups, children with "Less Complexity," or "More Complexity" based on PAARC level were examined. All correlations for the total sample and age subgroups were statistically significant and trends across age groups were evident with the stronger associations between domains for the infant group. Significant differences were found between mean PEDI-CAT Daily Activities, Mobility, and Social/Cognitive normative scores across the two complexity groups with children in the "Less Complex" group having higher PEDI-CAT scores for all domains. This study provides evidence indicating the PEDI-CAT can be used with confidence in capturing and differentiating children's level of function in a post-acute care setting. Implications for Rehabilitation The PEDI-CAT is measure of function for children with a variety of conditions and can be used in any clinical setting. Convergent validity of the PEDI-CAT's Daily Activities, Mobility, and Social/Cognitive domains was significant and particularly strong for infants and young children with medical complexity. The PEDI-CAT was able to discriminate groups of children with differing levels of medical complexity admitted to a pediatric post-acute care hospital.

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Science.gov (United States)

2013-01-01

Background Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs

Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools.

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Pololi, Linda H; Evans, Arthur T; Nickell, Leslie; Reboli, Annette C; Coplit, Lisa D; Stuber, Margaret L; Vasiliou, Vasilia; Civian, Janet T; Brennan, Robert T

2017-06-01

A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements. From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions. Six hundred and eighty-six students completed the survey (49 % women; 9 % underrepresented minorities), with a response rate of 89 % (range over the student cohorts 72-100 %). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model. The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.

Manual versus automated coding of free-text self-reported medication data in the 45 and Up Study: a validation study.

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Gnjidic, Danijela; Pearson, Sallie-Anne; Hilmer, Sarah N; Basilakis, Jim; Schaffer, Andrea L; Blyth, Fiona M; Banks, Emily

2015-03-30

Increasingly, automated methods are being used to code free-text medication data, but evidence on the validity of these methods is limited. To examine the accuracy of automated coding of previously keyed in free-text medication data compared with manual coding of original handwritten free-text responses (the 'gold standard'). A random sample of 500 participants (475 with and 25 without medication data in the free-text box) enrolled in the 45 and Up Study was selected. Manual coding involved medication experts keying in free-text responses and coding using Anatomical Therapeutic Chemical (ATC) codes (i.e. chemical substance 7-digit level; chemical subgroup 5-digit; pharmacological subgroup 4-digit; therapeutic subgroup 3-digit). Using keyed-in free-text responses entered by non-experts, the automated approach coded entries using the Australian Medicines Terminology database and assigned corresponding ATC codes. Based on manual coding, 1377 free-text entries were recorded and, of these, 1282 medications were coded to ATCs manually. The sensitivity of automated coding compared with manual coding was 79% (n = 1014) for entries coded at the exact ATC level, and 81.6% (n = 1046), 83.0% (n = 1064) and 83.8% (n = 1074) at the 5, 4 and 3-digit ATC levels, respectively. The sensitivity of automated coding for blank responses was 100% compared with manual coding. Sensitivity of automated coding was highest for prescription medications and lowest for vitamins and supplements, compared with the manual approach. Positive predictive values for automated coding were above 95% for 34 of the 38 individual prescription medications examined. Automated coding for free-text prescription medication data shows very high to excellent sensitivity and positive predictive values, indicating that automated methods can potentially be useful for large-scale, medication-related research.

Communication behaviours of skilled and less skilled oncologists: a validation study of the Medical Interaction Process System (MIPS).

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Ford, Sarah; Hall, Angela

2004-09-01

The Medical Interaction Process System (MIPS) was originally developed in order to create a reliable observation tool for analysing doctor-patient encounters in the oncology setting. This paper reports a series of analyses carried out to establish whether the behaviour categories of the MIPS can discriminate between skilled and less skilled communicators. This involved the use of MIPS coded cancer consultations to compare the MIPS indices of 10 clinicians evaluated by an independent professional as skilled communicators with 10 who were considered less skilled. Eleven out of the 15 MIPS variables tested were able to distinguish the skilled from the less skilled group. Although limitations to the study are discussed, the results indicate that the MIPS has satisfactory discriminatory power and the results provide validity data that meet key objectives for developing the system. There is an ever-increasing need for reliable methods of assessing doctors' communication skills and evaluating medical interview teaching programmes. Copyright 2004 Elsevier Ireland Ltd.

NF EN ISO 11137-1, July 2006. Sterilization of health care products - Irradiation - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

International Nuclear Information System (INIS)

2006-01-01

This part of the ISO 11137 standard specifies requirements for the development, validation and routine control of a radiation sterilization process for medical devices. Although the scope of this part of the ISO 11137 standard is limited to medical devices, it specifies requirements and provides guidance that may be applicable to other products and equipment. This part of the international standard covers radiation processes employing irradiators using the radionuclide 60 Co or 137 Cs, a beam from an electron generator or a beam from an X-ray generator. This part of the international standard does not: - specify requirements for development, validation and routine control of a process for inactivating the causative agents of spongiform encephalopathies such as scrapie, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease; - detail specified requirements for designating a medical device as sterile; - specify a quality management system for the control of all stages of production of medical devices; - specify requirements for occupational safety associated with the design and operation of irradiation facilities; - specify requirements for the sterilization of used or reprocessed devices

Development and validation of an LC-MS/MS method for the quantification of tiamulin, trimethoprim, tylosin, sulfadiazine and sulfamethazine in medicated feed.

Science.gov (United States)

Patyra, Ewelina; Nebot, Carolina; Gavilán, Rosa Elvira; Cepeda, Alberto; Kwiatek, Krzysztof

2018-01-22

A new multi-compound method for the analysis of veterinary drugs, namely tiamulin, trimethoprim, tylosin, sulfadiazine and sulfamethazine was developed and validated in medicated feeds. After extraction, the samples were centrifuged, diluted in Milli-Q water, filtered and analysed by high performance liquid chromatography coupled to tandem mass spectrometry. The separation of the analytes was performed on a biphenyl column with a gradient of 0.1% formic acid in acetonitrile and 0.1% formic acid in Milli-Q water. Quantitative validation was done in accordance with the guidelines laid down in European Commission Decision 2002/657/EC. Method performances were evaluated by the following parameters: linearity (R 2  tiamulin, tylosin and sulfamethazine were detected at the concentration levels declared by the manufacturers. The developed method can therefore be successfully used to routinely control the content and homogeneity of these antibacterial substances in medicated feed. Abbreviations AAFCO - Association of American Feed Control Officials; TYL - tylosin; TIAM - tiamulin fumarate; TRIM - trimethoprim; SDZ - sulfadiazine; SMZ - sulfamethazine; UV - ultraviolet detector; FLD - fluorescence detector; HPLC - high performance liquid chromatography; MS/MS - tandem mass spectrometry; LOD - limit of detection; LOQ - limit of quantification; CV - coefficient of variation; SD - standard deviation; U - uncertainty.

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making].

Science.gov (United States)

Moraleda Barba, Sandra; Ballesta Rodríguez, M Isabel; Delgado Quero, Antonio Luis; Lietor Villajos, Norberto; Moreno Corredor, Andrés; Delgado Rodríguez, Miguel

2015-03-01

To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. Observational study of prospective validation. Primary and hospital care of the basic health area of Jaen. One hundred twenty-nine patients. Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

A Medical Research and Evaluation Facility (MREF) and Studies Supporting the Medical Chemical Defense Program: Task 95-39: Methods Development and Validation of Two Mouse Bioassays for Use in Quantifying Botulinum Toxins (A, B, C, D and E) and Toxin Antibody Titers

National Research Council Canada - National Science Library

Olson, Carl

1997-01-01

Ths task was conducted for the U.S. Army Medical Materiel Development Activity (USAMMDA) to validate two mouse bioassays for quantify botulinum toxin potency and neutralizing antibodies to botulimun toxins...

Evaluation and feedback for effective clinical teaching in postgraduate medical education: validation of an assessment instrument incorporating the CanMEDS roles.

Science.gov (United States)

Fluit, Cornelia; Bolhuis, Sanneke; Grol, Richard; Ham, Marieke; Feskens, Remco; Laan, Roland; Wensing, Michel

2012-01-01

Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles. In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals. CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted. The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable.

Profiling medical school learning environments in Malaysia: a validation study of the Johns Hopkins Learning Environment Scale

Directory of Open Access Journals (Sweden)

Sean Tackett

2015-07-01

Full Text Available Purpose: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning Environment Scale (JHLES for preclinical students at three Malaysian medical schools with distinct educational and institutional models. Two schools were new international partnerships, and the third was school leaver program established without international partnership. Methods: First- and second-year students responded anonymously to surveys at the end of the academic year. The surveys included the JHLES, a 28-item survey using five-point Likert scale response options, the Dundee Ready Educational Environment Measure (DREEM, the most widely used method to assess learning environments internationally, a personal growth scale, and single-item global learning environment assessment variables. Results: The overall response rate was 369/429 (86%. After adjusting for the medical school year, gender, and ethnicity of the respondents, the JHLES detected differences across institutions in four out of seven domains (57%, with each school having a unique domain profile. The DREEM detected differences in one out of five categories (20%. The JHLES was more strongly correlated than the DREEM to two thirds of the single-item variables and the personal growth scale. The JHLES showed high internal reliability for the total score (α=0.92 and the seven domains (α, 0.56-0.85. Conclusion: The JHLES detected variation between learning environment domains across three educational settings, thereby creating unique learning environment profiles. Interpretation of these profiles may allow schools to understand how they are currently supporting trainees and identify areas needing attention.

Validation of cardiovascular diagnoses in the Greenlandic Hospital Discharge Register for epidemiological use

DEFF Research Database (Denmark)

Tvermosegaard, Maria; Ronn, Pernille Falberg; Pedersen, Michael Lynge

2018-01-01

not previously been validated specifically. The objective of the study was to validate diagnoses of CVD in GHDR. The study was conducted as a validation study with primary investigator comparing information in GHDR with information in medical records. Diagnoses in GHDR were considered correct and thus valid......Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In Greenland, valid estimates of prevalence and incidence of CVD do not exist and can only be calculated if diagnoses of CVD in the Greenlandic Hospital Discharge Register (GHDR) are correct. Diagnoses of CVD in GHDR have...... if they matched the diagnoses or the medical information in the medical records. A total of 432 online accessible medical records with a cardiovascular diagnosis according to GHDR from Queen Ingrid's Hospital from 2001 to 2013 (n=291) and from local health care centres from 2007 to 2013 (n=141) were reviewed...

Excuses, Excuses: Self-Handicapping in an Australian Adolescent Sample.

Science.gov (United States)

Warner, Suzanne; Moore, Susan

2004-01-01

The purpose of the present study was to examine gender differences in the self-handicapping tendencies of a sample of 337 Australian school attending adolescents, who were aged between 15 and 19 years. Self-handicapping, as measured by the shortened Self-Handicapping Scale, was examined in relation to self-esteem, performance attributions, coping…

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review.

Science.gov (United States)

Patterson, P Daniel; Weaver, Matthew D; Fabio, Anthony; Teasley, Ellen M; Renn, Megan L; Curtis, Brett R; Matthews, Margaret E; Kroemer, Andrew J; Xun, Xiaoshuang; Bizhanova, Zhadyra; Weiss, Patricia M; Sequeira, Denisse J; Coppler, Patrick J; Lang, Eddy S; Higgins, J Stephen

2018-02-15

This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. A systematic review study design was used and searched six databases, including one website. The research question guiding the search was developed a priori and registered with the PROSPERO database of systematic reviews: "Are there reliable and valid instruments for measuring fatigue among EMS personnel?" (2016:CRD42016040097). The primary outcome of interest was criterion-related validity. Important outcomes of interest included reliability (e.g., internal consistency), and indicators of sensitivity and specificity. Members of the research team independently screened records from the databases. Full-text articles were evaluated by adapting the Bolster and Rourke system for categorizing findings of systematic reviews, and the rated data abstracted from the body of literature as favorable, unfavorable, mixed/inconclusive, or no impact. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the quality of evidence. The search strategy yielded 1,257 unique records. Thirty-four unique experimental and non-experimental studies were determined relevant following full-text review. Nineteen studies reported on the reliability and/or validity of ten different fatigue survey instruments. Eighteen different studies evaluated the reliability and/or validity of four different sleepiness survey instruments. None of the retained studies reported sensitivity or specificity. Evidence quality was rated as very low across all outcomes. In this systematic review, limited evidence of the reliability and validity of 14 different survey instruments to assess the fatigue and/or sleepiness status of EMS personnel and related shift worker groups was identified.

Medical Statistics – Mathematics or Oracle? Farewell Lecture

Directory of Open Access Journals (Sweden)

Gaus, Wilhelm

2005-06-01

Full Text Available Certainty is rare in medicine. This is a direct consequence of the individuality of each and every human being and the reason why we need medical statistics. However, statistics have their pitfalls, too. Fig. 1 shows that the suicide rate peaks in youth, while in Fig. 2 the rate is highest in midlife and Fig. 3 in old age. Which of these contradictory messages is right? After an introduction to the principles of statistical testing, this lecture examines the probability with which statistical test results are correct. For this purpose the level of significance and the power of the test are compared with the sensitivity and specificity of a diagnostic procedure. The probability of obtaining correct statistical test results is the same as that for the positive and negative correctness of a diagnostic procedure and therefore depends on prevalence. The focus then shifts to the problem of multiple statistical testing. The lecture demonstrates that for each data set of reasonable size at least one test result proves to be significant - even if the data set is produced by a random number generator. It is extremely important that a hypothesis is generated independently from the data used for its testing. These considerations enable us to understand the gradation of "lame excuses, lies and statistics" and the difference between pure truth and the full truth. Finally, two historical oracles are cited.

[Validation of the Portuguese version of an instrument to measure the degree of patient knowledge about their medication].

Science.gov (United States)

Rubio, Joaquín Salmerón; García-Delgado, Pilar; Ferreira, Paula Iglésias; Santos, Henrique Mateus; Martínez-Martínez, Fernando

2014-04-01

The scope of this study was the validation of a cross-culturally adapted questionnaire into Portuguese in five community pharmacies in Portugal. The discriminatory power of items, content and construct validity and factor analysis of the main components and their reliability and stability were determined. A high degree of semantic equivalence between the original questionnaire and the cross-culturally adapted questionnaire into Portuguese was observed. A Kaiser-Meyer-Olkin index of 0.550 was obtained and the Bartlett sphericity test confirmed the adequacy of the data for the application of factor analysis (p <0.0001). Three factors which accounted for 52.6% of the total variability were considered. With respect to reliability the following results were obtained: 0.519 for Cronbach's alpha test; 0.89 for Cohen's kappa coefficient; and 0.756 (IC=0.598-0.963) for the CCI exam. In this work, the first adaptation for the Portuguese culture of a specific questionnaire was produced to measure the degree of knowledge patients have about their medication.

ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records.

Science.gov (United States)

Springate, David A; Kontopantelis, Evangelos; Ashcroft, Darren M; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

2014-01-01

Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects.

Awareness of academic use of smartphones and medical apps among medical students in a private medical college?

Science.gov (United States)

Shah, Jehanzaib; Haq, Usman; Bashir, Ali; Shah, Syed Aslam

2016-02-01

To assess the awareness of medical apps and academic use of smartphones among medical students. The questionnaire-based descriptive cross-sectional study was conducted in January 2015 and comprised medical students of the Rawal Institute of Health Sciences, Islamabad, Pakistan. The self-designed questionnaire was reviewed by a panel of expert for content reliability and validity. Questionnaires were distributed in the classrooms and were filled by the students anonymously. SPSS 16 was used for statistical analysis. Among the 569 medical students in the study, 545 (95.8%) had smartphones and 24(4.2%) were using simple cell phones. Overall, 226(41.46%) of the smart phone users were using some medical apps. Besides, 137(24.08%) were aware of the medical apps but were not using them. Also, 391(71.7%) students were not using any type of medical text eBooks through their phone, and only 154(28.3%) had relevant text eBooks in their phones. Medical college students were using smartphones mostly as a means of telecommunication rather than a gadget for improving medical knowledge.

Scientometric Analysis of Scientific Validity of Medical Archives Regarding Other Medical Journals in Bosnia and Herzegovina.

Science.gov (United States)

Masic, Izet; Begic, Edin; Zunic, Lejla

2016-02-01

Medical Archives is the oldest medical journal in Bosnia and Herzegovina (B&H) (founded in 1947.). A total of 104 articles were published in Medical Archives during 2015. Analyzing the type of articles, original articles are present in majority during 2015-80.7% (in last seven years, 561 (76%) were original out of 738). In last seven years, 651 (88.2%) articles were from the field of clinical medicine (preclinical disciplines, in the last three years are more represented than in previous years). Collaboration rate in 2015 was 0,92. Articles written in collaboration of five authors (21.1 %) are found to be predominant. From year to year, most often required time for a decision on acceptance or on the revision prior acceptance is between 50 and 60 days (30% of cases in 2015). During 2015, 47.1% of articles were originally from B&H (eleven countries were represented). H index of Medical Archive for 2014 was 12, and does not vary during the last decade. In 2015 in B&H about twenty-five journals are issued in the field of biomedical and life sciences in general (six are indexed on Medline/PubMed, one is indexed in the Science Citation Index Expanded (SCIE)/Web of Science base). According to GoogleScholar the biggest h5 index has Bosnian Journal of Basic Medical Sciences (BJBMS) and Medical Archives, while the biggest h5 median has BJBMS i Acta Informatica Medica. The highest H-index (13) in B&H has Izet Masic MD, PhD, Enver Zerem MD, PhD and Semir Vranic MD, PhD, while highest g-index (22) has Enver Zerem MD, PhD (analyzed by software package "Publish or Perish"). By comparing the state of medical publishing in B&H with neighboring countries (Croatia, Serbia, Montenegro), we have concluded that B&H is behind Croatia and Serbia by following parameters: Total Documents, Total Cites and H index but in front of Montenegro.

Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants.

Science.gov (United States)

Marsicano, Elisa de Oliveira; Fernandes, Neimar da Silva; Colugnati, Fernando; Grincenkov, Fabiane Rossi dos Santos; Fernandes, Natalia Maria da Silva; De Geest, Sabina; Sanders-Pinheiro, Helady

2013-05-21

Transplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients. The BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach's alpha) and validity (content, criterion, and construct validities). The final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach's alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65). The BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

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Ratanawongsa, Neda; Quan, Judy; Handley, Margaret A; Sarkar, Urmimala; Schillinger, Dean

2018-04-06

Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: "In the last 7 days, how many days did you MISS taking your …" diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Language-concordant ATSM demonstrated modest potential

Medical writing, revising and editing

DEFF Research Database (Denmark)

Pilegaard, Morten

2006-01-01

The globalization of science makes medical writing, editing and revision a rapidly growing field of linguistic study and practice. Medical science texts are written according to uniform, general guidelines and medical genres have become highly conventionalized in terms of structure and linguistic...... form. Medical editing often takes the form of peer review and mainly addresses issues of contents and overall validity. Medical revision incorporates the checking of the macrostructure and the microstructure of the text, its language and style and its suitability for the target reader or client...

Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm.

Science.gov (United States)

Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A; Tutino, Vincent M; Dou, Zhongwang; Siddiqui, Adnan H; Meng, Hui

2017-12-01

Computational fluid dynamics (CFD) is a promising tool to aid in clinical diagnoses of cardiovascular diseases. However, it uses assumptions that simplify the complexities of the real cardiovascular flow. Due to high-stakes in the clinical setting, it is critical to calculate the effect of these assumptions in the CFD simulation results. However, existing CFD validation approaches do not quantify error in the simulation results due to the CFD solver's modeling assumptions. Instead, they directly compare CFD simulation results against validation data. Thus, to quantify the accuracy of a CFD solver, we developed a validation methodology that calculates the CFD model error (arising from modeling assumptions). Our methodology identifies independent error sources in CFD and validation experiments, and calculates the model error by parsing out other sources of error inherent in simulation and experiments. To demonstrate the method, we simulated the flow field of a patient-specific intracranial aneurysm (IA) in the commercial CFD software star-ccm+. Particle image velocimetry (PIV) provided validation datasets for the flow field on two orthogonal planes. The average model error in the star-ccm+ solver was 5.63 ± 5.49% along the intersecting validation line of the orthogonal planes. Furthermore, we demonstrated that our validation method is superior to existing validation approaches by applying three representative existing validation techniques to our CFD and experimental dataset, and comparing the validation results. Our validation methodology offers a streamlined workflow to extract the "true" accuracy of a CFD solver.

Developing competencies for medical librarians in Pakistan.

Science.gov (United States)

Ullah, Midrar; Anwar, Mumtaz A

2013-03-01

To identify competencies for medical librarians and get these validated from head librarians and employers. The survey method was used. A structured questionnaire, listing 84 competency statements, covering eight areas, prepared after extensive literature review, expert scrutiny and pilot testing, using a 5-point Likert scale was distributed among the head librarians and chairpersons of library committees (CLC) in 115 medical libraries. Sixty seven (58%) useable responses were received from head librarians and 63 (55%) from CLC. Of the 84 competency statements 83 were validated by the head librarians, 44 receiving four or higher mean score while the other 39 statements getting mean scores in the range of 3.97 and 3.06. The CLC validated 80 statements. Only 27 statements received four or higher mean score from CLC while the other 53 got mean scores in the range of 3.97 and 3.22. Medical librarians are required to be well versed with all those competencies which are needed for general librarianship. In addition, they are expected to have adequate knowledge of health sciences environment including medical terminologies and concepts. Sound knowledge of some competencies specific for medical libraries is an additional requirement for library personnel. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Clinical validation of a medical grade color monitor for chest radiology

Science.gov (United States)

Jacobs, J.; Zanca, F.; Verschakelen, J.; Marchal, G.; Bosmans, H.

2009-02-01

Until recently, the specifications of medical grade monochrome LCD monitors outperformed those of color LCD monitors. New generations of color LCD monitors, however, show specifications that are in many respects similar to those of monochrome monitors typically used in diagnostic workstations. The aim of present study was to evaluate the impact of different medical grade monitors in terms of detection of simulated lung nodules in chest x-ray images. Specifically, we wanted to compare a new medical grade color monitor (Barco Coronis 6MP color) to a medical grade grayscale monitor (Barco Coronis 3MP monochrome) and a consumer color monitor (Philips 200VW 1.7MP color) by means of an observer performance experiment. Using the free-response acquisition data paradigm, seven radiologists were asked to detect and locate lung nodules (170 in total), simulated in half of the 200 chest X-ray images used in the experiment. The jackknife free-response receiver operating characteristic (JAFROC) analysis of the data showed a statistically significant difference between at least two monitors, F-value=3.77 and p-value =0.0481. The different Figure of Merit values were 0.727, 0.723 and 0.697 for the new color LCD monitor, the medical grade monitor and the consumer color monitor respectively. There was no difference between the needed reading times but there was a difference between the mean calculated Euclidian distances between the position marked by the observers and the center of the simulated nodule, indicating a better accuracy with both medical grade monitors. Present data suggests that the new generation of medical grade color monitors could be used as diagnostic workstations.

Developing a measure of medication-related quality of life for people with polypharmacy.

Science.gov (United States)

Tseng, Hsu-Min; Lee, Chia-Hui; Chen, Yin-Jen; Hsu, Hsiang-Hao; Huang, Li-Yueh; Huang, Jing-Long

2016-05-01

To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy. The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity. The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach's alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity. The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted.

Burnout Syndrome Among Medical Students at One University in Serbia: Validity and Reliability of the Maslach Burnout Inventory-Student Survey.

Science.gov (United States)

Ilic, Milena; Todorovic, Zeljko; Jovanovic, Milena; Ilic, Irena

2017-01-01

The Maslach Burnout Inventory-Student Survey (MBI-SS) contains 15 items that evaluate the following burnout dimensions: Emotional Exhaustion, Cynicism, and Academic Efficacy. The purpose of this study was to evaluate the dimensionality of the MBI-SS on a sample of Serbian medical students (N = 760). The overall Cronbach's α coefficient of the MBI-SS questionnaire was 0.757, while the Cronbach's α coefficients for Emotional Exhaustion, Cynicism, and Academic Efficacy were 0.869, 0.856, and 0.852, respectively. Principal Component Analysis with Oblimin rotation indicated 3 main components that explained 64.9% variance. The confirmatory factor analysis revealed good fit indices (χ 2 /df = 575.74/87, RMSEA = 0.086 (90% Confidence Interval for RMSEA = 0.079 to 0.092), CFI = 0.949, NNFI = 0.939, IFI = 0.949, GFI = 0.904) of the MBI-SS scale. The Serbian version of MBI-SS represents a valid and reliable instrument in the Serbian sample of medical students.

Studying Hospitalizations and Mortality in the Netherlands: Feasible and Valid Using Two-Step Medical Record Linkage with Nationwide Registers.

Directory of Open Access Journals (Sweden)

Elske Sieswerda

Full Text Available In the Netherlands, the postal code is needed to study hospitalizations of individuals in the nationwide hospitalization register. Studying hospitalizations longitudinally becomes troublesome if individuals change address. We aimed to report on the feasibility and validity of a two-step medical record linkage approach to examine longitudinal trends in hospitalizations and mortality in a study cohort. First, we linked a study cohort of 1564 survivors of childhood cancer with the Municipal Personal Records Database (GBA which has postal code history and mortality data available. Within GBA, we sampled a reference population matched on year of birth, gender and calendar year. Second, we extracted hospitalizations from the Hospital Discharge Register (LMR with a date of discharge during unique follow-up (based on date of birth, gender and postal code in GBA. We calculated the agreement of death and being hospitalized in survivors according to the registers and to available cohort data. We retrieved 1477 (94% survivors from GBA. Median percentages of unique/potential follow-up were 87% (survivors and 83% (reference persons. Characteristics of survivors and reference persons contributing to unique follow-up were comparable. Agreement of hospitalization during unique follow-up was 94% and agreement of death was 98%. In absence of unique identifiers in the Dutch hospitalization register, it is feasible and valid to study hospitalizations and mortality of individuals longitudinally using a two-step medical record linkage approach. Cohort studies in the Netherlands have the opportunity to study mortality and hospitalization rates over time. These outcomes provide insight into the burden of clinical events and healthcare use in studies on patients at risk of long-term morbidities.

Validation of the MARS (Medical Admission Risk System): A combined physiological and laboratory risk prediction tool for 5- to 7-day in-hospital mortality.

Science.gov (United States)

Ohman, Malin Charlotta; Atkins, Tara E Holm; Cooksley, Tim; Brabrand, Mikkel

2018-03-10

The MARS (Medical Admission Risk System) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5 and 7 day mortality. To perform an external independent validation of the MARS score. An unplanned secondary cohort study. Patients admitted to the medical admission unit (MAU) at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS score using 5 and 7 day mortality was the primary endpoint. 5858 patients were included in the study. 2923 (49.9%) patients were women with a median age of 65 years (15-107). The MARS score had an AUROC of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes. The MARS score had excellent discriminatory power but poor calibration in predicting both 5 and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.

A web-based team-oriented medical error communication assessment tool: development, preliminary reliability, validity, and user ratings.

Science.gov (United States)

Kim, Sara; Brock, Doug; Prouty, Carolyn D; Odegard, Peggy Soule; Shannon, Sarah E; Robins, Lynne; Boggs, Jim G; Clark, Fiona J; Gallagher, Thomas

2011-01-01

Multiple-choice exams are not well suited for assessing communication skills. Standardized patient assessments are costly and patient and peer assessments are often biased. Web-based assessment using video content offers the possibility of reliable, valid, and cost-efficient means for measuring complex communication skills, including interprofessional communication. We report development of the Web-based Team-Oriented Medical Error Communication Assessment Tool, which uses videotaped cases for assessing skills in error disclosure and team communication. Steps in development included (a) defining communication behaviors, (b) creating scenarios, (c) developing scripts, (d) filming video with professional actors, and (e) writing assessment questions targeting team communication during planning and error disclosure. Using valid data from 78 participants in the intervention group, coefficient alpha estimates of internal consistency were calculated based on the Likert-scale questions and ranged from α=.79 to α=.89 for each set of 7 Likert-type discussion/planning items and from α=.70 to α=.86 for each set of 8 Likert-type disclosure items. The preliminary test-retest Pearson correlation based on the scores of the intervention group was r=.59 for discussion/planning and r=.25 for error disclosure sections, respectively. Content validity was established through reliance on empirically driven published principles of effective disclosure as well as integration of expert views across all aspects of the development process. In addition, data from 122 medicine and surgical physicians and nurses showed high ratings for video quality (4.3 of 5.0), acting (4.3), and case content (4.5). Web assessment of communication skills appears promising. Physicians and nurses across specialties respond favorably to the tool.

Medical record validation of maternally reported history of preeclampsia

NARCIS (Netherlands)

M. Coolman (Marianne); C.J.M. de Groot (Christianne); V.W.V. Jaddoe (Vincent); A. Hofman (Albert); H. Raat (Hein); E.A.P. Steegers (Eric)

2010-01-01

textabstractObjective: In this study, we assessed the validity of maternally self-reported history of preeclampsia. Study Design and Setting: This study was embedded in the Generation R Study, a population-based prospective cohort study. Data were obtained from prenatal questionnaires and one

Medical messages in the media – barriers and solutions to improving medical journalism

Science.gov (United States)

Larsson, Anna; Oxman, Andrew D; Carling, Cheryl; Herrin, Jeph

2003-01-01

Abstract Context  Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health‐care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. Objective  To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. Design  We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi‐structured telephone interviews. Results  We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up‐to‐date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. Conclusion  Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health‐care professionals and journalists employing a variety of strategies will be needed to address

Computer science education for medical informaticians.

Science.gov (United States)

Logan, Judith R; Price, Susan L

2004-03-18

The core curriculum in the education of medical informaticians remains a topic of concern and discussion. This paper reports on a survey of medical informaticians with Master's level credentials that asked about computer science (CS) topics or skills that they need in their employment. All subjects were graduates or "near-graduates" of a single medical informatics Master's program that they entered with widely varying educational backgrounds. The survey instrument was validated for face and content validity prior to use. All survey items were rated as having some degree of importance in the work of these professionals, with retrieval and analysis of data from databases, database design and web technologies deemed most important. Least important were networking skills and object-oriented design and concepts. These results are consistent with other work done in the field and suggest that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are part of the core curriculum for medical informatics.

Medical Updates Number 5 to the International Space Station Probability Risk Assessment (PRA) Model Using the Integrated Medical Model

Science.gov (United States)

Butler, Doug; Bauman, David; Johnson-Throop, Kathy

2011-01-01

The Integrated Medical Model (IMM) Project has been developing a probabilistic risk assessment tool, the IMM, to help evaluate in-flight crew health needs and impacts to the mission due to medical events. This package is a follow-up to a data package provided in June 2009. The IMM currently represents 83 medical conditions and associated ISS resources required to mitigate medical events. IMM end state forecasts relevant to the ISS PRA model include evacuation (EVAC) and loss of crew life (LOCL). The current version of the IMM provides the basis for the operational version of IMM expected in the January 2011 timeframe. The objectives of this data package are: 1. To provide a preliminary understanding of medical risk data used to update the ISS PRA Model. The IMM has had limited validation and an initial characterization of maturity has been completed using NASA STD 7009 Standard for Models and Simulation. The IMM has been internally validated by IMM personnel but has not been validated by an independent body external to the IMM Project. 2. To support a continued dialogue between the ISS PRA and IMM teams. To ensure accurate data interpretation, and that IMM output format and content meets the needs of the ISS Risk Management Office and ISS PRA Model, periodic discussions are anticipated between the risk teams. 3. To help assess the differences between the current ISS PRA and IMM medical risk forecasts of EVAC and LOCL. Follow-on activities are anticipated based on the differences between the current ISS PRA medical risk data and the latest medical risk data produced by IMM.

Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2 in Adults with Non-Cancer Pain

Directory of Open Access Journals (Sweden)

Corey J. Hayes

2017-04-01

Full Text Available Limited evidence exists on how non-cancer pain (NCP affects an individual’s health-related quality of life (HRQoL. This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2, a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12 and SF Physical Component Summary (PCS12 were tested for reliability (internal consistency and test-retest reliability and validity (construct: convergent and discriminant; criterion: concurrent and predictive. A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8, and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC: 0.64; PCS12 ICC: 0.73. Both scales were significantly associated with a number of chronic conditions (p < 0.05. The PCS12 was strongly correlated with perceived health (r = 0.52 but weakly correlated with perceived mental health (r = 0.25. The MCS12 was moderately correlated with perceived mental health (r = 0.42 and perceived health (r = 0.33. Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89–0.90, MCS12: OR = 0.94 95%CI: 0.93–0.94. In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.

Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.

Science.gov (United States)

de Sena, David P; Fabricio, Daniela D; Lopes, Maria Helena I; da Silva, Vinicius D

2013-01-01

The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery) board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill) protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL) group had superior performance as confirmed by checklist scores (pmultimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.

Assessing students' communication skills: validation of a global rating.

Science.gov (United States)

Scheffer, Simone; Muehlinghaus, Isabel; Froehmel, Annette; Ortwein, Heiderose

2008-12-01

Communication skills training is an accepted part of undergraduate medical programs nowadays. In addition to learning experiences its importance should be emphasised by performance-based assessment. As detailed checklists have been shown to be not well suited for the assessment of communication skills for different reasons, this study aimed to validate a global rating scale. A Canadian instrument was translated to German and adapted to assess students' communication skills during an end-of-semester-OSCE. Subjects were second and third year medical students at the reformed track of the Charité-Universitaetsmedizin Berlin. Different groups of raters were trained to assess students' communication skills using the global rating scale. Validity testing included concurrent validity and construct validity: Judgements of different groups of raters were compared to expert ratings as a defined gold standard. Furthermore, the amount of agreement between scores obtained with this global rating scale and a different instrument for assessing communication skills was determined. Results show that communication skills can be validly assessed by trained non-expert raters as well as standardised patients using this instrument.

[Modification and evaluation of assessment of 
medication literacy].

Science.gov (United States)

Zheng, Feng; Zhong, Zhuqing; Ding, Siqing; Luo, Aijing; Liu, Zina

2016-11-28

To translate and revise the Medication Literacy Assessment in English (MedLitRxSE-English) and evaluate its validity and reliability.
 Methods: We introduced MedLitRxSE-English from abroad. According to the principles of Brislin and culture adjustment, we revised it as a Chinese edition. Using random sampling method, from Oct, 2014 to Jan, 2015, 461 non-hospitalized patients from the outpatient departments of the top three hospitals in Changsha city were investigated. The reliability and validity of the scale was tested.
 Results: The test-retest reliability of the Chinese version for medication literacy scale was 0.885; the split reliability was 0.840; K-R was 0.820; the correlations between the assessment of medication literacy and the corresponding items were 0.427-0.587; the confirmatory factor analysis revealed overall good fit. Root mean square error of approximation (RMSEA), χ2/df, goodness of fit index (GFI) and comparative fit index (CFI) was 0.08, 3.06, 0.91 and 0.94, respectively. 
 Conclusion: The Chinese version for the assessment of medication literacy is in good reliability and validity, and it can be used to evaluate the medication literacy in our country.

MEDIC: medical embedded device for individualized care.

Science.gov (United States)

Wu, Winston H; Bui, Alex A T; Batalin, Maxim A; Au, Lawrence K; Binney, Jonathan D; Kaiser, William J

2008-02-01

Presented work highlights the development and initial validation of a medical embedded device for individualized care (MEDIC), which is based on a novel software architecture, enabling sensor management and disease prediction capabilities, and commercially available microelectronic components, sensors and conventional personal digital assistant (PDA) (or a cell phone). In this paper, we present a general architecture for a wearable sensor system that can be customized to an individual patient's needs. This architecture is based on embedded artificial intelligence that permits autonomous operation, sensor management and inference, and may be applied to a general purpose wearable medical diagnostics. A prototype of the system has been developed based on a standard PDA and wireless sensor nodes equipped with commercially available Bluetooth radio components, permitting real-time streaming of high-bandwidth data from various physiological and contextual sensors. We also present the results of abnormal gait diagnosis using the complete system from our evaluation, and illustrate how the wearable system and its operation can be remotely configured and managed by either enterprise systems or medical personnel at centralized locations. By using commercially available hardware components and software architecture presented in this paper, the MEDIC system can be rapidly configured, providing medical researchers with broadband sensor data from remote patients and platform access to best adapt operation for diagnostic operation objectives.

Process validation for radiation processing

International Nuclear Information System (INIS)

Miller, A.

1999-01-01

Process validation concerns the establishment of the irradiation conditions that will lead to the desired changes of the irradiated product. Process validation therefore establishes the link between absorbed dose and the characteristics of the product, such as degree of crosslinking in a polyethylene tube, prolongation of shelf life of a food product, or degree of sterility of the medical device. Detailed international standards are written for the documentation of radiation sterilization, such as EN 552 and ISO 11137, and the steps of process validation that are described in these standards are discussed in this paper. They include material testing for the documentation of the correct functioning of the product, microbiological testing for selection of the minimum required dose and dose mapping for documentation of attainment of the required dose in all parts of the product. The process validation must be maintained by reviews and repeated measurements as necessary. This paper presents recommendations and guidance for the execution of these components of process validation. (author)

Algorithms to identify colonic ischemia, complications of constipation and irritable bowel syndrome in medical claims data: development and validation.

Science.gov (United States)

Sands, Bruce E; Duh, Mei-Sheng; Cali, Clorinda; Ajene, Anuli; Bohn, Rhonda L; Miller, David; Cole, J Alexander; Cook, Suzanne F; Walker, Alexander M

2006-01-01

A challenge in the use of insurance claims databases for epidemiologic research is accurate identification and verification of medical conditions. This report describes the development and validation of claims-based algorithms to identify colonic ischemia, hospitalized complications of constipation, and irritable bowel syndrome (IBS). From the research claims databases of a large healthcare company, we selected at random 120 potential cases of IBS and 59 potential cases each of colonic ischemia and hospitalized complications of constipation. We sought the written medical records and were able to abstract 107, 57, and 51 records, respectively. We established a 'true' case status for each subject by applying standard clinical criteria to the available chart data. Comparing the insurance claims histories to the assigned case status, we iteratively developed, tested, and refined claims-based algorithms that would capture the diagnoses obtained from the medical records. We set goals of high specificity for colonic ischemia and hospitalized complications of constipation, and high sensitivity for IBS. The resulting algorithms substantially improved on the accuracy achievable from a naïve acceptance of the diagnostic codes attached to insurance claims. The specificities for colonic ischemia and serious complications of constipation were 87.2 and 92.7%, respectively, and the sensitivity for IBS was 98.9%. U.S. commercial insurance claims data appear to be usable for the study of colonic ischemia, IBS, and serious complications of constipation. (c) 2005 John Wiley & Sons, Ltd.

Validation of the shortened Perceived Medical Condition Self-Management Scale in patients with chronic disease.

Science.gov (United States)

Wild, Marcus G; Ostini, Remo; Harrington, Magdalena; Cavanaugh, Kerri L; Wallston, Kenneth A

2018-05-21

Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Management Scale (PMCSMS). This study investigated the use of the PMCSMS in samples of patients with a chronic disease to develop an abbreviated version of the scale that could be more readily used in clinical contexts or in large population health cohort studies. The PMCSMS was administered as either a generic scale or as a disease-specific scale. The results of analyses using item response theory and classical test theory methods indicated that using 4 items of the scale resulted in similar internal consistency (α = .70-0.90) and temporal stability (test-retest r = .75 after 2 to 4 weeks) to the 8-item PMCSMS (r = .81 after 2 to 4 weeks). The 4 items selected had the greatest discriminability among participants (α parameters = 2.49-3.47). Scores from both versions also demonstrated similar correlations with related constructs such as health literacy (r = .13-0.29 vs. 0.14-0.27), self-rated health (r = .17-0.48 vs. 0.26-0.50), social support (r = .21-0.32 vs. 0.25-0.34), and medication adherence (r = .20-0.24 vs. 0.20-0.25). The results of this study indicate that 4-item PMCSMS scores are equally valid but more efficient, and have the potential to be beneficial for both research and clinical applications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Implicit and Explicit Weight Bias in a National Sample of 4732 Medical Students: The Medical Student CHANGES Study

OpenAIRE

Phelan, Sean M.; Dovidio, John F.; Puhl, Rebecca M.; Burgess, Diana J.; Nelson, David B.; Yeazel, Mark W.; Hardeman, Rachel; Perry, Sylvia; van Ryn, Michelle

2014-01-01

Objective To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. Design and Methods A web-based survey was completed by 4732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bi...

Validation of gamma irradiator controls for quality and regulatory compliance

International Nuclear Information System (INIS)

Harding, R.B.; Pinteric, F.J.A.

1995-01-01

Since 1978 the U.S. Food and Drug Administration (FDA) has had both the legal authority and the current good manufacturing practice (CGMP) regulations in progress to require irradiator owners who process medical devices to produce evidence of Irradiation Process Validation. One of the key components of Irradiation Process Validation is the validation of the irradiator controls. However it is only recently that FDA audits have focussed on this component of the process validation. (author)

Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.

Directory of Open Access Journals (Sweden)

David P de Sena

Full Text Available The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL group had superior performance as confirmed by checklist scores (p<0.002, overall global assessment (p = 0.017 and post-test results (p<0.001. All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.

Prevalence of multimorbidity in medical inpatients.

Science.gov (United States)

Schneider, Florian; Kaplan, Vladimir; Rodak, Roksana; Battegay, Edouard; Holzer, Barbara

2012-03-09

To validate the estimates of the prevalence of multimorbidity based on administrative hospital discharge data, with medical records and chart reviews as benchmarks. Retrospective cohort study. Medical division of a tertiary care teaching hospital. A total of 170 medical inpatients admitted from the emergency unit in January 2009. The prevalence of multimorbidity for three different definitions (≥2 diagnoses, ≥2 diagnoses from different ICD-10 chapters, and ≥2 medical conditions as defined by Charlson/Deyo) and three different data sources (administrative data, chart reviews, and medical records). The prevalence of multimorbidity in medical inpatients derived from administrative data, chart reviews and medical records was very high and concurred for the different definitions of multimorbidity (≥2 diagnoses: 96.5%, 95.3%, and 92.9% [p = 0.32], ≥2 diagnoses from different ICD-10 chapters: 86.5%, 90.0%, and 85.9% [p = 0.46], and ≥2 medical conditions as defined by Charlson/Deyo: 48.2%, 50.0%, and 46.5% [p = 0.81]). The agreement of rating of multimorbidity for administrative data and chart reviews and administrative data and medical records was 94.1% and 93.0% (kappa statistics 0.47) for ≥2 diagnoses; 86.0% and 86.5% (kappa statistics 0.52) for ≥2 diagnoses from different ICD-10 chapters; and 82.9% and 85.3% (kappa statistics 0.69) for ≥2 medical conditions as defined by Charlson/Deyo. Estimates of the prevalence of multimorbidity in medical inpatients based on administrative data, chart reviews and medical records were very high and congruent for the different definitions of multimorbidity. Agreement for rating multimorbidity based on the different data sources was moderate to good. Administrative hospital discharge data are a valid source for exploring the burden of multimorbidity in hospital settings.

Flipping the Continuing Medical Education Classroom: Validating a Measure of Attendees' Perceptions.

Science.gov (United States)

Stephenson, Christopher R; Wang, Amy T; Szostek, Jason H; Bonnes, Sara L; Ratelle, John T; Mahapatra, Saswati; Mandrekar, Jayawant N; Beckman, Thomas J; Wittich, Christopher M

2016-01-01

New teaching approaches for CME are needed. In flipped classrooms, coursework is completed beforehand and applied during class time. Studies of flipped classrooms and their potential benefits in CME have not been published. We sought to develop and validate an instrument measuring flipped classroom perceptions, identify whether participation changed perceptions, and determine which flipped classroom components were perceived as most effective. In this cross-sectional validation study, 167 participants in the Mayo Clinic's 2015 Internal Medicine Board Review course received surveys. Online modules were developed to deliver content before flipped classroom courses on acid-base disorders and electrolyte disorders. A flipped classroom perception instrument (FCPI) was developed and validated. The FCPI, with eight items structured on 5-point Likert scales, was given to participants before and after their flipped classroom experiences. Of the 167 participants, 111 returned surveys. Flipped classroom perceptions improved, with mean (SD) FCPI scores increasing from 3.74 (0.75) to 3.94 (0.76) (P flipped classrooms increased from 38% before the course to 53% after (P = .002). Positive changes in FCPI scores were unrelated to module completion. Most participants thought knowledge was enhanced by in-class sessions and online modules equally. The FCPI, the first validated measure of participants' perceptions of a CME flipped classroom, has strong validity evidence. Participants' perceptions of and preference for the flipped classroom improved after experiencing the flipped CME classroom. These findings support the need to further explore flipped classroom models in CME.

Computer knowledge amongst clinical year medical students in a ...

African Journals Online (AJOL)

Objective: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. Design: A survey using validated structured questionnaires. Setting: Medical school of Ahmadu Bello University, Zaria, Nigeria. Subjects: Two hundred and thirty seven clinical ...

Emotional intelligence scale for medical students

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Kalpana Srivastava

2011-01-01

Full Text Available Background: Emotional Intelligence has been associated with positive outcome process in varied professions. There is paucity of Indian literature on the subject; especially involving medical undergraduates; and presently there is no scale available to measure the same in the Indian scenario. Objective: To develop a scale to measure Emotional Intelligence among medical undergraduates. Materials and Methods: Four domains of Emotional intelligence were selected, viz. Self-Awareness, Self-Management, Social-Awareness & Social-Skills and these were included for the purpose of domains of the scale. On the basis of focused group discussions and in-depth deliberations with experts, undergraduate and postgraduate medical students a pool of 50 items was generated. The items were reduced to 27 based on expert consensus and on the basis of frequency of endorsement by expert reviews. It was followed by a pilot study of 50 undergraduates. This completed the preparation of the preliminary draft based on content analysis. The questionnaire was then administered in 480 students and the data was analyzed by appropriate statistical methods. For the purpose of concurrent validity, emotional intelligence scale developed by Dr. Ekta was used. Results: The Cronbach′s Alpha for Internal Consistency Reliability was 0.68. The EIS had a significant correlation with social awareness domain of Emotional Intelligence Test (EIT establishing Concurrent Validity. Conclusion: Emotional Intelligence Scale for medical undergraduates was constructed. Reliability and concurrent validity were also established for the same.

Is Echinococcus intermedius a valid species?

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Medical and veterinary sciences require scientific names to discriminate pathogenic organisms in our living environment. Various species concepts have been proposed for metazoan animals. There are, however, constant controversies over their validity because of lack of a common criterion to define ...

Performance and Symptom Validity Testing as a Function of Medical Board Evaluation in U.S. Military Service Members with a History of Mild Traumatic Brain Injury.

Science.gov (United States)

Armistead-Jehle, Patrick; Cole, Wesley R; Stegman, Robert L

2018-02-01

The study was designed to replicate and extend pervious findings demonstrating the high rates of invalid neuropsychological testing in military service members (SMs) with a history of mild traumatic brain injury (mTBI) assessed in the context of a medical evaluation board (MEB). Two hundred thirty-one active duty SMs (61 of which were undergoing an MEB) underwent neuropsychological assessment. Performance validity (Word Memory Test) and symptom validity (MMPI-2-RF) test data were compared across those evaluated within disability (MEB) and clinical contexts. As with previous studies, there were significantly more individuals in an MEB context that failed performance (MEB = 57%, non-MEB = 31%) and symptom validity testing (MEB = 57%, non-MEB = 22%) and performance validity testing had a notable affect on cognitive test scores. Performance and symptom validity test failure rates did not vary as a function of the reason for disability evaluation when divided into behavioral versus physical health conditions. These data are consistent with past studies, and extends those studies by including symptom validity testing and investigating the effect of reason for MEB. This and previous studies demonstrate that more than 50% of SMs seen in the context of an MEB will fail performance validity tests and over-report on symptom validity measures. These results emphasize the importance of using both performance and symptom validity testing when evaluating SMs with a history of mTBI, especially if they are being seen for disability evaluations, in order to ensure the accuracy of cognitive and psychological test data. Published by Oxford University Press 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Medical professionalism from a socio-cultural perspective: evaluating medical residents communicative attitudes during the medical encounter in malaysia.

Science.gov (United States)

Ganasegeran, K; Al-Dubai, S A R

2014-01-01

The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Cross-sectional survey, in a Malaysian public health hospital. A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Package of Social Sciences (SPSS®) (version 16.0, IBM, Armonk, NY) was used. Cronbach's alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%). Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters.

Prevalence of Self-Medication of Psychoactive Stimulants and ...

African Journals Online (AJOL)

Purpose: To evaluate the prevalence of self-medication of psychoactive stimulants and antidepressants among pharmacy students of Pakistan. Methods: A cross-sectional survey on self-medication of psychoactive stimulants and antidepressants among pharmacy students was conducted with a structured and validated ...

Medical talent management: a model for physician deployment.

Science.gov (United States)

Brightman, Baird

2007-01-01

This article aims to provide a focused cost-effective method for triaging physicians into appropriate non-clinical roles to benefit both doctors and healthcare organizations. Reviews a validated career-planning process and customize it for medical talent management. A structured career assessment can differentiate between different physician work styles and direct medical talent into best-fit positions. This allows healthcare organizations to create a more finely tuned career ladder than the familiar "in or out" binary choice. PRACTICAL IMPLICATIONS--Healthcare organizations can invest in cost-effective processes for the optimal utilization of their medical talent. Provides a new use for a well-validated career assessment and planning system. The actual value of this approach should be studied using best-practices in ROI research.

The SMS, Phone, and medical Examination sports injury surveillance system is a feasible and valid approach to measuring handball exposure, injury occurrence, and consequences in elite youth sport.

Science.gov (United States)

Møller, M; Wedderkopp, N; Myklebust, G; Lind, M; Sørensen, H; Hebert, J J; Attermann, J

2018-04-01

Current methods of sports injury surveillance are limited by lack of medical validation of self-reported injuries and/or incomplete information about injury consequences beyond time loss from sport. The aims of this study were to (a) evaluate the feasibility of the SMS, Phone, and medical Examination injury surveillance (SPEx) system (b) to evaluate the proportion of injuries and injury consequences reported by SPEx when compared to outcomes from a modified version of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. We followed 679 elite adolescent handball players over 31 weeks using the SPEx system. During the last 7 weeks, we also implemented a modified OSTRC questionnaire in a subgroup of 271 players via telephone interviews. The weekly response proportions to the primary SPEx questions ranged from 85% to 96% (mean 92%). SMS responses were received from 79% of the participants within 1 day. 95% of reported injuries were classified through the telephone interview within a week, and 67% were diagnosed by medical personnel. Comparisons between reported injuries from SPEx and OSTRC demonstrated fair (κ = 39.5% [25.1%-54.0%]) to substantial prevalence-adjusted bias-adjusted kappa (PABAK = 66.8% [95% CI 58.0%-75.6%]) agreement. The average injury severity score difference between SPEx and the OSTRC approach was -0.2 (95% CI -3.69-3.29) of possible 100 with 95% limits of agreement from(-14.81-14.41). These results support the feasibility and validity of the SPEx injury surveillance system in elite youth sport. Future studies should evaluate the external validity of SPEx system in different cohorts of athletes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Validation Report for Joint Medical Planning Tool (JMPT) Version 7.5.6 Medical Planning Tool

Science.gov (United States)

2013-09-19

surgical 847.3 Sprain of sacrum Non-surgical 724.2 Lumbago Non-surgical 724.02 Spinal stenosis of lumbar region Non-surgical 681 Cellulitis and abscess... Cellulitis and abscess of face 682.6 Cellulitis and abscess of leg except foot 719.41 Pain in joint shoulder 11 JMPT Validation Report ICD-9 ICD-9

The ASEAN economic community and medical qualification.

Science.gov (United States)

Kittrakulrat, Jathurong; Jongjatuporn, Witthawin; Jurjai, Ravipol; Jarupanich, Nicha; Pongpirul, Krit

2014-01-01

In the regional movement toward ASEAN Economic Community (AEC), medical professions including physicians can be qualified to practice medicine in another country. Ensuring comparable, excellent medical qualification systems is crucial but the availability and analysis of relevant information has been lacking. This study had the following aims: 1) to comparatively analyze information on Medical Licensing Examinations (MLE) across ASEAN countries and 2) to assess stakeholders' view on potential consequences of AEC on the medical profession from a Thai perspective. To search for relevant information on MLE, we started with each country's national body as the primary data source. In case of lack of available data, secondary data sources including official websites of medical universities, colleagues in international and national medical student organizations, and some other appropriate Internet sources were used. Feasibility and concerns about validity and reliability of these sources were discussed among investigators. Experts in the region invited through HealthSpace.Asia conducted the final data validation. For the second objective, in-depth interviews were conducted with 13 Thai stakeholders, purposely selected based on a maximum variation sampling technique to represent the points of view of the medical licensing authority, the medical profession, ethicists and economists. MLE systems exist in all ASEAN countries except Brunei, but vary greatly. Although the majority has a national MLE system, Singapore, Indonesia, and Vietnam accept results of MLE conducted at universities. Thailand adopted the USA's 3-step approach that aims to check pre-clinical knowledge, clinical knowledge, and clinical skills. Most countries, however, require only one step. A multiple choice question (MCQ) is the most commonly used method of assessment; a modified essay question (MEQ) is the next most common. Although both tests assess candidate's knowledge, the Objective Structured Clinical

Examining the link between burnout and medical error: A checklist approach

Directory of Open Access Journals (Sweden)

Evangelia Tsiga

2017-09-01

Conclusions: The Medical Error Checklists developed in this study advance the study of medical errors by proposing a comprehensive, valid and reliable self-assessment tool. The results highlight the importance of hospital organizational factors in preventing medical errors.

Sterilization validation for medical devices at IRASM microbiological laboratory—Practical approaches

International Nuclear Information System (INIS)

Trandafir, Laura; Alexandru, Mioara; Constantin, Mihai; Ioniţă, Anca; Zorilă, Florina; Moise, Valentin

2012-01-01

EN ISO 11137 established regulations for setting or substantiating the dose for achieving the desired sterility assurance level. The validation studies can be designed in particular for different types of products. Each product needs distinct protocols for bioburden determination and sterility testing. The Microbiological Laboratory from Irradiation Processing Center (IRASM) deals with different types of products, mainly for the VD max 25 method. When it comes to microbiological evaluation the most challenging was cotton gauze. A special situation for establishing the sterilization validation method appears in cases of cotton packed in large quantities. The VD max 25 method cannot be applied for items with average bioburden more than 1000 CFU/pack, irrespective of the weight of the package. This is a method limitation and implies increased costs for the manufacturer when choosing other methods. For microbiological tests, culture condition should be selected in both cases of the bioburden and sterility testing. Details about choosing criteria are given. - Highlights: ► The paper presents aspects and results within the sterilization validation process. ► Critical aspects that can lead to the failure of the process were emphasized. ► Limitation methods were discussed.

Self-Assessment of Problem Solving Disposition in Medical Students

Directory of Open Access Journals (Sweden)

Silvia Lizett Olivares-Olivares

2014-01-01

Full Text Available Medical schools are committed to both students and society to develop capabilities required to succeed in health care environments. Present diagnosis and treatment methods become obsolete faster, demanding that medical schools incorporate competency-based education to keep pace with future demands. This study was conducted to assess the problem solving disposition of medical students. A three-subcategory model of the skill is proposed. The instrument was validated on content by a group of 17 experts in medical education and applied to 135 registered students on the sixth year of the M.D. Physician Surgeon program at a private medical school. Cronbach’s alpha indicated an internal consistency of 0.751. The findings suggest that selected items have both homogeneity and validity. The factor analysis resulted in components that were associated with three problem-solving subcategories. The students’ perceptions are higher in the pattern recognition and application of general strategies for problem solving subcategories of the Problem solving disposition model.

Developing a Questionnaire for Iranian Women's Attitude on Medical Ethics in Vaginal Childbirth.

Science.gov (United States)

Mirzaee Rabor, Firoozeh; Taghipour, Ali; Mirzaee, Moghaddameh; Mirzaii Najmabadi, Khadigeh; Fazilat Pour, Masoud; Fattahi Masoum, Seyed Hosein

2015-12-01

Vaginal delivery is one of the challenging issues in medical ethics. It is important to use an appropriate instrument to assess medical ethics attitudes in normal delivery, but the lack of tool for this purpose is clear. The aim of this study was to develop and validate a questionnaire for the assessment of women's attitude on medical ethics application in normal vaginal delivery. This methodological study was carried out in Iran in 2013 - 2014. Medical ethics attitude in vaginal delivery questionnaire (MEAVDQ) was developed using the findings of a qualitative data obtained from a grounded theory research conducted on 20 women who had vaginal childbirth, in the first phase. Then, the validation criteria of this tool were tested by content and face validity in the second phase. Exploratory factor analysis was used for construct validity and reliability was also tested by Cronbach's alpha coefficient in the third phase of this study. SPSS version 13 was used in this study. The sample size for construct validity was 250 females who had normal vaginal childbirth. In the first phase of this study (tool development), by the use of four obtained categories and nine subcategories from grounded theory and literature review, three parts (98-items) of this tool were obtained (A, B and J). Part A explained the first principle of medical ethics, part B pointed to the second and third principles of medical ethics, and part J explained the fourth principle of medical ethics. After evaluating and confirming its face and content validity, 75 items remained in the questionnaire. In construct validity, by the employment of exploratory factor analysis, in parts A, B and J, 3, 7 and 3 factors were formed, respectively; and 62.8%, 64% and 51% of the total variances were explained by the obtained factors in parts A, B and J, respectively. The names of these factors in the three parts were achieved by consideration of the loading factor and medical ethics principles. The subscales of

The predictive validity of a situational judgement test, a clinical problem solving test and the core medical training selection methods for performance in specialty training .

Science.gov (United States)

Patterson, Fiona; Lopes, Safiatu; Harding, Stephen; Vaux, Emma; Berkin, Liz; Black, David

2017-02-01

The aim of this study was to follow up a sample of physicians who began core medical training (CMT) in 2009. This paper examines the long-term validity of CMT and GP selection methods in predicting performance in the Membership of Royal College of Physicians (MRCP(UK)) examinations. We performed a longitudinal study, examining the extent to which the GP and CMT selection methods (T1) predict performance in the MRCP(UK) examinations (T2). A total of 2,569 applicants from 2008-09 who completed CMT and GP selection methods were included in the study. Looking at MRCP(UK) part 1, part 2 written and PACES scores, both CMT and GP selection methods show evidence of predictive validity for the outcome variables, and hierarchical regressions show the GP methods add significant value to the CMT selection process. CMT selection methods predict performance in important outcomes and have good evidence of validity; the GP methods may have an additional role alongside the CMT selection methods. © Royal College of Physicians 2017. All rights reserved.

Julgamentos de Plausibilidade e Reações Emocionais a Desculpas

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Renan Benigno Saraiva

2013-09-01

Full Text Available Excuses are frequently used to minimize internal causal attributions when social obligations are not fullfilled. This research investigated judgments of plausibility and emotional reactions to excuses, as well as their acceptability. One hundred and fifty five college students gave their ratings on several scenarios of excuse giving for routine situations. Situations involving motives perceived as legitimate received higher scores of plausibility and positive emotional reactions, followed by situations perceived as controllable, and those of internal causes. Results are discussed in the light of the impression management literature and its efficacy in maintaining informal bondings.

Medical professionalism from a socio-cultural perspective: Evaluating medical residents communicative attitudes during the medical encounter in Malaysia

Directory of Open Access Journals (Sweden)

K Ganasegeran

2014-01-01

Full Text Available Context: The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. Aims: We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Settings and Design: Cross-sectional survey, in a Malaysian public health hospital. Materials and Methods: A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Analysis: Statistical Package of Social Sciences (SPSS® (version 16.0, IBM, Armonk, NY was used. Cronbach′s alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Results: Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%. Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. Conclusion: The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters.

Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).

Science.gov (United States)

Ely, E Wesley; Truman, Brenda; Shintani, Ayumi; Thomason, Jason W W; Wheeler, Arthur P; Gordon, Sharon; Francis, Joseph; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Sessler, Curtis N; Dittus, Robert S; Bernard, Gordon R

2003-06-11

Goal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation scales have been appropriately tested for reliability and validity. To test the reliability and validity of the Richmond Agitation-Sedation Scale (RASS). Prospective cohort study. Adult medical and coronary ICUs of a university-based medical center. Thirty-eight medical ICU patients enrolled for reliability testing (46% receiving mechanical ventilation) from July 21, 1999, to September 7, 1999, and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1, 2000, to May 3, 2001. Interrater reliability of the RASS, Glasgow Coma Scale (GCS), and Ramsay Scale (RS); validity of the RASS correlated with reference standard ratings, assessments of content of consciousness, GCS scores, doses of sedatives and analgesics, and bispectral electroencephalography. In 290-paired observations by nurses, results of both the RASS and RS demonstrated excellent interrater reliability (weighted kappa, 0.91 and 0.94, respectively), which were both superior to the GCS (weighted kappa, 0.64; P<.001 for both comparisons). Criterion validity was tested in 411-paired observations in the first 96 patients of the validation cohort, in whom the RASS showed significant differences between levels of consciousness (P<.001 for all) and correctly identified fluctuations within patients over time (P<.001). In addition, 5 methods were used to test the construct validity of the RASS, including correlation with an attention screening examination (r = 0.78, P<.001), GCS scores (r = 0.91, P<.001), quantity of different psychoactive medication dosages 8 hours prior to assessment (eg, lorazepam: r = - 0.31, P<.001), successful extubation (P =.07), and bispectral electroencephalography (r = 0.63, P

Validity of Cognitive Load Measures in Simulation-Based Training: A Systematic Review.

Science.gov (United States)

Naismith, Laura M; Cavalcanti, Rodrigo B

2015-11-01

Cognitive load theory (CLT) provides a rich framework to inform instructional design. Despite the applicability of CLT to simulation-based medical training, findings from multimedia learning have not been consistently replicated in this context. This lack of transferability may be related to issues in measuring cognitive load (CL) during simulation. The authors conducted a review of CLT studies across simulation training contexts to assess the validity evidence for different CL measures. PRISMA standards were followed. For 48 studies selected from a search of MEDLINE, EMBASE, PsycInfo, CINAHL, and ERIC databases, information was extracted about study aims, methods, validity evidence of measures, and findings. Studies were categorized on the basis of findings and prevalence of validity evidence collected, and statistical comparisons between measurement types and research domains were pursued. CL during simulation training has been measured in diverse populations including medical trainees, pilots, and university students. Most studies (71%; 34) used self-report measures; others included secondary task performance, physiological indices, and observer ratings. Correlations between CL and learning varied from positive to negative. Overall validity evidence for CL measures was low (mean score 1.55/5). Studies reporting greater validity evidence were more likely to report that high CL impaired learning. The authors found evidence that inconsistent correlations between CL and learning may be related to issues of validity in CL measures. Further research would benefit from rigorous documentation of validity and from triangulating measures of CL. This can better inform CLT instructional design for simulation-based medical training.

48 CFR 52.222-27 - Affirmative Action Compliance Requirements for Construction.

Science.gov (United States)

2010-10-01

... performance by other Contractors or subcontractors toward a goal in an approved plan does not excuse any... which the Contractor has a collective bargaining agreement, to refer minorities or women shall excuse... the following: (1) Ensure a working environment free of harassment, intimidation, and coercion at all...

[Reliability and validity of the Chinese version on Alcohol Use Disorders Identification Test].

Science.gov (United States)

Zhang, C; Yang, G P; Li, Z; Li, X N; Li, Y; Hu, J; Zhang, F Y; Zhang, X J

2017-08-10

Objective: To assess the reliability and validity of the Chinese version on Alcohol Use Disorders Identification Test (AUDIT) among medical students in China and to provide correct way of application on the recommended scales. Methods: An E-questionnaire was developed and sent to medical students in five different colleges. Students were all active volunteers to accept the testings. Cronbach's α and split-half reliability were calculated to evaluate the reliability of AUDIT while content, contract, discriminant and convergent validity were performed to measure the validity of the scales. Results: The overall Cronbach's α of AUDIT was 0.782 and the split-half reliability was 0.711. Data showed that the domain Cronbach's α and split-half reliability were 0.796 and 0.794 for hazardous alcohol use, 0.561 and 0.623 for dependence symptoms, and 0.647 and 0.640 for harmful alcohol use. Results also showed that the content validity index on the levels of items I-CVI) were from 0.83 to 1.00, the content validity index of scale level (S-CVI/UA) was 0.90, content validity index of average scale level (S-CVI/Ave) was 0.99 and the content validity ratios (CVR) were from 0.80 to 1.00. The simplified version of AUDIT supported a presupposed three-factor structure which could explain 61.175% of the total variance revealed through exploratory factor analysis. AUDIT semed to have good convergent and discriminant validity, with the success rate of calibration experiment as 100%. Conclusion: AUDIT showed good reliability and validity among medical students in China thus worth for promotion on its use.

Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction.

Science.gov (United States)

Hasselberg, Marie; Beer, Netta; Blom, Lisa; Wallis, Lee A; Laflamme, Lucie

2014-01-01

To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects. Systematic review of peer-reviewed journal articles. Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals. Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded. The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently. Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management. Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological shortcomings. As in the case of telemedicine in general, user and system quality aspects are poorly

Smartphone based automatic organ validation in ultrasound video.

Science.gov (United States)

Vaish, Pallavi; Bharath, R; Rajalakshmi, P

2017-07-01

Telesonography involves transmission of ultrasound video from remote areas to the doctors for getting diagnosis. Due to the lack of trained sonographers in remote areas, the ultrasound videos scanned by these untrained persons do not contain the proper information that is required by a physician. As compared to standard methods for video transmission, mHealth driven systems need to be developed for transmitting valid medical videos. To overcome this problem, we are proposing an organ validation algorithm to evaluate the ultrasound video based on the content present. This will guide the semi skilled person to acquire the representative data from patient. Advancement in smartphone technology allows us to perform high medical image processing on smartphone. In this paper we have developed an Application (APP) for a smartphone which can automatically detect the valid frames (which consist of clear organ visibility) in an ultrasound video and ignores the invalid frames (which consist of no-organ visibility), and produces a compressed sized video. This is done by extracting the GIST features from the Region of Interest (ROI) of the frame and then classifying the frame using SVM classifier with quadratic kernel. The developed application resulted with the accuracy of 94.93% in classifying valid and invalid images.

Extraordinary Exceptions at the International Criminal Court : The (New) Rules and Jurisprudence on Presence at Trial

NARCIS (Netherlands)

Knottnerus, Abel S.

2014-01-01

After their election as President and Vice-President of Kenya, Uhuru Kenyatta and William Ruto asked to be excused from continuous presence during their trials at the ICC. This request raised difficult questions for the Court’s Judges. First, can the accused be excused or is continuous presence a

Medical Injury Identification Using Hospital Discharge Data

National Research Council Canada - National Science Library

Layde, Peter M; Meurer, Linda N; Guse, Clare; Meurer, John R; Yang, Hongyan; Laud, Prakash; Kuhn, Evelyn M; Brasel, Karen J; Hargarten, Stephen W

2005-01-01

.... The development, validation, and testing of screening criteria for medical injury was based on International Classification of Disease code discharge diagnoses using 2001 patient data from Wisconsin hospitals...

Improving third-year medical students' competency in clinical moral reasoning : two interventions

NARCIS (Netherlands)

Cummins, P.J.; Mendis, K.J.; Fallar, R.; Favia, A.; Frank, L.E.; Plunkett, C.; Gligorov, N.; Rhodes, R.

2016-01-01

Background: This article reports on the impact of two ethics interventions implemented for third-year medical students. Previous research validated our institution's model for assessing medical students' competency in medical ethics. Confident in our assessment model, the bioethics faculty sought to

Comparing Tolerance of Ambiguity in Veterinary and Medical Students.

Science.gov (United States)

Hancock, Jason; Hammond, Jennifer A; Roberts, Martin; Mattick, Karen

Current guidelines suggest that educators in both medical and veterinary professions should do more to ensure that students can tolerate ambiguity. Designing curricula to achieve this requires the ability to measure and understand differences in ambiguity tolerance among and within professional groups. Although scales have been developed to measure tolerance of ambiguity in both medical and veterinary professions, no comparative studies have been reported. We compared the tolerance of ambiguity of medical and veterinary students, hypothesizing that veterinary students would have higher tolerance of ambiguity, given the greater patient diversity and less well-established evidence base underpinning practice. We conducted a secondary analysis of questionnaire data from first- to fourth-year medical and veterinary students. Tolerance of ambiguity scores were calculated and compared using the TAMSAD scale (29 items validated for the medical student population), the TAVS scale (27 items validated for the veterinary student population), and a scale comprising the 22 items common to both scales. Using the TAMSAD and TAVS scales, medical students had a significantly higher mean tolerance of ambiguity score than veterinary students (56.1 vs. 54.1, pambiguity than veterinary students, although this depends on the scale used.

Accuracy of nurse documentation of delirium symptoms in medical charts.

Science.gov (United States)

Voyer, Philippe; Cole, Martin G; McCusker, Jane; St-Jacques, Sylvie; Laplante, Johanne

2008-04-01

The purpose of this study undertaken in an acute care hospital was to evaluate sensitivity and specificity of the documentation of nurse-reported delirium symptoms in medical charts. This is a descriptive study based on the clinical assessments of a study nurse and nursing notes in the medical charts of 226 delirious older patients newly admitted to an acute care hospital. The results of this prospective validation study indicated that documentation of delirium symptoms is poor. Disorientation, agitation and altered level of consciousness were the three symptoms yielding a higher level of sensitivity, but even so said symptoms were reported in less than a third of the medical charts. Univariate analysis suggested that higher comorbidity level, more severe symptoms of delirium and the use of physical restraints were associated with more valid documentation of delirium symptoms in medical charts. Lastly, this study corroborates results of previous studies, indicating that documentation of delirium symptoms in medical charts can be improved. Future study should target improving nurse documentation of delirium symptoms in medical charts.

22 CFR 51.28 - Minors.

Science.gov (United States)

2010-04-01

... under § 51.28(a)(5) must be made by a senior passport authorizing officer pursuant to guidance issued by... appearance of the minor is specifically excused by a senior passport authorizing officer pursuant to guidance..., unless the personal appearance of the minor is specifically excused by a senior passport authorizing...

Academic Performance in the Context of a "Three Excused Absences" Psychiatry Clerkship Policy

Science.gov (United States)

Schillerstrom, Jason E.; Lutz, Mary

2013-01-01

Objective: In order to better manage medical student absences during the psychiatry clerkship, a policy allowing students to miss up to 3 days without penalty was developed. The purpose of this study was to describe absence patterns and compare academic performance between students with and without absences. Method: Authors reviewed the academic…

Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes.

Science.gov (United States)

Havyer, Rachel D A; Wingo, Majken T; Comfere, Nneka I; Nelson, Darlene R; Halvorsen, Andrew J; McDonald, Furman S; Reed, Darcy A

2014-06-01

Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. Review is limited to quantitative assessments of teamwork in internal

A Universal Standard for the Validation of Blood Pressure Measuring Devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement.

Science.gov (United States)

Stergiou, George S; Alpert, Bruce; Mieke, Stephan; Asmar, Roland; Atkins, Neil; Eckert, Siegfried; Frick, Gerhard; Friedman, Bruce; Graßl, Thomas; Ichikawa, Tsutomu; Ioannidis, John P; Lacy, Peter; McManus, Richard; Murray, Alan; Myers, Martin; Palatini, Paolo; Parati, Gianfranco; Quinn, David; Sarkis, Josh; Shennan, Andrew; Usuda, Takashi; Wang, Jiguang; Wu, Colin O; O'Brien, Eoin

2018-03-01

In the past 30 years, several organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring, and the International Organization for Standardization (ISO), have developed protocols for clinical validation of BP measuring devices. However, it is recognized that science, as well as patients, consumers, and manufacturers, would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Therefore, an international initiative was taken by the AAMI, ESH, and ISO experts who agreed to develop a universal standard for device validation. This statement presents the key aspects of a validation procedure, which were agreed by the AAMI, ESH, and ISO representatives as the basis for a single universal validation protocol. As soon as the AAMI/ESH/ISO standard is fully developed, this will be regarded as the single universal standard and will replace all other previous standards/protocols. © 2018 American Heart Association, Inc., and Wolters Kluwer Health, Inc.

Inter-laboratory comparison to validate the dicentric assay as a cytogenetic triage tool for medical management of radiation accidents

Energy Technology Data Exchange (ETDEWEB)

Beinke, Christina, E-mail: christinabeinke@bundeswehr.org [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Oestreicher, Ursula [Federal Office for Radiation Protection, Neuherberg (Germany); Riecke, Armin [Department for Internal Medicine, Federal Armed Forces Hospital, Ulm (Germany); Kulka, Ulrike [Federal Office for Radiation Protection, Neuherberg (Germany); Meineke, Viktor [Bundeswehr Institute of Radiobiology Affiliated to the University of Ulm, Neuherbergstrasse 11, 80937 Munich (Germany); Romm, Horst [Federal Office for Radiation Protection, Neuherberg (Germany)

2011-09-15

Radiation accidents with exposure of human beings can assume huge dimensions concerning occurring health impairments and essential medical resources such as personnel, patient care management and appropriate medical facilities. Particularly in mass-casualty events, a rapid sorting and allocation of victims to treatment is needed and their classification in medical treatment groups has to be conducted as fast as possible. For triage purposes several approaches can be considered. Clinical signs and symptoms are extremely helpful in estimating radiation effects on an organ-based level, whereas the assessment of radiation effects based on cytogenetic biodosimetry tools is the alternative approach. For both systems there are pros and cons with respect to the usefulness for specific applications, such as individual cases versus mass-casualty screening or whole- versus partial-body exposures. Among the biodosimetry tools the dicentric chromosome assay (DCA) is considered as the 'gold standard' for biodosimetry after an acute radiation exposure. Recently, steady progress in standardization and harmonization of the DCA has occurred, in order to enable the validated performance of the DCA in the frame of cooperative response of biodosimetry networks during a large scale radiological scenario. Using the DCA in triage mode which allows the stratification of radiation exposed victims into broad 1.0 Gy categories only 20-50 metaphase cells per subject are scored instead of the 500-1000 scored for routine analysis. Our data show that there are significant differences between the dicentric yields after 1.0 Gy and 3.0 Gy {gamma}-ray ex vivo exposure of blood suggesting this assay as suitable for the distinction between high and low dosed exposed individuals. These preliminary findings indicate the usefulness of the DCA also for therapeutic decision making.

Systematic review on the effectiveness of augmented reality applications in medical training.

Science.gov (United States)

Barsom, E Z; Graafland, M; Schijven, M P

2016-10-01

Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training. PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated. Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use. Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.

Validation of the Physician Teaching Motivation Questionnaire (PTMQ).

Science.gov (United States)

Dybowski, Christoph; Harendza, Sigrid

2015-10-02

Physicians play a major role as teachers in undergraduate medical education. Studies indicate that different forms and degrees of motivation can influence work performance in general and that teachers' motivation to teach can influence students' academic achievements in particular. Therefore, the aim of this study was to develop and to validate an instrument measuring teaching motivations in hospital-based physicians. We chose self-determination theory as a theoretical framework for item and scale development. It distinguishes between different dimensions of motivation depending on the amount of self-regulation and autonomy involved and its empirical evidence has been demonstrated in other areas of research. To validate the new instrument (PTMQ = Physician Teaching Motivation Questionnaire), we used data from a sample of 247 physicians from internal medicine and surgery at six German medical faculties. Structural equation modelling was conducted to confirm the factorial structure, correlation analyses and linear regressions were performed to examine concurrent and incremental validity. Structural equation modelling confirmed a good global fit for the factorial structure of the final instrument (RMSEA = .050, TLI = .957, SRMR = .055, CFI = .966). Cronbach's alphas indicated good internal consistencies for all scales (α = .75 - .89) except for the identified teaching motivation subscale with an acceptable internal consistency (α = .65). Tests of concurrent validity with global work motivation, perceived teaching competence, perceived teaching involvement and voluntariness of lesson allocation delivered theory-consistent results with slight deviations for some scales. Incremental validity over global work motivation in predicting perceived teaching involvement was also confirmed. Our results indicate that the PTMQ is a reliable, valid and therefore suitable instrument for assessing physicians' teaching motivation.

Assessing medical students' perceptions of patient safety: the medical student safety attitudes and professionalism survey.

Science.gov (United States)

Liao, Joshua M; Etchegaray, Jason M; Williams, S Tyler; Berger, David H; Bell, Sigall K; Thomas, Eric J

2014-02-01

To develop and test the psychometric properties of a survey to measure students' perceptions about patient safety as observed on clinical rotations. In 2012, the authors surveyed 367 graduating fourth-year medical students at three U.S. MD-granting medical schools. They assessed the survey's reliability and construct and concurrent validity. They examined correlations between students' perceptions of organizational cultural factors, organizational patient safety measures, and students' intended safety behaviors. They also calculated percent positive scores for cultural factors. Two hundred twenty-eight students (62%) responded. Analyses identified five cultural factors (teamwork culture, safety culture, error disclosure culture, experiences with professionalism, and comfort expressing professional concerns) that had construct validity, concurrent validity, and good reliability (Cronbach alphas > 0.70). Across schools, percent positive scores for safety culture ranged from 28% (95% confidence interval [CI], 13%-43%) to 64% (30%-98%), while those for teamwork culture ranged from 47% (32%-62%) to 74% (66%-81%). They were low for error disclosure culture (range: 10% [0%-20%] to 27% [20%-35%]), experiences with professionalism (range: 7% [0%-15%] to 23% [16%-30%]), and comfort expressing professional concerns (range: 17% [5%-29%] to 38% [8%-69%]). Each cultural factor correlated positively with perceptions of overall patient safety as observed in clinical rotations (r = 0.37-0.69, P safety behavioral intent item. This study provided initial evidence for the survey's reliability and validity and illustrated its applicability for determining whether students' clinical experiences exemplify positive patient safety environments.

Medical adherence to topical corticosteroid preparations prescribed for psoriasis

DEFF Research Database (Denmark)

Svendsen, Mathias Tiedemann; Andersen, Flemming; Hansen, Jakob

2017-01-01

OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS...... health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed....

Towards natural language question generation for the validation of ontologies and mappings.

Science.gov (United States)

Ben Abacha, Asma; Dos Reis, Julio Cesar; Mrabet, Yassine; Pruski, Cédric; Da Silveira, Marcos

2016-08-08

The increasing number of open-access ontologies and their key role in several applications such as decision-support systems highlight the importance of their validation. Human expertise is crucial for the validation of ontologies from a domain point-of-view. However, the growing number of ontologies and their fast evolution over time make manual validation challenging. We propose a novel semi-automatic approach based on the generation of natural language (NL) questions to support the validation of ontologies and their evolution. The proposed approach includes the automatic generation, factorization and ordering of NL questions from medical ontologies. The final validation and correction is performed by submitting these questions to domain experts and automatically analyzing their feedback. We also propose a second approach for the validation of mappings impacted by ontology changes. The method exploits the context of the changes to propose correction alternatives presented as Multiple Choice Questions. This research provides a question optimization strategy to maximize the validation of ontology entities with a reduced number of questions. We evaluate our approach for the validation of three medical ontologies. We also evaluate the feasibility and efficiency of our mappings validation approach in the context of ontology evolution. These experiments are performed with different versions of SNOMED-CT and ICD9. The obtained experimental results suggest the feasibility and adequacy of our approach to support the validation of interconnected and evolving ontologies. Results also suggest that taking into account RDFS and OWL entailment helps reducing the number of questions and validation time. The application of our approach to validate mapping evolution also shows the difficulty of adapting mapping evolution over time and highlights the importance of semi-automatic validation.

Development and validation of a musculoskeletal physical examination decision-making test for medical students.

Science.gov (United States)

Bishop, Julie Y; Awan, Hisham M; Rowley, David M; Nagel, Rollin W

2013-01-01

Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees. We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate. Academic medical center in the Midwestern United States. Orthopedic residents, chairmen, and medical students. Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, pphysical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, pphysical examination decision-making test

A review of m-health in medical imaging.

Science.gov (United States)

Perera, Chandrashan Mahendra; Chakrabarti, Rahul

2015-02-01

The increasing capabilities of camera-equipped mobile phones have led to a growing body of evidence regarding their use in medical imaging across a broad range of medical specialties. This article reviews the current evidence for the use of mobile health (m-health) in medical imaging. We performed a structured review of the published literature regarding m-health in medical imaging using the Medline, PubMed, and Web of Science databases (January 2002-August 2013). The two authors independently extracted data regarding type of specialty, purpose, and study design of publications. In total, 235 articles were identified. The majority of studies were case reports or noncomparative product validation studies. The greatest volume of publications originated in the fields of radiology (21%), dermatology (15%), laboratory techniques (15%), and plastic surgery (12%). Among these studies, m-health was used as diagnostic aids, for patient monitoring, and to improve communication between health practitioners. With the growing use of mobile phones for medical imaging, considerations need to be given to informed consent, privacy, image storage and transfer, and guidelines for healthcare workers and patients. There are several novel uses of mobile devices for medical imaging that show promise across a variety of areas and subspecialties of healthcare. Currently, studies are mostly exploratory in nature. To validate these devices, studies with higher methodological rigor are required.

Perceived Medical School stress of undergraduate medical students predicts academic performance: an observational study.

Science.gov (United States)

Kötter, Thomas; Wagner, Josefin; Brüheim, Linda; Voltmer, Edgar

2017-12-16

Medical students are exposed to high amounts of stress. Stress and poor academic performance can become part of a vicious circle. In order to counteract this circularity, it seems important to better understand the relationship between stress and performance during medical education. The most widespread stress questionnaire designed for use in Medical School is the "Perceived Medical School Stress Instrument" (PMSS). It addresses a wide range of stressors, including workload, competition, social isolation and financial worries. Our aim was to examine the relation between the perceived Medical School stress of undergraduate medical students and academic performance. We measured Medical School stress using the PMSS at two different time points (at the end of freshman year and at the end of sophomore year) and matched stress scores together with age and gender to the first medical examination (M1) grade of the students (n = 456). PMSS scores from 2 and 14 months before M1 proved to be significant predictors for medical students' M1 grade. Age and gender also predict academic performance, making older female students with high stress scores a potential risk group for entering the vicious circle of stress and poor academic performance. PMSS sum scores 2 and 14 months before the M1 exam seem to have an independent predictive validity for medical students' M1 grade. More research is needed to identify potential confounders.

Validation of Bayesian analysis of compartmental kinetic models in medical imaging.

Science.gov (United States)

Sitek, Arkadiusz; Li, Quanzheng; El Fakhri, Georges; Alpert, Nathaniel M

2016-10-01

Kinetic compartmental analysis is frequently used to compute physiologically relevant quantitative values from time series of images. In this paper, a new approach based on Bayesian analysis to obtain information about these parameters is presented and validated. The closed-form of the posterior distribution of kinetic parameters is derived with a hierarchical prior to model the standard deviation of normally distributed noise. Markov chain Monte Carlo methods are used for numerical estimation of the posterior distribution. Computer simulations of the kinetics of F18-fluorodeoxyglucose (FDG) are used to demonstrate drawing statistical inferences about kinetic parameters and to validate the theory and implementation. Additionally, point estimates of kinetic parameters and covariance of those estimates are determined using the classical non-linear least squares approach. Posteriors obtained using methods proposed in this work are accurate as no significant deviation from the expected shape of the posterior was found (one-sided P>0.08). It is demonstrated that the results obtained by the standard non-linear least-square methods fail to provide accurate estimation of uncertainty for the same data set (P<0.0001). The results of this work validate new methods for a computer simulations of FDG kinetics. Results show that in situations where the classical approach fails in accurate estimation of uncertainty, Bayesian estimation provides an accurate information about the uncertainties in the parameters. Although a particular example of FDG kinetics was used in the paper, the methods can be extended for different pharmaceuticals and imaging modalities. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Validating relationships among attachment, emotional intelligence and clinical communication.

Science.gov (United States)

Cherry, M Gemma; Fletcher, Ian; O'Sullivan, Helen

2014-10-01

In a previous study, we found that emotional intelligence (EI) mediates the negative influences of Year 1 medical students' attachment styles on their provider-patient communication (PPC). However, in that study, students were examined on a relatively straightforward PPC skill set and were not assessed on their abilities to elicit relevant clinical information from standardised patients. The influence of these psychological variables in more demanding and realistic clinical scenarios warrants investigation. This study aimed to validate previous research findings by exploring the mediating effect of EI on the relationship between medical students' attachment styles and their PPC across an ecologically valid PPC objective structured clinical examination (OSCE). Year 2 medical students completed measures of attachment (the Experiences in Close Relationships-Short Form [ECR-SF], a 12-item measure which provides attachment avoidance and attachment anxiety dimensional scores) and EI (the Mayer-Salovey-Caruso Emotional Intelligence Test [MSCEIT], a 141-item measure on the perception, use, understanding and management of emotions), prior to their summative PPC OSCE. Provider-patient communication was assessed using OSCE scores. Structural equation modelling (SEM) was used to validate our earlier model of the relationships between attachment style, EI and PPC. A total of 296 of 382 (77.5%) students participated. Attachment avoidance was significantly negatively correlated with total EI scores (r = -0.23, p < 0.01); total EI was significantly positively correlated with OSCE scores (r = 0.32, p < 0.01). Parsimonious SEM confirmed that EI mediated the negative influence of attachment avoidance on OSCE scores. It significantly predicted 14% of the variance in OSCE scores, twice as much as the 7% observed in the previous study. In more demanding and realistic clinical scenarios, EI makes a greater contribution towards effective PPC. Attachment is perceived to be stable

Challenges in validating the sterilisation dose for processed human amniotic membranes

International Nuclear Information System (INIS)

Yusof, Norimah; Hassan, Asnah; Firdaus Abd Rahman, M.N.; Hamid, Suzina A.

2007-01-01

Most of the tissue banks in the Asia Pacific region have been using ionising radiation at 25 kGy to sterilise human tissues for save clinical usage. Under tissue banking quality system, any dose employed for sterilisation has to be validated and the validation exercise has to be a part of quality document. Tissue grafts, unlike medical items, are not produced in large number per each processing batch and tissues relatively have a different microbial population. A Code of Practice established by the International Atomic Energy Agency (IAEA) in 2004 offers several validation methods using smaller number of samples compared to ISO 11137 (1995), which is meant for medical products. The methods emphasise on bioburden determination, followed by sterility test on samples after they were exposed to verification dose for attaining of sterility assurance level (SAL) of 10 -1 . This paper describes our experience in using the IAEA Code of Practice in conducting the validation exercise for substantiating 25 kGy as sterilisation dose for both air-dried amnion and those preserved in 99% glycerol

Challenges in validating the sterilisation dose for processed human amniotic membranes

Energy Technology Data Exchange (ETDEWEB)

Yusof, Norimah [Malaysian Nuclear Agency, Bangi, 43000 Kajang, Selangor (Malaysia)], E-mail: norimah@mint.gov.my; Hassan, Asnah [Malaysian Nuclear Agency, Bangi, 43000 Kajang, Selangor (Malaysia); Firdaus Abd Rahman, M.N.; Hamid, Suzina A. [National Tissue Bank, Hospital Universiti Sains Malaysia, Kubang Kerian, 16130 Kelantan (Malaysia)

2007-11-15

Most of the tissue banks in the Asia Pacific region have been using ionising radiation at 25 kGy to sterilise human tissues for save clinical usage. Under tissue banking quality system, any dose employed for sterilisation has to be validated and the validation exercise has to be a part of quality document. Tissue grafts, unlike medical items, are not produced in large number per each processing batch and tissues relatively have a different microbial population. A Code of Practice established by the International Atomic Energy Agency (IAEA) in 2004 offers several validation methods using smaller number of samples compared to ISO 11137 (1995), which is meant for medical products. The methods emphasise on bioburden determination, followed by sterility test on samples after they were exposed to verification dose for attaining of sterility assurance level (SAL) of 10{sup -1}. This paper describes our experience in using the IAEA Code of Practice in conducting the validation exercise for substantiating 25 kGy as sterilisation dose for both air-dried amnion and those preserved in 99% glycerol.

Defining nuclear medical file formal based on DICOM standard

International Nuclear Information System (INIS)

He Bin; Jin Yongjie; Li Yulan

2001-01-01

With the wide application of computer technology in medical area, DICOM is becoming the standard of digital imaging and communication. The author discusses how to define medical imaging file formal based on DICOM standard. It also introduces the format of ANMIS system the authors defined the validity and integrality of this format

Sterilization validation for medical devices at IRASM microbiological laboratory—Practical approaches

Science.gov (United States)

Trandafir, Laura; Alexandru, Mioara; Constantin, Mihai; Ioniţă, Anca; Zorilă, Florina; Moise, Valentin

2012-09-01

EN ISO 11137 established regulations for setting or substantiating the dose for achieving the desired sterility assurance level. The validation studies can be designed in particular for different types of products. Each product needs distinct protocols for bioburden determination and sterility testing. The Microbiological Laboratory from Irradiation Processing Center (IRASM) deals with different types of products, mainly for the VDmax25 method. When it comes to microbiological evaluation the most challenging was cotton gauze. A special situation for establishing the sterilization validation method appears in cases of cotton packed in large quantities. The VDmax25 method cannot be applied for items with average bioburden more than 1000 CFU/pack, irrespective of the weight of the package. This is a method limitation and implies increased costs for the manufacturer when choosing other methods. For microbiological tests, culture condition should be selected in both cases of the bioburden and sterility testing. Details about choosing criteria are given.

Self-Assessment of Problem Solving Disposition in Medical Students

OpenAIRE

Olivares-Olivares, Silvia Lizett; López-Cabrera, Mildred Vanessa

2014-01-01

Medical schools are committed to both students and society to develop capabilities required to succeed in health care environments. Present diagnosis and treatment methods become obsolete faster, demanding that medical schools incorporate competency-based education to keep pace with future demands. This study was conducted to assess the problem solving disposition of medical students. A three-subcategory model of the skill is proposed. The instrument was validated on content by a group of 17 ...

Radiation sterilization of medical devices

International Nuclear Information System (INIS)

Kaluska, I.; Stuglik, Z.

1996-01-01

Overview of sterilization methods of medical devices has been given, with the special stress put on radiation sterilization. A typical validation program for radiation sterilization has been shown and also a comparison of European and ISO standards concerning radiation sterilization has been discussed. (author). 13 refs, 1 fig., 2 tabs

Development and validation of an instrument to assess and improve clinical consultation skills

OpenAIRE

Lefroy, JE; Gay, SP; Gibson, S; Williams, S; McKinley, RK

2011-01-01

Context: Development of medical students’ consultation skills with patients is at the core of the UK General Medical Council’s 'Tomorrow’s Doctors' guide (2009). Teaching and assessment of these skills must therefore be a core component of the medical undergraduate curriculum. The Calgary Cambridge guide to the medical interview and the Leicester Assessment Package (LAP) provide a foundation for teaching and assessment, but both have different strengths. Objective: To develop and validate a c...

Barriers to medication error reporting among hospital nurses.

Science.gov (United States)

Rutledge, Dana N; Retrosi, Tina; Ostrowski, Gary

2018-03-01

The study purpose was to report medication error reporting barriers among hospital nurses, and to determine validity and reliability of an existing medication error reporting barriers questionnaire. Hospital medication errors typically occur between ordering of a medication to its receipt by the patient with subsequent staff monitoring. To decrease medication errors, factors surrounding medication errors must be understood; this requires reporting by employees. Under-reporting can compromise patient safety by disabling improvement efforts. This 2017 descriptive study was part of a larger workforce engagement study at a faith-based Magnet ® -accredited community hospital in California (United States). Registered nurses (~1,000) were invited to participate in the online survey via email. Reported here are sample demographics (n = 357) and responses to the 20-item medication error reporting barriers questionnaire. Using factor analysis, four factors that accounted for 67.5% of the variance were extracted. These factors (subscales) were labelled Fear, Cultural Barriers, Lack of Knowledge/Feedback and Practical/Utility Barriers; each demonstrated excellent internal consistency. The medication error reporting barriers questionnaire, originally developed in long-term care, demonstrated good validity and excellent reliability among hospital nurses. Substantial proportions of American hospital nurses (11%-48%) considered specific factors as likely reporting barriers. Average scores on most barrier items were categorised "somewhat unlikely." The highest six included two barriers concerning the time-consuming nature of medication error reporting and four related to nurses' fear of repercussions. Hospitals need to determine the presence of perceived barriers among nurses using questionnaires such as the medication error reporting barriers and work to encourage better reporting. Barriers to medication error reporting make it less likely that nurses will report medication

Medication errors of nurses and factors in refusal to report medication errors among nurses in a teaching medical center of iran in 2012.

Science.gov (United States)

Mostafaei, Davoud; Barati Marnani, Ahmad; Mosavi Esfahani, Haleh; Estebsari, Fatemeh; Shahzaidi, Shiva; Jamshidi, Ensiyeh; Aghamiri, Seyed Samad

2014-10-01

About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries. The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses. The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses. The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study. Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction.

Directory of Open Access Journals (Sweden)

Marie Hasselberg

Full Text Available OBJECTIVE: To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects. DESIGN: Systematic review of peer-reviewed journal articles. DATA SOURCES: Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals. ELIGIBILITY CRITERIA: Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded. METHOD: The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently. RESULTS: Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management. CONCLUSIONS: Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

Science.gov (United States)

Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Validation of gamma irradiator controls for quality and regulatory compliance

International Nuclear Information System (INIS)

Harding, R.B.; Pinteric, F.J.A.

1995-01-01

Since 1978 the U.S. Food and Drug Administration (FDA) has had both the legal authority and the Current Good Manufacturing Practice (CGMP) regulations in place to require irradiator owners who process medical devices to produce evidence of Irradiation Process Validation. One of the key components of Irradiation Process Validation is the validation of the irradiator controls. However, it is only recently that FDA audits have focused on this component of the process validation. What is Irradiator Control System Validation? What constitutes evidence of control? How do owners obtain evidence? What is the irradiator supplier's role in validation? How does the ISO 9000 Quality Standard relate to the FDA's CGMP requirement for evidence of Control System Validation? This paper presents answers to these questions based on the recent experiences of Nordion's engineering and product management staff who have worked with several US-based irradiator owners. This topic - Validation of Irradiator Controls - is a significant regulatory compliance and operations issues within the irradiator suppliers' and users' community. (author)

Validation Of Critical Knowledge-Based Systems

Science.gov (United States)

Duke, Eugene L.

1992-01-01

Report discusses approach to verification and validation of knowledge-based systems. Also known as "expert systems". Concerned mainly with development of methodologies for verification of knowledge-based systems critical to flight-research systems; e.g., fault-tolerant control systems for advanced aircraft. Subject matter also has relevance to knowledge-based systems controlling medical life-support equipment or commuter railroad systems.

29 CFR 1926.50 - Medical services and first aid.

Science.gov (United States)

2010-07-01

... 29 Labor 8 2010-07-01 2010-07-01 false Medical services and first aid. 1926.50 Section 1926.50... Environmental Controls § 1926.50 Medical services and first aid. (a) The employer shall insure the availability... employees, a person who has a valid certificate in first-aid training from the U.S. Bureau of Mines, the...

Module for Interns in Medical Ethics: A Developmental Diegesis.

Science.gov (United States)

Mahajan, Rajiv; Goyal, Parmod Kumar; Sidhu, Tanvir Kaur; Kaur, Upinder; Kaur, Sandeep; Gupta, Vitull

2017-12-01

Media report is rife with incidences of doctor-patients' conflict, and this partly is due to communication gap and unethical practices being adopted by the doctors. Our regular curriculum fails to impart any training in ethical issues in patient care. Imparting training to students in these soft-skills is the need of the hour. To develop a module for interns in medical ethics (MIME) in patient care, validate it and pilot run the module for standardization. After conducting faculty development workshop in curriculum designing and three rounds of Delphi with alumni, a module in medical ethics was developed and peer validated. The questionnaire for pilot run, questionnaire for future use of module delivery and pre- and post-test were also peer validated. The module was delivered to 17 interns as pilot run in the form of 4 days' workshop. After pilot run, the module was standardized to 10 broad topics and 3 days' workshop. The questionnaire for future delivery of module in regular routine was also validated during pilot run. Twenty-five faculty members participated in 1 day faculty development workshop and 59 alumni completed three rounds of Delphi. After peer review by five experts, a module of 11 broad areas was developed and was pilot run on 17 interns. Based on the feedback from pilot run, a standardized, validated 18 h teaching MIME in patient care was developed. Pilot study proves that curriculum innovation in the form of medical ethics training to interns; when as undergraduate students, they actively participate in patient care under supervision will go a long way in inculcating soft skills like ethics, compassion and communication in them.

Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit-Based Algorithms with Diagnosis Codes.

Science.gov (United States)

Dobson-Belaire, Wendy; Goodfield, Jason; Borrelli, Richard; Liu, Fei Fei; Khan, Zeba M

2018-01-01

Using diagnosis code-based algorithms is the primary method of identifying patient cohorts for retrospective studies; nevertheless, many databases lack reliable diagnosis code information. To develop precise algorithms based on medication claims/prescriber visits (MCs/PVs) to identify psoriasis (PsO) patients and psoriatic patients with arthritic conditions (PsO-AC), a proxy for psoriatic arthritis, in Canadian databases lacking diagnosis codes. Algorithms were developed using medications with narrow indication profiles in combination with prescriber specialty to define PsO and PsO-AC. For a 3-year study period from July 1, 2009, algorithms were validated using the PharMetrics Plus database, which contains both adjudicated medication claims and diagnosis codes. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the developed algorithms were assessed using diagnosis code as the reference standard. Chosen algorithms were then applied to Canadian drug databases to profile the algorithm-identified PsO and PsO-AC cohorts. In the selected database, 183,328 patients were identified for validation. The highest PPVs for PsO (85%) and PsO-AC (65%) occurred when a predictive algorithm of two or more MCs/PVs was compared with the reference standard of one or more diagnosis codes. NPV and specificity were high (99%-100%), whereas sensitivity was low (≤30%). Reducing the number of MCs/PVs or increasing diagnosis claims decreased the algorithms' PPVs. We have developed an MC/PV-based algorithm to identify PsO patients with a high degree of accuracy, but accuracy for PsO-AC requires further investigation. Such methods allow researchers to conduct retrospective studies in databases in which diagnosis codes are absent. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

External validation of the simple clinical score and the HOTEL score, two scores for predicting short-term mortality after admission to an acute medical unit.

Science.gov (United States)

Stræde, Mia; Brabrand, Mikkel

2014-01-01

Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Pre-planned prospective observational cohort study. Danish 460-bed regional teaching hospital. We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ(2) = 2.68 (10 degrees of freedom), P = 0.998 and χ(2) = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ(2) = 5.56 (10 degrees of freedom), P = 0.234. We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision.

The Internal Consistency and Validity of the Vaccination Attitudes Examination Scale: A Replication Study.

Science.gov (United States)

Wood, Louise; Smith, Michael; Miller, Christopher B; O'Carroll, Ronan E

2018-06-19

Vaccinations are important preventative health behaviors. The recently developed Vaccination Attitudes Examination (VAX) Scale aims to measure the reasons behind refusal/hesitancy regarding vaccinations. The aim of this replication study is to conduct an independent test of the newly developed VAX Scale in the UK. We tested (a) internal consistency (Cronbach's α); (b) convergent validity by assessing its relationships with beliefs about medication, medical mistrust, and perceived sensitivity to medicines; and (c) construct validity by testing how well the VAX Scale discriminated between vaccinators and nonvaccinators. A sample of 243 UK adults completed the VAX Scale, the Beliefs About Medicines Questionnaire, the Perceived Sensitivity to Medicines Scale, and the Medical Mistrust Index, in addition to demographics of age, gender, education levels, and social deprivation. Participants were asked (a) whether they received an influenza vaccination in the past year and (b) if they had a young child, whether they had vaccinated the young child against influenza in the past year. The VAX (a) demonstrated high internal consistency (α = .92); (b) was positively correlated with medical mistrust and beliefs about medicines, and less strongly correlated with perceived sensitivity to medicines; and (c) successfully differentiated parental influenza vaccinators from nonvaccinators. The VAX demonstrated good internal consistency, convergent validity, and construct validity in an independent UK sample. It appears to be a useful measure to help us understand the health beliefs that promote or deter vaccination behavior.

Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 3.0.

Science.gov (United States)

Simon, Tamara D; Haaland, Wren; Hawley, Katherine; Lambka, Karen; Mangione-Smith, Rita

2018-02-26

To modify the Pediatric Medical Complexity Algorithm (PMCA) to include both International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) codes for classifying children with chronic disease (CD) by level of medical complexity and to assess the sensitivity and specificity of the new PMCA version 3.0 for correctly identifying level of medical complexity. To create version 3.0, PMCA version 2.0 was modified to include ICD-10-CM codes. We applied PMCA version 3.0 to Seattle Children's Hospital data for children with ≥1 emergency department (ED), day surgery, and/or inpatient encounter from January 1, 2016, to June 30, 2017. Starting with the encounter date, up to 3 years of retrospective discharge data were used to classify children as having complex chronic disease (C-CD), noncomplex chronic disease (NC-CD), and no CD. We then selected a random sample of 300 children (100 per CD group). Blinded medical record review was conducted to ascertain the levels of medical complexity for these 300 children. The sensitivity and specificity of PMCA version 3.0 was assessed. PMCA version 3.0 identified children with C-CD with 86% sensitivity and 86% specificity, children with NC-CD with 65% sensitivity and 84% specificity, and children without CD with 77% sensitivity and 93% specificity. PMCA version 3.0 is an updated publicly available algorithm that identifies children with C-CD, who have accessed tertiary hospital emergency department, day surgery, or inpatient care, with very good sensitivity and specificity when applied to hospital discharge data and with performance to earlier versions of PMCA. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Five suggestions for future medical education in Korea.

Science.gov (United States)

Yang, Eunbae B; Meng, Kwang Ho

2014-09-01

This study is to investigate the historical characteristics of medical education and healthcare environment in Korea and to suggest the desirable direction for future medical education. We draw a consensus through the literature analysis and several debates from the eight experts of medical education. There are several historical characteristics of medical education: medical education as vocational education and training, as a higher education, rapid growth of new medical schools, change to the medical education system, curriculum development, reinforcement of medical humanities, improvement of teaching and evaluation methods, validation of the national health personnel licensing examination, accreditation system for quality assurance, and establishment of specialized medical education division. The changes of health care environment in medical education are development of medical technologies, changes in the structures of the population and diseases, growth of information and communication technology, consumer-centered society, and increased intervention by the third party stakeholder. We propose five suggestions to be made to improve future medical education. They are plan for outcome and competency-based medical education, connection between the undergraduate and graduate medical education, reinforcement of continuous quality improvement of medical education, reorganization of the medical education system and construction of leadership of "academic medicine."

High prevalence of self-medication practices among medical and pharmacy students: a study from Jordan.

Science.gov (United States)

Alkhatatbeh, Mohammad J; Alefan, Qais; Alqudah, Mohammad A Y

2016-05-01

To assess self-medication practices and to evaluate the impact of obtaining medical knowledge on self-medication among medical and pharmacy students at Jordan University of Science and Technology. This was a cross-sectional study. A well-validated questionnaire that included 3 sections about self-medication was administered to the subjects after introducing the term "self-medication" verbally. 1,317 students had participated in the study and were subgrouped according to their academic level into seniors and juniors. Compared to the general population rate of 42.5%, self-medication practice was reported by (1,034, 78.5%) of the students and most common amongst pharmacy students (n = 369, 82.9%) compared to Pharm.D. (n = 357, 77.9%) and medical students (n = 308, 74.4%) (p = 0.009). There was no significant difference between juniors and seniors (557, 79.1% vs. 477, 77.8%, p = 0.59, respectively). Headache (71.2%) and common cold (56.5%) were frequent ailments that provoked self-medication. Analgesics (79.9%) and antibiotics (59.8%) were frequently used to self-treat these aliments. Reasons for self-medication included previous disease experience (55.7%); minor aliments (55.3%); and having enough medical knowledge (32.1%). Medicines were used according to instructions obtained mainly from the leaflet (28.8%); pharmacist (20.7%); and university courses (19.7%). Senior students were more aware of the risk of self-medication than junior students. The majority of students frequently advise other people about self-medication (83.6%). Self-medication was common among students irrespective to their level of medical knowledge. Obtaining medical knowledge increased the students' awareness of the risk of self-medication which may result in practicing responsible self-medication. However, medical teaching institutions need to educate students about the proper use of medicines as a therapeutic tool.

California Diploma Project Technical Report III: Validity Study--Validity Study of the Health Sciences and Medical Technology Standards

Science.gov (United States)

McGaughy, Charis; Bryck, Rick; de Gonzalez, Alicia

2012-01-01

This study is a validity study of the recently revised version of the Health Science Standards. The purpose of this study is to understand how the Health Science Standards relate to college and career readiness, as represented by survey ratings submitted by entry-level college instructors of health science courses and industry representatives. For…

Screening for postdeployment conditions: development and cross-validation of an embedded validity scale in the neurobehavioral symptom inventory.

Science.gov (United States)

Vanderploeg, Rodney D; Cooper, Douglas B; Belanger, Heather G; Donnell, Alison J; Kennedy, Jan E; Hopewell, Clifford A; Scott, Steven G

2014-01-01

To develop and cross-validate internal validity scales for the Neurobehavioral Symptom Inventory (NSI). Four existing data sets were used: (1) outpatient clinical traumatic brain injury (TBI)/neurorehabilitation database from a military site (n = 403), (2) National Department of Veterans Affairs TBI evaluation database (n = 48 175), (3) Florida National Guard nonclinical TBI survey database (n = 3098), and (4) a cross-validation outpatient clinical TBI/neurorehabilitation database combined across 2 military medical centers (n = 206). Secondary analysis of existing cohort data to develop (study 1) and cross-validate (study 2) internal validity scales for the NSI. The NSI, Mild Brain Injury Atypical Symptoms, and Personality Assessment Inventory scores. Study 1: Three NSI validity scales were developed, composed of 5 unusual items (Negative Impression Management [NIM5]), 6 low-frequency items (LOW6), and the combination of 10 nonoverlapping items (Validity-10). Cut scores maximizing sensitivity and specificity on these measures were determined, using a Mild Brain Injury Atypical Symptoms score of 8 or more as the criterion for invalidity. Study 2: The same validity scale cut scores again resulted in the highest classification accuracy and optimal balance between sensitivity and specificity in the cross-validation sample, using a Personality Assessment Inventory Negative Impression Management scale with a T score of 75 or higher as the criterion for invalidity. The NSI is widely used in the Department of Defense and Veterans Affairs as a symptom-severity assessment following TBI, but is subject to symptom overreporting or exaggeration. This study developed embedded NSI validity scales to facilitate the detection of invalid response styles. The NSI Validity-10 scale appears to hold considerable promise for validity assessment when the NSI is used as a population-screening tool.

SatCom Systems for Health and Medical Care

Science.gov (United States)

Diez, Hubert

2002-01-01

Convinced since 1997 that the satellite was capable of providing a real added value either autonomously or as a complement to terrestrial infrastructures, CNES (the French Space Agency) began a determined study, validation and demonstration procedure for new satellite services. At a national but also European and worldwide level, several experiments or projects have been set-up. In each of them (tele-consultations, distant education, tele-epidemiology, tele-echography, assistance to people, training and therapeutic assistance, disaster telemedicine, etc...) well suited satcoms are used. (telecommunications for broadcasting, multicasting, downloading,...- localization, positioning, - low medium and high data rate bidirectional systems,). Medical reference people are associated in each pilot projects first to define the needs but also to manage the medical validation aspects. Our aim is always to test, validate and adapt these new services to bring them into line with the users' expectations. The value added of these technologies in sustainable healthcare services are systematically demonstrated in real situations, with real users, both in terms of quality of service and of economic validity. For several projects CNES has developed typical hardware, or technical on as technical platform. The main projects and their relevant satcom systems will be presented and discussed : - Tele-consultation, - Distance learning and training, - Assistance to people, - Tele-epidemiology, - Disaster telemedicine.

Assessing medical students' self-regulation as aptitude in computer-based learning.

Science.gov (United States)

Song, Hyuksoon S; Kalet, Adina L; Plass, Jan L

2011-03-01

We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman's Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC's reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC. Bivariate correlation analysis results indicated that the SRMC scores had a moderate degree of correlation with student achievement in a teacher-developed test. In Study 2, 58 third-year clerkship students completed the SRMC. Regression analysis results indicated that the frequency of medical students' usage of self-regulation strategies was associated with their general clinical knowledge measured by a nationally standardized licensing exam. These two studies provided evidence for the reliability and concurrent validity of the SRMC to assess medical students' self-regulation as aptitude. Future work should provide evidence to guide and improve instructional design as well as inform educational policy.

Practical design control implementation for medical devices

CERN Document Server

Justiniano, Jose

2003-01-01

Bringing together the concepts of design control and reliability engineering, this book is a must for medical device manufacturers. It helps them meet the challenge of designing and developing products that meet or exceed customer expectations and also meet regulatory requirements. Part One covers motivation for design control and validation, design control requirements, process validation and design transfer, quality system for design control, and measuring design control program effectiveness. Part Two discusses risk analysis and FMEA, designing-in reliability, reliability and design verific

Design of experiments in medical physics: Application to the AAA beam model validation.

Science.gov (United States)

Dufreneix, S; Legrand, C; Di Bartolo, C; Bremaud, M; Mesgouez, J; Tiplica, T; Autret, D

2017-09-01

The purpose of this study is to evaluate the usefulness of the design of experiments in the analysis of multiparametric problems related to the quality assurance in radiotherapy. The main motivation is to use this statistical method to optimize the quality assurance processes in the validation of beam models. Considering the Varian Eclipse system, eight parameters with several levels were selected: energy, MLC, depth, X, Y 1 and Y 2 jaw dimensions, wedge and wedge jaw. A Taguchi table was used to define 72 validation tests. Measurements were conducted in water using a CC04 on a TrueBeam STx, a TrueBeam Tx, a Trilogy and a 2300IX accelerator matched by the vendor. Dose was computed using the AAA algorithm. The same raw data was used for all accelerators during the beam modelling. The mean difference between computed and measured doses was 0.1±0.5% for all beams and all accelerators with a maximum difference of 2.4% (under the 3% tolerance level). For all beams, the measured doses were within 0.6% for all accelerators. The energy was found to be an influencing parameter but the deviations observed were smaller than 1% and not considered clinically significant. Designs of experiment can help define the optimal measurement set to validate a beam model. The proposed method can be used to identify the prognostic factors of dose accuracy. The beam models were validated for the 4 accelerators which were found dosimetrically equivalent even though the accelerator characteristics differ. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Confirmatory Factor Analysis of the Universiti Sains Malaysia Emotional Quotient Inventory Among Medical Students in Malaysia

Directory of Open Access Journals (Sweden)

Wan Nor Arifin

2016-05-01

Full Text Available The Universiti Sains Malaysia Emotional Quotient Inventory (USMEQ-i is a Malay-language emotional intelligence (EI inventory that was based on a mixed-model approach of EI. It was specifically developed and validated for use among medical course applicants. However, evidence to support its use among medical students is inadequate. This study aims to provide further construct validity evidence for the USMEQ-i among medical students through confirmatory factor analysis (CFA. A cross-sectional study was carried out on a sample of 479 medical students in Universiti Sains Malaysia (USM. After a preliminary analysis, data from only 317 respondents were found suitable for inclusion in CFA. CFA was performed using the maximum likelihood estimation method with bootstrapping due to the nonnormality of items at the multivariate level. The results of the analysis support the two-factor model of the EI component and the one-factor model of the faking component. However, the USMEQ-i should be administered with caution until further cross-validation studies are conducted among students in other medical schools in Malaysia.

Validity of mid arm circumference to detect protein energy malnutrition among 8-11 months old infants in a rural medical college of West Bengal.

Science.gov (United States)

Sadhukhan, Sanjoy Kr; Chatterjee, Chitra; Shrivastava, Prabha; Sardar, Jadav Chandra; Joardar, Gautam Kr; Lahiri, Saibendu

2010-09-01

This institution-based cross-sectional observational validation study was conducted in the immunisation clinic of North Bengal Medical College and Hospital, Sushrutanagar. The objective was to identify the validity characteristics of mid arm circumference to detect protein energy malnutrition among 8-11 months infants and to find out a suitable cut-off value if any. Study variables were age, sex, body weight and mid arm circumference. Mid arm circumference was validated against weight for age criteria (gold standard) of malnutrition. The mean mid arm circumference of the infants was found to be almost constant with only about 2.22% change over 4 months, signifying that single cut-off point can be used to detect protein energy malnutrition. Mid arm circumference values from 13.0 to 12.5 cm were found to have the highest accuracy to detect protein energy malnutrition (about 86%). The cut-off values of 12.5 and 12.6 cm were noted to have a sensitivity and specificity of about 52% and 96% respectively, a false negativity of 48% but a false positivity of only 4%. Receiver operating characteristics curve detected 12.5(12.6) cm as the best diagnostic cut-off point which can detect more than 50% of the malnourished babies with very little false positivity/misdiagnosis (only 4%). A simple measuring tape with some reorientation of the health workers can detect the beginning of childhood malnutrition.

Validating the Patient Experience with Treatment and Self-Management (PETS), a patient-reported measure of treatment burden, in people with diabetes.

Science.gov (United States)

Rogers, Elizabeth A; Yost, Kathleen J; Rosedahl, Jordan K; Linzer, Mark; Boehm, Deborah H; Thakur, Azra; Poplau, Sara; Anderson, Roger T; Eton, David T

2017-01-01

To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach's alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being), and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition distress, overall physical and mental health, and medication adherence. Respondents were 37-88 years old, 59% female, 29% non-white, and 67% college-educated. PETS scales showed good reliability (Cronbach's alphas ≥0.74). Higher PETS scale scores (greater treatment burden) were correlated with more chronic condition distress, less medication convenience, lower self-efficacy, and worse general physical and mental health. Participants less (versus more) adherent to medications and those with more (versus fewer) health care financial difficulties had higher mean PETS scores. Medication burden was the scale that was most consistently associated with

Refusal to medical interventions.

Science.gov (United States)

Palacios, G; Herreros, B; Pacho, E

2014-10-01

Refusal to medical interventions is the not acceptance, voluntary and free, of an indicated medical intervention. What the physician should do in case of refusal? It is understandable that the rejection of a validated medical intervention is difficult to accept by the responsible physician when raises the conflict protection of life versus freedom of choice. Therefore it is important to follow some steps to incorporate the most relevant aspects of the conflict. These steps include: 1) Give complete information to patients, informing on possible alternatives, 2) determine whether the patient can decide (age, competency and level of capacity), 3) to ascertain whether the decision is free, 4) analyze the decision with the patient, 5) to persuade, 6) if the patient kept in the rejection decision, consider conscientious objection, 7) take the decision based on the named criteria, 8) finally, if the rejection is accepted, offer available alternatives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Use of medical imaging as an epidemiologic tracer

International Nuclear Information System (INIS)

Dartigues, J.F.

1987-01-01

Medical imaging is a source of data for clinical and epidemiological research just like any other factual information obtained during medical treatment. Medical imaging data, like any other information, are not really useful unless they are obtained in rigorously controlled and determined conditions, defined a priori in the research protocol. In order to be use as an epidemiologic tracer (that is, as a meaning of finding a given pathology in a given population and during a given time period), the imaging data have to be valid, reliable, and representative, of easy access and obtained at a low cost [fr

Teaching communication skills and medical ethics to undergraduate medical student

Directory of Open Access Journals (Sweden)

SADIA AHSIN

2013-07-01

Full Text Available Introduction: The purpose of this study was to improve communication skills and knowledge of bioethics of last year medical students doing clerkship and to evaluate the effectiveness of using workshops for this purpose from students’ point of view, in order to continue such programs in future. Methods: After Ethical approval for the study a two-day workshop on teaching effective communication skills and principles of medical ethics was planned and conducted by the department of Medical Education through multidisciplinary faculty of Foundation University Medical College, Pakistan. A total of 102 last year medical students participated in this workshop. The students were divided into 8 groups each containing 12 students. A team of pre trained facilitators for each group conducted the group activities. Teaching strategies including interactive discussions on basic principles of doctor-patient relationship, power point presentations, day to day case scenarios, video clips and presentations involving students in role plays were used. Pre and post workshop self evaluation proformas about knowledge and skills of communication and medical ethics were rated (0=none, 1=below average, 2=average, 3=above average, 4=very good, 5=excellent by the students. Results: 89 out of 102 participants returned the proformas. A significant percentage of students (%82 showed improvement in their knowledge and skills of appreciating bioethical issues like valid informed consent, patient confidentiality, end of life issues and breaking bad news by rating as “very good” after participation in the workshop. More than %70 students recommended this activity for other students. Conclusion: Teaching through interactive workshops was found to be an effective method as reflected by students’ feedback. Therefore, the program will be continued in future.

Competency-Based Training and Simulation: Making a "Valid" Argument.

Science.gov (United States)

Noureldin, Yasser A; Lee, Jason Y; McDougall, Elspeth M; Sweet, Robert M

2018-02-01

The use of simulation as an assessment tool is much more controversial than is its utility as an educational tool. However, without valid simulation-based assessment tools, the ability to objectively assess technical skill competencies in a competency-based medical education framework will remain challenging. The current literature in urologic simulation-based training and assessment uses a definition and framework of validity that is now outdated. This is probably due to the absence of awareness rather than an absence of comprehension. The following review article provides the urologic community an updated taxonomy on validity theory as it relates to simulation-based training and assessments and translates our simulation literature to date into this framework. While the old taxonomy considered validity as distinct subcategories and focused on the simulator itself, the modern taxonomy, for which we translate the literature evidence, considers validity as a unitary construct with a focus on interpretation of simulator data/scores.

Validation of fragility fractures in primary care electronic medical records: A population-based study.

Science.gov (United States)

Martinez-Laguna, Daniel; Soria-Castro, Alberto; Carbonell-Abella, Cristina; Orozco-López, Pilar; Estrada-Laza, Pilar; Nogues, Xavier; Díez-Perez, Adolfo; Prieto-Alhambra, Daniel

2017-11-28

Electronic medical records databases use pre-specified lists of diagnostic codes to identify fractures. These codes, however, are not specific enough to disentangle traumatic from fragility-related fractures. We report on the proportion of fragility fractures identified in a random sample of coded fractures in SIDIAP. Patients≥50 years old with any fracture recorded in 2012 (as per pre-specified ICD-10 codes) and alive at the time of recruitment were eligible for this retrospective observational study in 6 primary care centres contributing to the SIDIAP database (www.sidiap.org). Those with previous fracture/s, non-responders, and those with dementia or a serious psychiatric disease were excluded. Data on fracture type (traumatic vs fragility), skeletal site, and basic patient characteristics were collected. Of 491/616 (79.7%) patients with a registered fracture in 2012 who were contacted, 331 (349 fractures) were included. The most common fractures were forearm (82), ribs (38), and humerus (32), and 225/349 (64.5%) were fragility fractures, with higher proportions for classic osteoporotic sites: hip, 91.7%; spine, 87.7%; and major fractures, 80.5%. This proportion was higher in women, the elderly, and patients with a previously coded diagnosis of osteoporosis. More than 4 in 5 major fractures recorded in SIDIAP are due to fragility (non-traumatic), with higher proportions for hip (92%) and vertebral (88%) fracture, and a lower proportion for fractures other than major ones. Our data support the validity of SIDIAP for the study of the epidemiology of osteoporotic fractures. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Medical education in India: time to make some changes.

Science.gov (United States)

Jayakrishnan, T; Honhar, M; Jolly, G P; Abraham, J; T, Jayakrishnan

2012-01-01

India is in need of well-trained doctors. We highlight and analyse some of the problems affecting medical education in India and their possible solutions. The medical education system can be reviewed under four heads: selection of students, medical training, evaluation, and the development and accreditation of faculty. In India, students enter medical colleges without receiving sufficient orientation about the profession. If students were given some exposure to various professions in the final years of school, it would help address this issue. Medical students are selected on the basis of pre-medical tests consisting of multiple-choice questions, the validity of which is being questioned increasingly. There is no coordination between the scheduling of lectures on various diseases and their management and the clinical exposure of the students. Active involvement in treatment is limited to the final year, called internship, which is hampered by preparation for postgraduate entrance examinations. Efforts should be made to provide hands-on experience at an earlier time in the course. A systematic and reliable programme for evaluation is a must. There is a need for a shift in the focus of evaluation, which should assess the application of knowledge rather than the ability to recall facts. The replacement of the traditional long-/short-case examinations with more valid and reliable instruments for the assessment of clinical skills should be considered. 'Vision 2015', a document developed by the Medical Council of India, contains many notable recommendations for the improvement of the current system. If these are implemented effectively, the impact of improvement in Indian medical education will be felt globally. Copyright 2012, NMJI.

Comparison of MMPI-2 Validity Scales among Compensation-Seeking Caucasian and Asian American Medical Patients

Science.gov (United States)

Tsushima, William T.; Tsushima, Vincent G.

2009-01-01

Validity scales of the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) are widely used for the detection of exaggerated psychological complaints, although little is known about the results of these scales with racial or ethnic minority individuals. Five validity scales derived from the MMPI-2, including the F Scale, the Back Infrequency…

A Baseline Patient Model to Support Testing of Medical Cyber-Physical Systems.

Science.gov (United States)

Silva, Lenardo C; Perkusich, Mirko; Almeida, Hyggo O; Perkusich, Angelo; Lima, Mateus A M; Gorgônio, Kyller C

2015-01-01

Medical Cyber-Physical Systems (MCPS) are currently a trending topic of research. The main challenges are related to the integration and interoperability of connected medical devices, patient safety, physiologic closed-loop control, and the verification and validation of these systems. In this paper, we focus on patient safety and MCPS validation. We present a formal patient model to be used in health care systems validation without jeopardizing the patient's health. To determine the basic patient conditions, our model considers the four main vital signs: heart rate, respiratory rate, blood pressure and body temperature. To generate the vital signs we used regression models based on statistical analysis of a clinical database. Our solution should be used as a starting point for a behavioral patient model and adapted to specific clinical scenarios. We present the modeling process of the baseline patient model and show its evaluation. The conception process may be used to build different patient models. The results show the feasibility of the proposed model as an alternative to the immediate need for clinical trials to test these medical systems.

Psychometrics of the scale of attitudes toward physician-pharmacist collaboration: a study with medical students.

Science.gov (United States)

Hojat, Mohammadreza; Spandorfer, John; Isenberg, Gerald A; Vergare, Michael J; Fassihi, Reza; Gonnella, Joseph S

2012-01-01

Despite the emphasis placed on interdisciplinary education and interprofessional collaboration between physicians and pharmacologists, no psychometrically sound instrument is available to measure attitudes toward collaborative relationships. This study was designed to examine psychometrics of an instrument for measuring attitudes toward physician-pharmacist collaborative relationships for administration to students in medical and pharmacy schools and to physicians and pharmacists. The Scale of Attitudes Toward Physician-Pharmacist Collaboration was completed by 210 students at Jefferson Medical College. Factor analysis and correlational methods were used to examine psychometrics of the instrument. Consistent with the conceptual framework of interprofessional collaboration, three underlying constructs, namely "responsibility and accountability;" "shared authority;" and "interdisciplinary education" emerged from the factor analysis of the instrument providing support for its construct validity. The reliability coefficient alpha for the instrument was 0.90. The instrument's criterion-related validity coefficient with scores of a validated instrument (Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration) was 0.70. Findings provide support for the validity and reliability of the instrument for medical students. The instrument has the potential to be used for the evaluation of interdisciplinary education in medical and pharmacy schools, and for the evaluation of patient outcomes resulting from collaborative physician-pharmacist relationships.

Relationships between medical student burnout, empathy, and professionalism climate.

Science.gov (United States)

Brazeau, Chantal M L R; Schroeder, Robin; Rovi, Sue; Boyd, Linda

2010-10-01

Medical student burnout is prevalent, and there has been much discussion about burnout and professionalism in medical education and the clinical learning environment. Yet, few studies have attempted to explore relationships between those issues using validated instruments. Medical students were surveyed at the beginning of their fourth year using the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy-Student Version, and the Professionalism Climate Instrument. The data were analyzed using Statistical Package for the Social Sciences, and Spearman correlation analysis was performed. Scores indicative of higher medical student burnout were associated with lower medical student empathy scores and with lower professionalism climate scores observed in medical students, residents, and faculty. Investigators observed relationships between medical student burnout, empathy, and professionalism climate. These findings may have implications for the design of curriculum interventions to promote student well-being and professionalism.

NF EN ISO 11137-1, July 2006. Sterilization of health care products - Irradiation - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices; NF EN ISO 11137-1, Juillet 2006. Sterilisation des produits de sante - Irradiation - Partie 1: exigences relatives a la mise au point, a la validation et au controle de routine d'un procede de sterilisation pour les dispositifs medicaux

Energy Technology Data Exchange (ETDEWEB)

NONE

2006-07-01

This part of the ISO 11137 standard specifies requirements for the development, validation and routine control of a radiation sterilization process for medical devices. Although the scope of this part of the ISO 11137 standard is limited to medical devices, it specifies requirements and provides guidance that may be applicable to other products and equipment. This part of the international standard covers radiation processes employing irradiators using the radionuclide {sup 60}Co or {sup 137}Cs, a beam from an electron generator or a beam from an X-ray generator. This part of the international standard does not: - specify requirements for development, validation and routine control of a process for inactivating the causative agents of spongiform encephalopathies such as scrapie, bovine spongiform encephalopathy and Creutzfeldt-Jakob disease; - detail specified requirements for designating a medical device as sterile; - specify a quality management system for the control of all stages of production of medical devices; - specify requirements for occupational safety associated with the design and operation of irradiation facilities; - specify requirements for the sterilization of used or reprocessed devices.

Assessment of Medical Risks and Optimization of their Management using Integrated Medical Model

Science.gov (United States)

Fitts, Mary A.; Madurai, Siram; Butler, Doug; Kerstman, Eric; Risin, Diana

2008-01-01

The Integrated Medical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

Consensus validation of the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria.

LENUS (Irish Health Repository)

Holton, Alice E

2017-11-08

Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol-medication interactions for use in older adults.

Medical Records and Correspondence Demand Respect

Directory of Open Access Journals (Sweden)

M Benamer

2007-01-01

there is to know or has every diagnostic tool available. I understand from speaking to doctors who practice in Libya that medical documentation is rudimentary. If it exists, it lacks clarity, continuity, confidentiality, and accountability. Doctors fail to sign and date their orders if they enter them in patients’ notes [2]. Relaying patients’ information to colleagues is mainly done verbally without much documentation [3]. People who need to go abroad for governmental paid treatment may request a medical report. These are almost always simple, short letters without clear diagnoses, treatment recommendations, or a current medication list. I recall senior surgeons who left the duty of writing the operative notes to the most junior doctor on the team. There is a lesson to be learnt here from other physicians who demand more of themselves and of their colleagues, as it helps advance practice There might be few potential reasons to explain why this malpractice is happening:1. Concern about litigation.2. Lack of basic clerical support.3. Lack of appropriate stationary or reliable postal service4. No clear guidelines from the relevant governing body 5. Lack of confidence6. Lack of a general practitioner to look after the patient’s interest With widespread communication technology, there is no excuse for doctors today to fail to document patient information. Computer software provides a simple method for documentation and allows for the swift electronic transmission of data to and from colleagues. We are more prone to litigation if we fail to record what we have done with our patients. We may forget the old adage “if it’s not documented, it was not done.” This is how attorneys approach medical documentation when retained for legal services. It is important we do not forget this simple fact. I was unable to find any clear guidelines from the medical board in Libya about keeping case notes and writing correspondence, although these guidelines are widely available

Using 'big data' to validate claims made in the pharmaceutical approval process.

Science.gov (United States)

Wasser, Thomas; Haynes, Kevin; Barron, John; Cziraky, Mark

2015-01-01

Big Data in the healthcare setting refers to the storage, assimilation, and analysis of large quantities of information regarding patient care. These data can be collected and stored in a wide variety of ways including electronic medical records collected at the patient bedside, or through medical records that are coded and passed to insurance companies for reimbursement. When these data are processed it is possible to validate claims as a part of the regulatory review process regarding the anticipated performance of medications and devices. In order to analyze properly claims by manufacturers and others, there is a need to express claims in terms that are testable in a timeframe that is useful and meaningful to formulary committees. Claims for the comparative benefits and costs, including budget impact, of products and devices need to be expressed in measurable terms, ideally in the context of submission or validation protocols. Claims should be either consistent with accessible Big Data or able to support observational studies where Big Data identifies target populations. Protocols should identify, in disaggregated terms, key variables that would lead to direct or proxy validation. Once these variables are identified, Big Data can be used to query massive quantities of data in the validation process. Research can be passive or active in nature. Passive, where the data are collected retrospectively; active where the researcher is prospectively looking for indicators of co-morbid conditions, side-effects or adverse events, testing these indicators to determine if claims are within desired ranges set forth by the manufacturer. Additionally, Big Data can be used to assess the effectiveness of therapy through health insurance records. This, for example, could indicate that disease or co-morbid conditions cease to be treated. Understanding the basic strengths and weaknesses of Big Data in the claim validation process provides a glimpse of the value that this research

Nuclear data for medical applications

International Nuclear Information System (INIS)

Capote, Roberto

2011-01-01

Nuclear science plays an increasingly important role in medical applications, in particular the need for radioisotopes in both cancer therapy and diagnostic techniques is very well established. Over the previous thirty years, many laboratories have reported a significant body of experimental data relevant to medical radionuclide production, and international data centres have compiled most of these data. However, till late 90s no systematic effort had been devoted to their standardization and assembly. These needs are being addressed through three IAEA Coordinated Research Projects on Nuclear Data for the Production of Radionuclides that started in 1999. Monitor cross sections to be used in charged particle measurements have been also evaluated (see http://www-nds.iaea.org/medical/monitor reactions.html). A review of IAEA recommended cross sections for the production of medical radioisotopes will be presented. Theoretical modelling of nuclear reactions will be discussed both for nuclear data evaluation and validation. The role of the Recommended Input Parameter Library (RIPL) in defining the input for production codes like EMPIRE and TALYS will be highlighted. (author)

Medical Students' Personal Qualities and Values as Correlates of Primary Care Interest

Science.gov (United States)

Borges, Nicole J.; Jones, Bonnie J.

2004-01-01

Medical schools must use selection methods that validly measure applicants' noncognitive qualities, but primary-care (PC) schools have a particular need. This study correlated entering students' personality and values scores with their professed interest in PC. 93 medical students completed instruments assessing personality (16PF & PSP), values,…

Splenomegaly - Diagnostic validity, work-up, and underlying causes

DEFF Research Database (Denmark)

Curovic Rotbain, Emelie; Lund Hansen, Dennis; Schaffalitzky de Muckadell, Ove

2017-01-01

to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis. However, some patients remain without a causal diagnosis, despite extensive medical work-up. PATIENTS AND METHODS: We identified 129 patients through the DNRP, that had been...... given the ICD-10 splenomegaly diagnosis code in 1994-2013 at Odense University Hospital, Denmark, excluding patients with prior splenomegaly, malignant haematological neoplasia or liver cirrhosis. Medical records were reviewed for validity of the splenomegaly diagnosis, diagnostic work...... significant under-coding, it should be considered if supplementary data sources should be used in addition, in order to attain a more representative population. Haematological diseases were the most common cause, however in a large fraction of patients no causal diagnosis was found....

Shape analysis in medical image analysis

CERN Document Server

Tavares, João

2014-01-01

This book contains thirteen contributions from invited experts of international recognition addressing important issues in shape analysis in medical image analysis, including techniques for image segmentation, registration, modelling and classification, and applications in biology, as well as in cardiac, brain, spine, chest, lung and clinical practice. This volume treats topics such as, anatomic and functional shape representation and matching; shape-based medical image segmentation; shape registration; statistical shape analysis; shape deformation; shape-based abnormity detection; shape tracking and longitudinal shape analysis; machine learning for shape modeling and analysis; shape-based computer-aided-diagnosis; shape-based medical navigation; benchmark and validation of shape representation, analysis and modeling algorithms. This work will be of interest to researchers, students, and manufacturers in the fields of artificial intelligence, bioengineering, biomechanics, computational mechanics, computationa...

Empirical Validation of the Information–Motivation–Behavioral Skills Model of Diabetes Medication Adherence: A Framework for Intervention

Science.gov (United States)

Mayberry, Lindsay S.; Osborn, Chandra Y.

2014-01-01

OBJECTIVE Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information–Motivation–Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model’s hypotheses in a sample of adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. RESULTS The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P motivation (indirect effect 0.12 [0.05–0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = −0.30; P motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior. PMID:24598245

Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention.

Science.gov (United States)

Mayberry, Lindsay S; Osborn, Chandra Y

2014-01-01

Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information-Motivation-Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model's hypotheses in a sample of adults with type 2 diabetes. Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C. The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P information (indirect effect 0.08 [0.01-0.15]) and motivation (indirect effect 0.12 [0.05-0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = -0.30; P information, motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior.

Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease

NARCIS (Netherlands)

Guerra, Beniamino; Haile, Sarah R.; Lamprecht, Bernd; Ramírez, Ana S.; Martinez-Camblor, Pablo; Kaiser, Bernhard; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban-González, Cristóbal; Soler-Cataluña, Juan J.; de-Torres, Juan P.; Miravitlles, Marc; Celli, Bartolome R.; Marin, Jose M.; ter Riet, Gerben; Sobradillo, Patricia; Lange, Peter; Garcia-Aymerich, Judith; Antó, Josep M.; Turner, Alice M.; Han, MeiLan K.; Langhammer, Arnulf; Leivseth, Linda; Bakke, Per; Johannessen, Ane; Oga, Toru; Cosio, Borja; Ancochea-Bermúdez, Julio; Echazarreta, Andres; Roche, Nicolas; Burgel, Pierre-Régis; Sin, Don D.; Soriano, Joan B.; Puhan, Milo A.

2018-01-01

External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores

Validation of data and indicators in the Danish Cholecystectomy Database

DEFF Research Database (Denmark)

Harboe, Kirstine Moll; Anthonsen, Kristian; Bardram, Linda

2009-01-01

and postoperative complications RESEARCH DESIGN AND SUBJECTS: Data from 1360 medical records of patients undergoing cholecystectomy were compared to the relevant administrative data from the National Patient Registry. The medical records served as the "gold standard". The association between the individual...... indicators and the occurrence of a postoperative complication was assessed. MEASURES: Validation of administrative data against the gold standard was done by the calculation of per cent agreement (including kappa-values) sensitivity/specificity and predictive values. The association between indicators...

Multivariable prediction model for suspected giant cell arteritis: development and validation

Directory of Open Access Journals (Sweden)

Ing EB

2017-11-01

Full Text Available Edsel B Ing,1 Gabriela Lahaie Luna,2 Andrew Toren,3 Royce Ing,4 John J Chen,5 Nitika Arora,6 Nurhan Torun,7 Otana A Jakpor,8 J Alexander Fraser,9 Felix J Tyndel,10 Arun NE Sundaram,10 Xinyang Liu,11 Cindy TY Lam,1 Vivek Patel,12 Ezekiel Weis,13 David Jordan,14 Steven Gilberg,14 Christian Pagnoux,15 Martin ten Hove21Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, 2Department of Ophthalmology, Queen’s University, Kingston, ON, 3Department of Ophthalmology, University of Laval, Quebec, QC, 4Toronto Eyelid, Strabismus and Orbit Surgery Clinic, Toronto, ON, Canada; 5Mayo Clinic, Department of Ophthalmology and Neurology, 6Mayo Clinic, Department of Ophthalmology, Rochester, MN, 7Department of Surgery, Division of Ophthalmology, Harvard Medical School, Boston, MA, 8Harvard Medical School, Boston, MA, USA; 9Department of Clinical Neurological Sciences and Ophthalmology, Western University, London, 10Department of Medicine, University of Toronto Medical School, Toronto, ON, Canada; 11Department of Medicine, Fudan University Shanghai Medical College, Shanghai, People’s Republic of China; 12Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 13Departments of Ophthalmology, Universities of Alberta and Calgary, Edmonton and Calgary, AB, 14Department of Ophthalmology, University of Ottawa, Ottawa, ON, 15Vasculitis Clinic, Mount Sinai Hospital, Toronto, ON, CanadaPurpose: To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA.Methods: A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL, diplopia

Development and validation of a nursing professionalism evaluation model in a career ladder system.

Science.gov (United States)

Kim, Yeon Hee; Jung, Young Sun; Min, Ja; Song, Eun Young; Ok, Jung Hui; Lim, Changwon; Kim, Kyunghee; Kim, Ji-Su

2017-01-01

The clinical ladder system categorizes the degree of nursing professionalism and rewards and is an important human resource tool for managing nursing. We developed a model to evaluate nursing professionalism, which determines the clinical ladder system levels, and verified its validity. Data were collected using a clinical competence tool developed in this study, and existing methods such as the nursing professionalism evaluation tool, peer reviews, and face-to-face interviews to evaluate promotions and verify the presented content in a medical institution. Reliability and convergent and discriminant validity of the clinical competence evaluation tool were verified using SmartPLS software. The validity of the model for evaluating overall nursing professionalism was also analyzed. Clinical competence was determined by five dimensions of nursing practice: scientific, technical, ethical, aesthetic, and existential. The structural model explained 66% of the variance. Clinical competence scales, peer reviews, and face-to-face interviews directly determined nursing professionalism levels. The evaluation system can be used for evaluating nurses' professionalism in actual medical institutions from a nursing practice perspective. A conceptual framework for establishing a human resources management system for nurses and a tool for evaluating nursing professionalism at medical institutions is provided.

Touchfree medical interfaces.

Science.gov (United States)

Rossol, Nathaniel; Cheng, Irene; Rui Shen; Basu, Anup

2014-01-01

Real-time control of visual display systems via mid-air hand gestures offers many advantages over traditional interaction modalities. In medicine, for example, it allows a practitioner to adjust display values, e.g. contrast or zoom, on a medical visualization interface without the need to re-sterilize the interface. However, when users are holding a small tool (such as a pen, surgical needle, or computer stylus) the need to constantly put the tool down in order to make hand gesture interactions is not ideal. This work presents a novel interface that automatically adjusts for gesturing with hands and hand-held tools to precisely control medical displays. The novelty of our interface is that it uses a single set of gestures designed to be equally effective for fingers and hand-held tools without using markers. This type of interface was previously not feasible with low-resolution depth sensors such as Kinect, but is now achieved by using the recently released Leap Motion controller. Our interface is validated through a user study on a group of people given the task of adjusting parameters on a medical image.

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

Science.gov (United States)

De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

2016-07-08

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Using linked electronic data to validate algorithms for health outcomes in administrative databases.

Science.gov (United States)

Lee, Wan-Ju; Lee, Todd A; Pickard, Alan Simon; Shoaibi, Azadeh; Schumock, Glen T

2015-08-01

The validity of algorithms used to identify health outcomes in claims-based and administrative data is critical to the reliability of findings from observational studies. The traditional approach to algorithm validation, using medical charts, is expensive and time-consuming. An alternative method is to link the claims data to an external, electronic data source that contains information allowing confirmation of the event of interest. In this paper, we describe this external linkage validation method and delineate important considerations to assess the feasibility and appropriateness of validating health outcomes using this approach. This framework can help investigators decide whether to pursue an external linkage validation method for identifying health outcomes in administrative/claims data.

Multiple choice exams of medical knowledge with open books and web access? A validity study

DEFF Research Database (Denmark)

O'Neill, Lotte; Simonsen, Eivind Ortind; Knudsen, Ulla Breth

2015-01-01

Background: Open book tests have been suggested to lower test anxiety and promote deeper learning strategies. In the Aarhus University medical program, ¼ of the curriculum assess students’ medical knowledge with ‘open book, open web’ (OBOW) multiple choice examinations. We found little existing...

Development and evaluation of a computer-based medical work assessment programme

Directory of Open Access Journals (Sweden)

Spallek Michael

2008-12-01

Full Text Available Abstract Background There are several ways to conduct a job task analysis in medical work environments including pencil-paper observations, interviews and questionnaires. However these methods implicate bias problems such as high inter-individual deviations and risks of misjudgement. Computer-based observation helps to reduce these problems. The aim of this paper is to give an overview of the development process of a computer-based job task analysis instrument for real-time observations to quantify the job tasks performed by physicians working in different medical settings. In addition reliability and validity data of this instrument will be demonstrated. Methods This instrument was developed in consequential steps. First, lists comprising tasks performed by physicians in different care settings were classified. Afterwards content validity of task lists was proved. After establishing the final task categories, computer software was programmed and implemented in a mobile personal computer. At least inter-observer reliability was evaluated. Two trained observers recorded simultaneously tasks of the same physician. Results Content validity of the task lists was confirmed by observations and experienced specialists of each medical area. Development process of the job task analysis instrument was completed successfully. Simultaneous records showed adequate interrater reliability. Conclusion Initial results of this analysis supported the validity and reliability of this developed method for assessing physicians' working routines as well as organizational context factors. Based on results using this method, possible improvements for health professionals' work organisation can be identified.

The PMA Scale: A Measure of Physicians' Motivation to Adopt Medical Devices.

Science.gov (United States)

Hatz, Maximilian H M; Sonnenschein, Tim; Blankart, Carl Rudolf

2017-04-01

Studies have often stated that individual-level determinants are important drivers for the adoption of medical devices. Empirical evidence supporting this claim is, however, scarce. At the individual level, physicians' adoption motivation was often considered important in the context of adoption decisions, but a clear notion of its dimensions and corresponding measurement scales is not available. To develop and subsequently validate a scale to measure the motivation to adopt medical devices of hospital-based physicians. The development and validation of the physician-motivation-adoption (PMA) scale were based on a literature search, internal expert meetings, a pilot study with physicians, and a three-stage online survey. The data collected in the online survey were analyzed using exploratory factor analysis (EFA), and the PMA scale was revised according to the results. Confirmatory factor analysis (CFA) was conducted to test the results from the EFA in the third stage. Reliability and validity tests and subgroup analyses were also conducted. Overall, 457 questionnaires were completed by medical personnel of the National Health Service England. The EFA favored a six-factor solution to appropriately describe physicians' motivation. The CFA confirmed the results from the EFA. Our tests indicated good reliability and validity of the PMA scale. This is the first reliable and valid scale to measure physicians' adoption motivation. Future adoption studies assessing the individual level should include the PMA scale to obtain more information about the role of physicians' motivation in the broader adoption context. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A systematic review of factors influencing student ratings in undergraduate medical education course evaluations

OpenAIRE

Schiekirka, Sarah; Raupach, Tobias

2015-01-01

Background Student ratings are a popular source of course evaluations in undergraduate medical education. Data on the reliability and validity of such ratings have mostly been derived from studies unrelated to medical education. Since medical education differs considerably from other higher education settings, an analysis of factors influencing overall student ratings with a specific focus on medical education was needed. Methods For the purpose of this systematic review, online databases (Pu...

Validation of treatment escalation as a definition of atopic eczema flares.

Directory of Open Access Journals (Sweden)

Kim S Thomas

Full Text Available Atopic eczema (AE is a chronic disease with flares and remissions. Long-term control of AE flares has been identified as a core outcome domain for AE trials. However, it is unclear how flares should be defined and measured.To validate two concepts of AE flares based on daily reports of topical medication use: (i escalation of treatment and (ii days of topical anti-inflammatory medication use (topical corticosteroids and/or calcineurin inhibitors.Data from two published AE studies (studies A (n=336 and B (n=60 were analysed separately. Validity and feasibility of flare definitions were assessed using daily global bother (scale 0 to 10 as the reference standard. Intra-class correlations were reported for continuous variables, and odds ratios and area under the receiver operator characteristic (ROC curve for binary outcome measures.Good agreement was found between both AE flare definitions and change in global bother: area under the ROC curve for treatment escalation of 0.70 and 0.73 in studies A and B respectively, and area under the ROC curve of 0.69 for topical anti-inflammatory medication use (Study A only. Significant positive relationships were found between validated severity scales (POEM, SASSAD, TIS and the duration of AE flares occurring in the previous week - POEM and SASSAD rose by half a point for each unit increase in number of days in flare. Smaller increases were observed on the TIS scale. Completeness of daily diaries was 95% for Study A and 60% for Study B over 16 weeks.Both definitions were good proxy indicators of AE flares. We found no evidence that 'escalation of treatment' was a better measure of AE flares than 'use of topical anti-inflammatory medications'. Capturing disease flares in AE trials through daily recording of medication use is feasible and appears to be a good indicator of long-term control.Current Controlled Trials ISRCTN71423189 (Study A.

Space Technology - Game Changing Development NASA Facts: Autonomous Medical Operations

Science.gov (United States)

Thompson, David E.

2018-01-01

The AMO (Autonomous Medical Operations) Project is working extensively to train medical models on the reliability and confidence of computer-aided interpretation of ultrasound images in various clinical settings, and of various anatomical structures. AI (Artificial Intelligence) algorithms recognize and classify features in the ultrasound images, and these are compared to those features that clinicians use to diagnose diseases. The acquisition of clinically validated image assessment and the use of the AI algorithms constitutes fundamental baseline for a Medical Decision Support System that will advise crew on long-duration, remote missions.

Special Forces Medical Sergeants' perceptions and beliefs regarding their current medical sustainment program: implications for the field.

Science.gov (United States)

Wilson, Ramey L; DeZee, Kent J

2014-01-01

Special Forces Medical Sergeants (SFMS) are trained to provide trauma and medical care in support of military operations and diplomatic missions throughout the world with indirect physician oversight. This study assessed their perceptions of the current program designed to sustain their medical skills. An Internet-based survey was developed using the constructs of the Theory of Reasoned Action/Planned Behavior and validated through survey best practices. Of the 334 respondents, 92.8% had deployed at least once as an SFMS. Respondents reported spending 4 hours per week sustaining their medical skills and were highly confident that they could perform their duties on a no-notice deployment. On a 5-point, Likert-type response scale, SFMS felt that only slight change is needed to the Special Operations Medical Skills Sustainment Course (mean: 2.17; standard deviation [SD]: 1.05), while moderate change is needed to the Medical Proficiency Training (mean: 2.82; SD: 1.21) and nontrauma modules (mean: 3.02; SD: 1.22). Respondents desire a medical sustainment program that is provided by subject matter experts, involves actual patient care, incorporates new technology, uses hands-on simulation, and is always available. SFMS are challenged to sustain their medical skills in the current operational environment, and barriers to medical training should be minimized to facilitate sustainment training. Changes to the current medical sustainment program should incorporate operator-level perspectives to ensure acceptability and utility but must be balanced with organizational realities. Improving the medical sustainment program will prepare SFMS for the challenges of future missions. 2014.

Identification of documented medication non-adherence in physician notes.

Science.gov (United States)

Turchin, Alexander; Wheeler, Holly I; Labreche, Matthew; Chu, Julia T; Pendergrass, Merri L; Einbinder, Jonathan S; Einbinder, Jonathan Seth

2008-11-06

Medication non-adherence is common and the physicians awareness of it may be an important factor in clinical decision making. Few sources of data on physician awareness of medication non-adherence are available. We have designed an algorithm to identify documentation of medication non-adherence in the text of physician notes. The algorithm recognizes eight semantic classes of documentation of medication non-adherence. We evaluated the algorithm against manual ratings of 200 randomly selected notes of hypertensive patients. The algorithm detected 89% of the notes with documented medication non-adherence with specificity of 84.7% and positive predictive value of 80.2%. In a larger dataset of 1,000 documents, notes that documented medication non-adherence were more likely to report significantly elevated systolic (15.3% vs. 9.0%; p = 0.002) and diastolic (4.1% vs. 1.9%; p = 0.03) blood pressure. This novel clinically validated tool expands the range of information on medication non-adherence available to researchers.

External review and validation of the Swedish national inpatient register

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Kim Jeong-Lim

2011-06-01

Full Text Available Abstract Background The Swedish National Inpatient Register (IPR, also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973 but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.

Improving the non-technical skills of hospital medical emergency teams: The Team Emergency Assessment Measure (TEAM™).

Science.gov (United States)

Cant, Robyn P; Porter, Joanne E; Cooper, Simon J; Roberts, Kate; Wilson, Ian; Gartside, Christopher

2016-12-01

This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure (TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes. Registered nurses (RNs) and medical staff (n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the (TEAM™) instrument was completed by multiple clinicians at medical emergency episodes. In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) (P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating (P technical skills of medical emergency teams are known to often be suboptimal; however, average ratings of 89% were achieved in this real-world study. TEAM™ is a valid, reliable and easy to use tool, for both training and clinical settings, with benefits for team performance when used as an assessment and/or debriefing tool. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments

Directory of Open Access Journals (Sweden)

Pérez-Escamilla B

2015-04-01

��Green–Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH; and Martín–Bayarre–Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach’s α, varied from 0.43 to 0.889. Additional statistical techniques utilized to assess the psychometric properties of the questionnaires varied greatly across studies. Conclusion: At this stage, none of the six questionnaires included could be considered a gold standard. However, this revision will assist health professionals in the selection of the most appropriate tool for their individual circumstances. Keywords: validation, hypertension, medication, compliance, scale, validity, reliability

Historical Medical Value of Donguibogam

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Bong-Keun Song

2016-03-01

Full Text Available Oriental medicine, since its origin in China, has had a long history extending over 2000 years. Today, it comprises several types of medicine predominately practiced in East Asia, including traditional Chinese, traditional Korean, and Kampo medicine. The distinctive medical system of traditional Korean medicine was established shortly after the publication of Donguibogam by Dr. Heo Jun in 1613. Donguibogam is highly acclaimed across East Asia; in 2009, in light of its historical medical value, the United Nations Educational, Scientific, and Cultural Organization registered the book on its cultural heritage list. Here, we review the historical medical value of Donguibogam. The findings confirm that Donguibogam developed a unique and independent form of traditional Korean medicine and innovatively reformed the disease classification system. Moreover, Donguibogam emphasized the importance of disease prevention and medical pragmatism. This book also accelerated the development of folk medicine. Owing to its historical medical value, Donguibogam is now considered the 'bible' of Oriental medicine. Its wide acceptance has contributed to the expansion of Korean medicine utilization among the general public. Donguibogam has also played an important role in the establishment of traditional Korean medicine as a universally valid and original form of medicine, independent of traditional Chinese medicine.

Do medical students like communication? Validation of the German CSAS (Communication Skills Attitude Scale).

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Busch, Anne-Kathrin; Rockenbauch, Katrin; Schmutzer, Gabriele; Brähler, Elmar

2015-01-01

Attitudes towards communication skills of medical undergraduates can be gathered using the Communication Skills Attitude Scale (CSAS). We aimed to develop a German version of the CSAS (CSAS-G) in order to explore attitudes towards communication skills in a German cohort. Additionally the potential influence of demographic factors was examined. We realized the CSAS-G and conducted a survey with 529 participants from 3 different years of study. We then carried out an explorative as well as confirmatory factor analysis and compared the attitudinal scores. Multiple regression analysis was performed. The confirmatory analysis confirmed the two-subscale system revealed by the explorative factor analysis. Students indicate low levels of negative attitudes and moderate levels of positive attitudes. Attitudinal scores differ significantly in relation to gender. The CSAS-G can be used in German cohorts to evaluate attitudes towards communication skills. Medical students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of German medical students.

Evaluating the Predictive Validity of Suicidal Intent and Medical Lethality in Youth

Science.gov (United States)

Sapyta, Jeffrey; Goldston, David B.; Erkanli, Alaattin; Daniel, Stephanie S.; Heilbron, Nicole; Mayfield, Andrew; Treadway, S. Lyn

2012-01-01

Objectives: To examine whether suicidal intent and medical lethality of past suicide attempts are predictive of future attempts, the association between intent and lethality, and the consistency of these characteristics across repeated attempts among youth. Method: Suicide attempts in a 15-year prospective study of 180 formerly psychiatrically…

Validity and reliability of the Persian version of mobile phone addiction scale

OpenAIRE

Mazaheri, Maryam Amidi; Karbasi, Mojtaba

2014-01-01

Background: With regard to large number of mobile users especially among college students in Iran, addiction to mobile phone is attracting increasing concern. There is an urgent need for reliable and valid instrument to measure this phenomenon. This study examines validity and reliability of the Persian version of mobile phone addiction scale (MPAIS) in college students. Materials and Methods: this methodological study was down in Isfahan University of Medical Sciences. One thousand one hundr...

Construct validity of the reporter-interpreter-manager-educator structure for assessing students' patient encounter skills

DEFF Research Database (Denmark)

Tolsgaard, Martin G.; Arendrup, Henrick; Lindhardt, Bjarne O.

2012-01-01

PURPOSE: The aim of this study, done in Denmark, was to explore the construct validity of a Reporter-Interpreter-Manager-Educator (RIME)-structured scoring format for assessing patient encounter skills. METHOD: The authors developed a RIME-structured scoring form and explored its construct validity...... in a two-step procedure. The first step (implemented in 2009) was a randomized, controlled, experimental study in which the performance of three groups (16 fourth-year medical students, 16 sixth-year medical students, and 16 interns) was assessed in two simulated patient encounters. The second step...... (carried out during 2009-2010) was an observational study of patient encounter skills where clinician examiners used the scoring form in end-of-clerkship oral examinations of three consecutive cohorts of a total of 547 fourth-year medical students. RESULTS: In the experimental study, RIME scores showed...

Professionalism perspectives among medical students of a novel medical graduate school in Malaysia.

Science.gov (United States)

Haque, Mainul; Zulkifli, Zainal; Haque, Seraj Zohurul; Kamal, Zubair M; Salam, Abdus; Bhagat, Vidya; Alattraqchi, Ahmed Ghazi; Rahman, Nor Iza A

2016-01-01

Defining professionalism in this constantly evolving world is not easy. How do you measure degrees of benevolence and compassion? If it is so obvious to our profession, what professionalism is, then why is it so difficult to teach it to medical students and residents? Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. However, medical professionalism is defined as the basis for the trust in the patient-physician relationship, caring and compassion, insight, openness, respect for patient dignity, confidentiality, autonomy, presence, altruism, and those qualities that lead to trust-competence, integrity, honesty, morality, and ethical conduct. The purpose of this study is to explore professionalism in terms of its fundamental elements among medical students of Universiti Sultan Zainal Abidin (UniSZA). This was a cross-sectional study carried out on medical students of UniSZA. The study population included preclinical and clinical medical students of UniSZA from Year I to Year V of academic session 2014/2015. The simple random sampling technique was used to select the sample. Data were collected using a validated instrument. The data were then compiled and analyzed using SPSS Version 21. Out of 165 questionnaires distributed randomly among Year I to Year V medical students of UniSZA, 144 returned, giving a response rate of 87%. Among the study participants, 38% (54) and 62% (90) were males and females, respectively. The grand total score was 170.92±19.08. A total of 166.98±20.15 and 173.49±18.09 were the total professionalism score of male and female study participants, respectively, with no statistically significant (P=0.61) differences. This study found almost similar levels of familiarity with all fundamental issues of professionalism with no statistically (P>0.05) significant differences. Medical faculty members

Measuring the Medical School Educational Environment: Validating an Approach from Saudi Arabia

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Alshehri, Sarah A.; Alshehri, Abdulrahman F.; Erwin, T. Dary

2012-01-01

Objective: This study is an empirical analysis of the female students' attitudes toward the medical educational environment and climate in the College of Medicine at King Khalid University. Setting: The Dundee Ready Educational Environment Measure (DREEM) questionnaire was administered on the same day to 100 female students studying in the third…

Assessment of Medical Students in a New Curriculum.

Science.gov (United States)

Engel, Charles E.; And Others

1980-01-01

Reliable and valid methods of student assessment in Newcastle University's new undergraduate medical curriculum are examined as indices of competence within the constraints of the educational program objectives. Considerable attention is given to the assessment of sciences basic to medicine through assessment instruments developed from clinical…

Assessment of the resident’s promotion exam: One step to validity of competency measurement in Arak University of Medical Sciences

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Z Anbari

2013-03-01

Full Text Available Introduction: Designing a tool for measuring of residents’competency with attention to their main role in education and practice of university. This study aims to assess the residents’ promotion tests of clinical departments at Arak University of Medicals Sciences. Methods: This cross- sectional study that was undertook in 2010 at Arak University of Medical Sciences. Seven hundred and fifty multiple choice questions related to resident promotion tests in surgery, internal medicine, pediatrics, gynecology and anesthesiology was compared. Questionnaire of each department contained 150 questions.   These questions were evaluated in the following domains: structure, Blum taxonomy, discrimination and difficulty index of questions and compliance to the core curriculums. Data gathering tool were: Millmen standard check list for evaluating questions’ structure and check list for evaluating Blum taxonomy and core curriculum and OMR system for evaluating discrimination and difficulty index. The validity and reliability of tools was confirmed and data were analyzed using by ANOVA and X2 tests. Results: Results showed gynecology department had structural problem (4.5±4.2 compared with other departments. Internal medicine department had the highest Blum domain (40% application and 47% comprehension, surgery department had the highest learning aims (90.7% and was assessed as the most suitable questions from difficulty index (67.3% and discrimination index (73.5%. There was significant difference between structural problem, core curriculum and rate of standard questions in various clinical departments (P=0.001. Conclusion: This study confirmed the necessity of test assessment in universities, to form effective educational workshops, control of questions before exams and incentives for clinical departments to design standard questions. Development of electronic question analysis system is recommended.

Development of a behaviour change communication tool for medical students: the 'Tent Pegs' booklet.

Science.gov (United States)

Chisholm, Anna; Hart, Jo; Mann, Karen; Peters, Sarah

2014-01-01

To describe the development and validation of a behaviour change communication tool for medical students. Behaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the 'Tent Pegs' booklet) and validated using discriminant content validity methods with 11 expert judges. One-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p≤0.002). Only BCTs within the 'empowering people to change' domain were not significantly different from the value zero (mean confidence rating=1.2, p>0.05); these BCTs were most frequently allocated to the 'addressing thoughts and emotions' domain instead. BCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the 'empowering people to change' domain. The existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Health Care Consumer's Perception of the Electronic Medical Record

African Journals Online (AJOL)

Method: A structured questionnaire was developed, validated and utilized in this quantitative research project. Quantitative data were collected ... Electronic Medical Records (EMR), as a health information technology innovation, has ... EMR will provide a highly effective, reliable, secure, and innovative information system.

Evidence based medical imaging (EBMI)

International Nuclear Information System (INIS)

Smith, Tony

2008-01-01

Background: The evidence based paradigm was first described about a decade ago. Previous authors have described a framework for the application of evidence based medicine which can be readily adapted to medical imaging practice. Purpose: This paper promotes the application of the evidence based framework in both the justification of the choice of examination type and the optimisation of the imaging technique used. Methods: The framework includes five integrated steps: framing a concise clinical question; searching for evidence to answer that question; critically appraising the evidence; applying the evidence in clinical practice; and, evaluating the use of revised practices. Results: This paper illustrates the use of the evidence based framework in medical imaging (that is, evidence based medical imaging) using the examples of two clinically relevant case studies. In doing so, a range of information technology and other resources available to medical imaging practitioners are identified with the intention of encouraging the application of the evidence based paradigm in radiography and radiology. Conclusion: There is a perceived need for radiographers and radiologists to make greater use of valid research evidence from the literature to inform their clinical practice and thus provide better quality services

Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer.

Science.gov (United States)

Blum, David; Rosa, Daniel; deWolf-Linder, Susanne; Hayoz, Stefanie; Ribi, Karin; Koeberle, Dieter; Strasser, Florian

2014-12-01

Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer. The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts. First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions. Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch. Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization. Copyright © 2014 American Academy of Hospice and

Three controversies over item disclosure in medical licensure examinations

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Yoon Soo Park

2015-09-01

Full Text Available In response to views on public's right to know, there is growing attention to item disclosure – release of items, answer keys, and performance data to the public – in medical licensure examinations and their potential impact on the test's ability to measure competence and select qualified candidates. Recent debates on this issue have sparked legislative action internationally, including South Korea, with prior discussions among North American countries dating over three decades. The purpose of this study is to identify and analyze three issues associated with item disclosure in medical licensure examinations – 1 fairness and validity, 2 impact on passing levels, and 3 utility of item disclosure – by synthesizing existing literature in relation to standards in testing. Historically, the controversy over item disclosure has centered on fairness and validity. Proponents of item disclosure stress test takers’ right to know, while opponents argue from a validity perspective. Item disclosure may bias item characteristics, such as difficulty and discrimination, and has consequences on setting passing levels. To date, there has been limited research on the utility of item disclosure for large scale testing. These issues requires ongoing and careful consideration.

Validation of second trimester miscarriages and spontaneous deliveries

DEFF Research Database (Denmark)

Sundtoft, Iben Blaabjerg; Sneider, Kirstine; Christiansen, Ole Bjarne

2015-01-01

OBJECTIVE: To validate the diagnosis of second trimester miscarriages/deliveries (16+0 weeks to 27+6 weeks of gestation) recorded as miscarriages in the Danish National Patient Registry or spontaneous deliveries in the Danish Medical Birth Registry, and asses the validity of risk factors, pregnancy...... information and calculated positive predictive values of the registry diagnoses stratified by type of registry, as well as sensitivity, specificity, positive predictive value, and kappa coefficients of risk factors, pregnancy complications, and cerclage. RESULTS: Miscarriage/spontaneous delivery in the second......-based information on pregnancy complications need to be improved. We recommend that all pregnancies ending spontaneously beyond the first trimester are included in the national birth registry and described by appropriate variables....

A conceptual framework for homeostasis: development and validation

Science.gov (United States)

Wenderoth, Mary Pat; Michael, Joel; Cliff, William; Wright, Ann; Modell, Harold

2016-01-01

We have developed and validated a conceptual framework for understanding and teaching organismal homeostasis at the undergraduate level. The resulting homeostasis conceptual framework details critical components and constituent ideas underlying the concept of homeostasis. It has been validated by a broad range of physiology faculty members from community colleges, primarily undergraduate institutions, research universities, and medical schools. In online surveys, faculty members confirmed the relevance of each item in the framework for undergraduate physiology and rated the importance and difficulty of each. The homeostasis conceptual framework was constructed as a guide for teaching and learning of this critical core concept in physiology, and it also paves the way for the development of a concept inventory for homeostasis. PMID:27105740

The development and initial validation of the cyberchondria severity scale (CSS).

Science.gov (United States)

McElroy, Eoin; Shevlin, Mark

2014-03-01

Cyberchondria is a form of anxiety characterised by excessive online health research. It may lead to increased levels of psychological distress, worry, and unnecessary medical expenses. The aim of the present study was to develop a psychometrically sound measure of this dimension. A sample of undergraduate students (N = 208; 64% female) completed a pilot version of the cyberchondria severity scale (CSS) along with the short form version of the depression, anxiety and stress scale (DASS-21). Exploratory factor analysis identified a correlated five factor structure that were labelled 'Compulsion', 'Distress', 'Excessiveness', 'Reassurance Seeking' and 'Mistrust of Medical Professional'. The CSS demonstrated good psychometric properties; the subscales had high internal consistency, along with good concurrent and convergent validity. The CSS may prove useful in a wide variety of future research activities. It may also facilitate the development and validation of interventions for cyberchondria. Copyright © 2014 Elsevier Ltd. All rights reserved.

Motivation, learning strategies, participation and medical school performance.

Science.gov (United States)

Stegers-Jager, Karen M; Cohen-Schotanus, Janke; Themmen, Axel P N

2012-07-01

Medical schools wish to better understand why some students excel academically and others have difficulty in passing medical courses. Components of self-regulated learning (SRL), such as motivational beliefs and learning strategies, as well as participation in scheduled learning activities, have been found to relate to student performance. Although participation may be a form of SRL, little is known about the relationships among motivational beliefs, learning strategies, participation and medical school performance. This study aimed to test and cross-validate a hypothesised model of relationships among motivational beliefs (value and self-efficacy), learning strategies (deep learning and resource management), participation (lecture attendance, skills training attendance and completion of optional study assignments) and Year 1 performance at medical school. Year 1 medical students in the cohorts of 2008 (n = 303) and 2009 (n = 369) completed a questionnaire on motivational beliefs and learning strategies (sourced from the Motivated Strategies for Learning Questionnaire) and participation. Year 1 performance was operationalised as students' average Year 1 course examination grades. Structural equation modelling was used to analyse the data. Participation and self-efficacy beliefs were positively associated with Year 1 performance (β = 0.78 and β = 0.19, respectively). Deep learning strategies were negatively associated with Year 1 performance (β =- 0.31), but positively related to resource management strategies (β = 0.77), which, in turn, were positively related to participation (β = 0.79). Value beliefs were positively related to deep learning strategies only (β = 0.71). The overall structural model for the 2008 cohort accounted for 47% of the variance in Year 1 grade point average and was cross-validated in the 2009 cohort. This study suggests that participation mediates the relationships between motivation and learning strategies, and medical school

Labtracker+, a medical smartphone app for the interpretation of consecutive laboratory results: an external validation study.

Science.gov (United States)

Hilderink, Judith M; Rennenberg, Roger J M W; Vanmolkot, Floris H M; Bekers, Otto; Koopmans, Richard P; Meex, Steven J R

2017-09-01

When monitoring patients over time, clinicians may struggle to distinguish 'real changes' in consecutive blood parameters from so-called natural fluctuations. In practice, they have to do so by relying on their clinical experience and intuition. We developed Labtracker+ , a medical app that calculates the probability that an increase or decrease over time in a specific blood parameter is real, given the time between measurements. We presented patient cases to 135 participants to examine whether there is a difference between medical students, residents and experienced clinicians when it comes to interpreting changes between consecutive laboratory results. Participants were asked to interpret if changes in consecutive laboratory values were likely to be 'real' or rather due to natural fluctuations. The answers of the study participants were compared with the calculated probabilities by the app Labtracker+ and the concordance rates were assessed. Medical students (n=92), medical residents from the department of internal medicine (n=19) and internists (n=24) at a Dutch University Medical Centre. Concordance rates between the study participants and the calculated probabilities by the app Labtracker+ were compared. Besides, we tested whether physicians with clinical experience scored better concordance rates with the app Labtracker+ than inexperienced clinicians. Medical residents and internists showed significantly better concordance rates with the calculated probabilities by the app Labtracker+ than medical students, regarding their interpretation of differences between consecutive laboratory results (p=0.009 and p<0.001, respectively). The app Labtracker+ could serve as a clinical decision tool in the interpretation of consecutive laboratory test results and could contribute to rapid recognition of parameter changes by physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

Validating the Patient Experience with Treatment and Self-Management (PETS, a patient-reported measure of treatment burden, in people with diabetes

Directory of Open Access Journals (Sweden)

Rogers EA

2017-11-01

Full Text Available Elizabeth A Rogers,1,2 Kathleen J Yost,3 Jordan K Rosedahl,3 Mark Linzer,4 Deborah H Boehm,5 Azra Thakur,5 Sara Poplau,5 Roger T Anderson,6 David T Eton3 1Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA; 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA; 3Department of Health Services Research, Mayo Clinic, Rochester, MN, USA; 4Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; 5Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 6University of Virginia School of Medicine, Charlottesville, VA, USA Aims: To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS, in people with diabetes. Methods: We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach’s alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being, and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition

Attitude toward plagiarism among Iranian medical faculty members.

Science.gov (United States)

Ghajarzadeh, Mahsa; Norouzi-Javidan, Abbas; Hassanpour, Kiana; Aramesh, Kiarash; Emami-Razavi, Seyed Hassan

2012-01-01

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6±3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7±0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4±0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1). It is essential to provide materials (such as workshops, leaflets and mandatory courses) to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism.

Design and Technical Validation of a Telemedicine Service for Rural Healthcare in Ecuador.

Science.gov (United States)

Vasquez-Cevallos, Leonel A; Bobokova, Jana; González-Granda, Patricia V; Iniesta, José M; Gómez, Enrique J; Hernando, M Elena

2017-12-12

Telemedicine is becoming increasingly important in Ecuador, especially in areas such as rural primary healthcare and medical education. Rural telemedicine programs in the country need to be strengthened by means of a technological platform adapted to local surroundings and offering advantages such as access to specialized care, continuing education, and so on, combined with modest investment requirements. This present article presents the design of a Telemedicine Platform (TMP) for rural healthcare services in Ecuador and a preliminary technical validation with medical students and teachers. An initial field study was designed to capture the requirements of the TMP. In a second phase, the TMP was validated in an academic environment along three consecutive academic courses. Assessment was by means of user polls and analyzing user interactions as registered automatically by the platform. The TMP was developed using Web-based technology and open code software. One hundred twenty-four students and 6 specialized faculty members participated in the study, conducting a total of 262 teleconsultations of clinical cases and 226 responses, respectively. The validation results show that the TMP is a useful communication tool for the documentation and discussion of clinical cases. Moreover, its usage may be recommended as a teaching methodology, to strengthen the skills of medical undergraduates. The results indicate that implementing the system in rural healthcare services in Ecuador would be feasible.

Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

Science.gov (United States)

Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

2008-02-01

Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

Exploring academic procrastination among Turkish students: possible gender differences in prevalence and reasons.

Science.gov (United States)

Ozer, Bilge Uzun; Demir, Ayhan; Ferrari, Joseph R

2009-04-01

The authors examined the prevalence of and reasons, or excuses, for academic procrastination as a function of gender and academic grade level. In Study 1, a factor analysis of responses by 203 Turkish undergraduate students to an academic procrastination measure provided evidence of reliability and validity for the revised scale. In Study 2,784 students (363 women, 421 men; M age = 20.6 years, SD age = 1.74 years) completed the validated Turkish Procrastination Assessment Scale-Students. The results were that 52% of students self-reported frequent academic procrastination, with male students reporting more frequent procrastination on academic tasks than female students. Significantly more female students than male students reported greater academic procrastination because of fear of failure and laziness; male students reported more academic procrastination as a result of risk taking and rebellion against control than did female students.

Academic Medical Centers as digital health catalysts.

Science.gov (United States)

DePasse, Jacqueline W; Chen, Connie E; Sawyer, Aenor; Jethwani, Kamal; Sim, Ida

2014-09-01

Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. Recently, two large bi-coastal Academic Medical Centers, the University of California, San Francisco (UCSF) through the Center for Digital Health Innovation (CDHI) and Partners Healthcare through the Center for Connected Health (CCH) have launched centers focused on digital health innovation. These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models. Copyright © 2014 Elsevier Inc. All rights reserved.

Do medical students like communication? Validation of the German CSAS (Communication Skills Attitude Scale)

Science.gov (United States)

Busch, Anne-Kathrin; Rockenbauch, Katrin; Schmutzer, Gabriele; Brähler, Elmar

2015-01-01

Objectives: Attitudes towards communication skills of medical undergraduates can be gathered using the Communication Skills Attitude Scale (CSAS). We aimed to develop a German version of the CSAS (CSAS-G) in order to explore attitudes towards communication skills in a German cohort. Additionally the potential influence of demographic factors was examined. Methods: We realized the CSAS-G and conducted a survey with 529 participants from 3 different years of study. We then carried out an explorative as well as confirmatory factor analysis and compared the attitudinal scores. Multiple regression analysis was performed. Results: The confirmatory analysis confirmed the two-subscale system revealed by the explorative factor analysis. Students indicate low levels of negative attitudes and moderate levels of positive attitudes. Attitudinal scores differ significantly in relation to gender. Conclusion: The CSAS-G can be used in German cohorts to evaluate attitudes towards communication skills. Medical students in our study show basically a positive approach. Further investigation is necessary to explore and understand attitudes towards communication skills of German medical students. PMID:25699103

Experience with a pharmacy technician medication history program.

Science.gov (United States)

Cooper, Julie B; Lilliston, Michelle; Brooks, DeAnne; Swords, Bruce

2014-09-15

The implementation and outcomes of a pharmacy technician medication history program are described. An interprofessional medication reconciliation team, led by a clinical pharmacist and a clinical nurse specialist, was charged with implementing a new electronic medication reconciliation system to improve compliance with medication reconciliation at discharge and capture compliance-linked reimbursement. The team recommended that the pharmacy department be allocated new pharmacy technician full-time-equivalent positions to assume ownership of the medication history process. Concurrent with the implementation of this program, a medication history standard was developed to define rules for documentation of what a patient reports he or she is actually taking. The standard requires a structured interview with the patient or caregiver and validation with outside sources as indicated to determine which medications to document in the medication history. The standard is based on four medication administration category rules: scheduled, as-needed, short-term, and discontinued medications. The medication history standard forms the core of the medication history technician training and accountability program. Pharmacy technicians are supervised by pharmacists, using a defined accountability plan based on a set of medical staff approved rules for what medications comprise a best possible medication history. Medication history accuracy and completeness rates have been consistently over 90% and rates of provider compliance with medication reconciliation rose from under 20% to 100% since program implementation. A defined medication history based on a medication history standard served as an effective foundation for a pharmacy technician medication history program, which helped improve provider compliance with discharge medication reconciliation. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Traditional health practitioners and the authority to issue medical ...

African Journals Online (AJOL)

to face in selecting the credible practitioners from the bogus ones for registration ... for registration. It is clear that the definition of a traditional health ... medical certificate and its validity can bring about came sharply to the fore in Kievits Kroon ...

Medical identity theft in the emergency department: awareness is crucial.

Science.gov (United States)

Mancini, Michelino

2014-11-01

Medical identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient's identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior.

Medical Identity Theft in the Emergency Department: Awareness is Crucial

Science.gov (United States)

Mancini, Michelino

2014-01-01

Medical Identity theft in the emergency department (ED) can harm numerous individuals, and many frontline healthcare providers are unaware of this growing concern. The two cases described began as typical ED encounters until red flags were discovered upon validating the patient’s identity. Educating all healthcare personnel within and outside the ED regarding the subtle signs of medical identity theft and implementing institutional policies to identify these criminals will discourage further fraudulent behavior. PMID:25493150

Using standardized patients to assess communication skills in medical and nursing students.

Science.gov (United States)

Ryan, C Anthony; Walshe, Nuala; Gaffney, Robert; Shanks, Andrew; Burgoyne, Louise; Wiskin, Connie M

2010-03-17

A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS). Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE's) in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE's and a previously validated global rating scale for CCS. Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5) and sixty four nursing students (Year 2/3 of 4) were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE's for the students. Students who did not pass the assessment were referred for remediation CCS learning. Almost three quarters of medical students (33/46; 72%) and 81% of nursing students (56/64) passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language. A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.

Validity of dementia diagnoses in the danish hospital registers

DEFF Research Database (Denmark)

Phung, T.K.T.; Andersen, B.B.; Phung, T.K.T.

2007-01-01

.24-0.48). Conclusion: The validity of dementia syndrome in the Danish hospital registers was high and allows for epidemiological studies about dementia. Alzheimer's disease, although underregistered, also had a good validity once the diagnosis was registered. In general, other ICD-10 dementia subtypes in the registers......Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety...

[The prevalence of burnout and the related factors among some medical students in Korea].

Science.gov (United States)

Choi, Jaewon; Son, Shill Lee; Kim, Suh Hee; Kim, Hyunsoo; Hong, Jee-Young; Lee, Moo-Sik

2015-12-01

This study was conducted to examine the relationship between the prevalence of burnout and its related factors in medical students in Korea. All available medical students in the metropolitan city of Daejeon, Korea, were asked to answer self-administered questionnaires from July 1 to July 26 in 2013. A total of 534 medical students participated. The Maslach Burnout Inventory-Student Survey (MBI-SS) and structured questionnaires on related factors were used. Confirmatory factor analysis and Cronbach's α were used to verify the applicability of the MBI-SS to medical students in Korea. We also performed chi-square test and logistic regression analysis to identify the factors that were associated with burnout. The MBI-SS was reliable and valid in measuring burnout in Korean medical students. Our confirmatory factor analysis approved and explained the appropriateness of the model fit. The prevalence of burnout among medical students was 26.4% (n=141). Suchrates were higher in students who were female, experienced greater levels of depression, had poor academic performance, feared dropping out, and were stressed by the poor quality of the class facilities. The MBI-SS is a valid instrument to measure academic burnout in Korean medical students. Further studies should be performed, because improvements in the mental health of medical students will benefit these doctors-to-be and their future patients.

Sleep quality in medical students: a comparison across the various phases of the medical course

Science.gov (United States)

Corrêa, Camila de Castro; de Oliveira, Felipe Kazan; Pizzamiglio, Diego Scherlon; Ortolan, Erika Veruska Paiva; Weber, Silke Anna Theresa

2017-01-01

ABSTRACT Objective: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course. Methods: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups. Results: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C. Conclusions: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students. PMID:29365004

Relationship of academic success of medical students with motivation and pre-admission grades.

Science.gov (United States)

Luqman, Muhammad

2013-01-01

To determine predictive validity of pre-admission scores of medical students, evaluate correlation between level of motivation and later on academic success in a medical college. Analytical study. Foundation University Medical College, Islamabad, from June to August 2011. A non-probability convenience sampling of students of 1st to final year MBBS classes was done after obtaining informed consent. These students filled out 'Strength of Motivation for Medical School' (SMMS) questionnaire. The data of pre-admission grades of these students along with academic success in college according to examination results in different years were collected. The correlation between the pre-admission grades and score of SMMS questionnaire with their academic success in medical college was found by applying Pearson co-efficient of correlation in order to determine the predictive validity. Only 46% students revealed strong motivation. A significant, moderate correlation was found between preadmission scores and academic success in 1st year modular examination (0.52) which became weaker in various professional examinations in higher classes. However, no significant correlation was observed between motivation and academic success of medical students in college. Selecting medical students by pre-admission scores or motivation level alone may not be desirable. A combination of measures of cognitive ability criteria (FSc/pre-admission test scores) and non-cognitive skills (personality traits) is recommended to be employed with the use of right tools for selection of students in medical schools.

Validation of the Korean Version of the Mini-Sleep Questionnaire–Insomnia in Korean College Students

Directory of Open Access Journals (Sweden)

Hee-Ju Kim, PhD, RN, OCN

2017-03-01

Conclusion: The Mini-Sleep Questionnaire–Insomnia showed acceptable reliability and validity. Yet, the limited distribution in sleep medications warrants further evaluations in the clinical population.

Usually Available Clinical and Laboratory Data Are Insufficient for a Valid Medication Review: A Crossover Study

NARCIS (Netherlands)

Hurkens, K. P. G. M.; Mestres-Gonzalvo, C.; de Wit, H. A. J. M.; van der Kuy, P. H. M.; Janknegt, R.; Verhey, F.; Schols, J. M. G. A.; Stehouwer, C. D. A.; Winkens, B.; Mulder, W.

2016-01-01

To establish the quality of medication reviews performed by nursing home physicians, general practitioners and pharmacists. 15 Pharmacists, 13 general practitioners and 18 nursing home physicians performed a medication review for three cases (A, B and C), at three evaluation moments. First, they

Validation of core competencies during residency training in anaesthesiology

Directory of Open Access Journals (Sweden)

Spies, Claudia

2011-01-01

Full Text Available Background and goal: Curriculum development for residency training is increasingly challenging in times of financial restrictions and time limitations. Several countries have adopted the CanMEDS framework for medical education as a model into their curricula of specialty training. The purpose of the present study was to validate the competency goals, as derived from CanMEDS, of the Department of Anaesthesiology and Intensive Care Medicine of the Berlin Charité University Medical Centre, by conducting a staff survey. These goals for the qualification of specialists stipulate demonstrable competencies in seven areas: expert medical action, efficient collaboration in a team, communications with patients and family, management and organisation, lifelong learning, professional behaviour, and advocacy of good health. We had previously developed a catalogue of curriculum items based on these seven core competencies. In order to evaluate the validity of this catalogue, we surveyed anaesthetists at our department in regard to their perception of the importance of each of these items. In addition to the descriptive acquisition of data, it was intended to assess the results of the survey to ascertain whether there were differences in the evaluation of these objectives by specialists and registrars. Methods: The questionnaire with the seven adapted CanMEDS Roles included items describing each of their underlying competencies. Each anaesthetist (registrars and specialists working at our institution in May of 2007 was asked to participate in the survey. Individual perception of relevance was rated for each item on a scale similar to the Likert system, ranging from 1 (highly relevant to 5 (not at all relevant, from which ratings means were calculated. For determination of reliability, we calculated Cronbach’s alpha. To assess differences between subgroups, we performed analysis of variance.Results: All seven roles were rated as relevant. Three of the seven

Psychometric properties of the mentor behaviour scale in a sample of Malaysian medical students

Directory of Open Access Journals (Sweden)

Jamilah A.M. Mohammad, MEd

2018-02-01

Conclusion: MBS demonstrates a satisfactory level of construct validity and a high level of internal consistency in measuring supportive mentor behaviours in a medical school setting. This result suggests that MBS can be used as a mentorship evaluation tool for feedback in the context of a Malaysian medical school.

Publication pressure and burn out among Dutch medical professors: a nationwide survey.

Directory of Open Access Journals (Sweden)

Joeri K Tijdink

Full Text Available BACKGROUND: Publication of scientific research papers is important for professionals working in academic medical centres. Quantitative measures of scientific output determine status and prestige, and serve to rank universities as well as individuals. The pressure to generate maximum scientific output is high, and quantitative aspects may tend to dominate over qualitative ones. How this pressure influences professionals' perception of science and their personal well-being is unknown. METHODS AND FINDINGS: We performed an online survey inviting all medical professors (n = 1206 of the 8 academic medical centres in The Netherlands to participate. They were asked to fill out 2 questionnaires; a validated Publication Pressure Questionnaire and the Maslach Burnout Inventory. In total, 437 professors completed the questionnaires. among them, 54% judge that publication pressure 'has become excessive', 39% believe that publication pressure 'affects the credibility of medical research' and 26% judge that publication pressure has a 'sickening effect on medical science'. The burn out questionnaire indicates that 24% of medical professors have signs of burn out. The number of years of professorship was significantly related with experiencing less publication pressure. Significant and strong associations between burn out symptoms and the level of perceived publication pressure were found. The main limitation is the possibility of response bias. CONCLUSION: A substantial proportion of medical professors believe that publication pressure has become excessive, and have a cynical view on the validity of medical science. These perceptions are statistically correlated to burn out symptoms. Further research should address the effects of publication pressure in more detail and identify alternative ways to stimulate the quality of medical science.

Validation of the Gatortail method for accurate sizing of pulmonary vessels from 3D medical images.

Science.gov (United States)

O'Dell, Walter G; Gormaley, Anne K; Prida, David A

2017-12-01

Detailed characterization of changes in vessel size is crucial for the diagnosis and management of a variety of vascular diseases. Because clinical measurement of vessel size is typically dependent on the radiologist's subjective interpretation of the vessel borders, it is often prone to high inter- and intra-user variability. Automatic methods of vessel sizing have been developed for two-dimensional images but a fully three-dimensional (3D) method suitable for vessel sizing from volumetric X-ray computed tomography (CT) or magnetic resonance imaging has heretofore not been demonstrated and validated robustly. In this paper, we refined and objectively validated Gatortail, a method that creates a mathematical geometric 3D model of each branch in a vascular tree, simulates the appearance of the virtual vascular tree in a 3D CT image, and uses the similarity of the simulated image to a patient's CT scan to drive the optimization of the model parameters, including vessel size, to match that of the patient. The method was validated with a 2-dimensional virtual tree structure under deformation, and with a realistic 3D-printed vascular phantom in which the diameter of 64 branches were manually measured 3 times each. The phantom was then scanned on a conventional clinical CT imaging system and the images processed with the in-house software to automatically segment and mathematically model the vascular tree, label each branch, and perform the Gatortail optimization of branch size and trajectory. Previously proposed methods of vessel sizing using matched Gaussian filters and tubularity metrics were also tested. The Gatortail method was then demonstrated on the pulmonary arterial tree segmented from a human volunteer's CT scan. The standard deviation of the difference between the manually measured and Gatortail-based radii in the 3D physical phantom was 0.074 mm (0.087 in-plane pixel units for image voxels of dimension 0.85 × 0.85 × 1.0 mm) over the 64 branches

Measuring psychological flexibility in medical students and residents: a psychometric analysis

Directory of Open Access Journals (Sweden)

Christie L. Palladino

2013-08-01

Full Text Available Purpose: Psychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners’ responses to three measures related to psychological flexibility. Methods: Fourth-year medical students and residents (n=275 completed three measures of overlapping aspects of psychological flexibility: (1 Acceptance and Action Questionnaire-II (AAQ-II; (2 Cognitive Fusion Questionnaire (CFQ; and (3 Mindful Attention and Awareness Questionnaire (MAAS. We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences. Results: We found good internal consistency for responses on the AAQ (α=0.93, MAAS (α=0.92, and CFQ (α=0.95. Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01. Conclusion: Our findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.

Psychometric Evaluation of a Korean Version of the Adherence to Refills and Medications Scale (ARMS) in Adults With Type 2 Diabetes.

Science.gov (United States)

Kim, Chun-Ja; Park, Eunyoung; Schlenk, Elizabeth A; Kim, Moonsun; Kim, Dae Jung

2016-04-01

The purpose of the study was to examine the reliability and validity of the Adherence to Refills and Medications Scale-Korean (ARMS-K) among Korean adults with type 2 diabetes. The Korean translated ARMS-K was back-translated to ensure translation equivalency. A cross-sectional survey was used to evaluate the psychometric properties with exploratory factor analysis for validity and Cronbach's alpha coefficients for reliability. The factor analysis of construct validity identified 3 dimensions of the ARMS-K, explaining 54.7% of the total variance. The internal consistency reliability for the total instrument was acceptable with a Cronbach's alpha of .801. There was good correlation between the ARMS-K and 8-item Morisky Medication Adherence Scale-Korean version (r = -0.698), indicating that these scales measure theoretically related constructs as evidence of convergent validity. As evidence of known groups validity, there was a significant association between the ARMS-K score and glycemic control (P = .048), indicating that the good glycemic controlled group was more likely to have a higher rate of adherence to refills and medications than the poor glycemic controlled group. These results support the cross-cultural applicability of the concepts underlying the ARMS-K. The ARMS-K can be used not only to assess adherence to refills and medications in Koreans with diabetes but also to examine the potential role of adherence to refills and medications in enhanced glycemic control of people with diabetes in a variety of clinical settings. © 2016 The Author(s).

The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease.

Science.gov (United States)

Wild, Marcus G; Wallston, Kenneth A; Green, Jamie A; Beach, Lauren B; Umeukeje, Ebele; Wright Nunes, Julie A; Ikizler, T Alp; Steed, Julia; Cavanaugh, Kerri L

2017-10-01

Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment of CKD requires dedicated involvement from both caretakers and patients. Self-efficacy, also known as perceived competence, contributes to successful maintenance of patient's CKD self-management behaviors such as medication adherence and dietary regulations. Despite a clear association between self-efficacy and improved CKD outcomes, there remains a lack of validated self-report measures of CKD self-efficacy. To address this gap, the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously validated Perceived Medical Condition Self-Management Scale. We then sought to validate this using data from two separate cohorts: a cross-sectional investigation of 146 patients with end-stage renal disease receiving maintenance hemodialysis and a longitudinal study of 237 patients with CKD not receiving dialysis. The PKDSMS was found to be positively and significantly correlated with self-management behaviors and medication adherence in both patient cohorts. The PKDSMS had acceptable reliability, was internally consistent, and exhibited predictive validity between baseline PKDSMS scores and self-management behaviors across multiple time points. Thus, the PKDSMS is a valid and reliable measure of CKD patient self-efficacy and supports the development of interventions enhancing perceived competence to improve CKD self-management. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Medical image computing and computer-assisted intervention - MICCAI 2005. Proceedings; Pt. 1

International Nuclear Information System (INIS)

Duncan, J.S.; Gerig, G.

2005-01-01

The two-volume set LNCS 3749 and LNCS 3750 constitutes the refereed proceedings of the 8th International Conference on Medical Image Computing and Computer-Assisted Intervention, MICCAI 2005, held in Palm Springs, CA, USA, in October 2005. Based on rigorous peer reviews the program committee selected 237 carefully revised full papers from 632 submissions for presentation in two volumes. The first volume includes all the contributions related to image analysis and validation, vascular image segmentation, image registration, diffusion tensor image analysis, image segmentation and analysis, clinical applications - validation, imaging systems - visualization, computer assisted diagnosis, cellular and molecular image analysis, physically-based modeling, robotics and intervention, medical image computing for clinical applications, and biological imaging - simulation and modeling. The second volume collects the papers related to robotics, image-guided surgery and interventions, image registration, medical image computing, structural and functional brain analysis, model-based image analysis, image-guided intervention: simulation, modeling and display, and image segmentation and analysis. (orig.)

Medical image computing and computer science intervention. MICCAI 2005. Pt. 2. Proceedings

International Nuclear Information System (INIS)

Duncan, J.S.; Yale Univ., New Haven, CT; Gerig, G.

2005-01-01

The two-volume set LNCS 3749 and LNCS 3750 constitutes the refereed proceedings of the 8th International Conference on Medical Image Computing and Computer-Assisted Intervention, MICCAI 2005, held in Palm Springs, CA, USA, in October 2005. Based on rigorous peer reviews the program committee selected 237 carefully revised full papers from 632 submissions for presentation in two volumes. The first volume includes all the contributions related to image analysis and validation, vascular image segmentation, image registration, diffusion tensor image analysis, image segmentation and analysis, clinical applications - validation, imaging systems - visualization, computer assisted diagnosis, cellular and molecular image analysis, physically-based modeling, robotics and intervention, medical image computing for clinical applications, and biological imaging - simulation and modeling. The second volume collects the papers related to robotics, image-guided surgery and interventions, image registration, medical image computing, structural and functional brain analysis, model-based image analysis, image-guided intervention: simulation, modeling and display, and image segmentation and analysis. (orig.)

Medical image computing and computer-assisted intervention - MICCAI 2005. Proceedings; Pt. 1

Energy Technology Data Exchange (ETDEWEB)

Duncan, J.S. [Yale Univ., New Haven, CT (United States). Dept. of Biomedical Engineering and Diagnostic Radiology; Gerig, G. (eds.) [North Carolina Univ., Chapel Hill (United States). Dept. of Computer Science

2005-07-01

The two-volume set LNCS 3749 and LNCS 3750 constitutes the refereed proceedings of the 8th International Conference on Medical Image Computing and Computer-Assisted Intervention, MICCAI 2005, held in Palm Springs, CA, USA, in October 2005. Based on rigorous peer reviews the program committee selected 237 carefully revised full papers from 632 submissions for presentation in two volumes. The first volume includes all the contributions related to image analysis and validation, vascular image segmentation, image registration, diffusion tensor image analysis, image segmentation and analysis, clinical applications - validation, imaging systems - visualization, computer assisted diagnosis, cellular and molecular image analysis, physically-based modeling, robotics and intervention, medical image computing for clinical applications, and biological imaging - simulation and modeling. The second volume collects the papers related to robotics, image-guided surgery and interventions, image registration, medical image computing, structural and functional brain analysis, model-based image analysis, image-guided intervention: simulation, modeling and display, and image segmentation and analysis. (orig.)

Medical image computing and computer science intervention. MICCAI 2005. Pt. 2. Proceedings

Energy Technology Data Exchange (ETDEWEB)

Duncan, J.S. [Yale Univ., New Haven, CT (United States). Dept. of Biomedical Engineering]|[Yale Univ., New Haven, CT (United States). Dept. of Diagnostic Radiology; Gerig, G. (eds.) [North Carolina Univ., Chapel Hill, NC (United States). Dept. of Computer Science

2005-07-01

The two-volume set LNCS 3749 and LNCS 3750 constitutes the refereed proceedings of the 8th International Conference on Medical Image Computing and Computer-Assisted Intervention, MICCAI 2005, held in Palm Springs, CA, USA, in October 2005. Based on rigorous peer reviews the program committee selected 237 carefully revised full papers from 632 submissions for presentation in two volumes. The first volume includes all the contributions related to image analysis and validation, vascular image segmentation, image registration, diffusion tensor image analysis, image segmentation and analysis, clinical applications - validation, imaging systems - visualization, computer assisted diagnosis, cellular and molecular image analysis, physically-based modeling, robotics and intervention, medical image computing for clinical applications, and biological imaging - simulation and modeling. The second volume collects the papers related to robotics, image-guided surgery and interventions, image registration, medical image computing, structural and functional brain analysis, model-based image analysis, image-guided intervention: simulation, modeling and display, and image segmentation and analysis. (orig.)

Metacognitive Listening Strategies Used by Saudi EFL Medical Students

Science.gov (United States)

Alhaison, Eid

2017-01-01

The present study investigated the metacognitive listening strategies among Saudi EFL medical students. The participants were 104 males and females, randomly selected to fill in the Metacognitive Awareness Listening Questionnaire (MALQ), developed and validated Vandergrift Goh, Mareschal, and Tafaghodtari (2006). The results revealed that…

Medically treated exacerbations in COPD by GOLD 1-4

DEFF Research Database (Denmark)

Sylvan Ingebrigtsen, Truls; Marott, Jacob L; Lange, Peter

2015-01-01

AIM: We hypothesized that medically treated exacerbations in COPD defined as treatments with oral corticosteroids alone or in combination with antibiotics by register linkage with a nationwide prescription registry is a valid, robust and low-biased measure of exacerbations. METHODS: A total of 13...

Sleep Disruption Medical Intervention Forecasting (SDMIF) Module for the Integrated Medical Model

Science.gov (United States)

Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry

2011-01-01

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

[Cultural adaptation and validation of the Medical Outcomes Study Social Support Survey questionnaire (MOS-SSS)].

Science.gov (United States)

Alonso Fachado, A; Montes Martinez, A; Menendez Villalva, C; Pereira, M Graça

2007-01-01

The aim of this study was the assesment of psychometric properties of the Portuguese version of the instrument "Medical Outcomes Study - Social Support Survey (MOSSSS)". This questionnaire has been translated and adapted in a Portuguese sample of 101 patients with chronic illness of a rural health centre in Portugal. The average age of patients was 63.4 years, 56.4% female. 29% were illiterate and 2% had completed high school. 78% had arterial hypertension and the 56.4% had diabetes mellitus type 2. The internal consistency was evaluated using Cronbach's alpha. Exploratory and Confirmatory factor analysis were performed in order to confirm reliability and validity of the scale and its multidimensional characteristics. The 2-week test-retest reliability was estimated using weighted kappa for the ordinals variables and intraclass coefficient correlation for the quantitative variables. Cronbach's alphas for the subscales ranged from 0.873 to 0.967 at test, and 0.862 to 0.972 at retest. Exploratory factor analysis revealed the existence of four factors (emotional, tangible, positive interaction and affection support) that explain the 72.71% of the variance. Confirmatory factor analysis supported the existence of four factors that allowed the application of the scale with original items. The goodness-of-fit measures corroborate the initial structure, with chi2/ df=2.01, GFI=0.998, CFI=0.999, AGFI=0.998, TLI=0.999, NFI=0.998, SRMR=0.332, RMSEA=0.76. The 2-weeks test-retest reliability of the Portuguese MOS-SSS as measured by the intraclass correlation coefficient was ranged from 0.941 to 0.966 for the four dimensions and the overall support index. The weighted kappa was ranged from 0.67 to 0.87 for all the items. The MOS-SSS Portuguese version demonstrates good psychometric properties and seems to be useful to measure multidimensional aspects of social support in the Portuguese population.

Validity and reliability of the Achilles tendon total rupture score.

Science.gov (United States)

Ganestam, Ann; Barfod, Kristoffer; Klit, Jakob; Troelsen, Anders

2013-01-01

The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. The purpose of the present study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately strong correlations with the physical subscores of the Medical Outcomes Study 36-item Short-Form Health Survey (r = .70 to .75; p questionnaire (r = .71; p validity. For study and follow-up purposes, the ATRS seems reliable for comparisons of groups of patients. Its usability is limited for repeated assessment of individual patients. The development of analysis guidelines would be desirable. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Completeness and validity in a national clinical thyroid cancer database

DEFF Research Database (Denmark)

Londero, Stefano Christian; Mathiesen, Jes Sloth; Krogdahl, Annelise

2014-01-01

cancer database: DATHYRCA. STUDY DESIGN AND SETTING: National prospective cohort. Denmark; population 5.5 million. Completeness of case ascertainment was estimated by the independent case ascertainment method using three governmental registries as a reference. The reabstracted record method was used...... to appraise the validity. For validity assessment 100 cases were randomly selected from the DATHYRCA database; medical records were used as a reference. RESULT: The database held 1934 cases of thyroid carcinoma and completeness of case ascertainment was estimated to 90.9%. Completeness of registration......BACKGROUND: Although a prospective national clinical thyroid cancer database (DATHYRCA) has been active in Denmark since January 1, 1996, no assessment of data quality has been performed. The purpose of the study was to evaluate completeness and data validity in the Danish national clinical thyroid...

Seven-day mortality can be predicted in medical patients by blood pressure, age, respiratory rate, loss of independence, and peripheral oxygen saturation (the PARIS score: a prospective cohort study with external validation.

Directory of Open Access Journals (Sweden)

Mikkel Brabrand

Full Text Available Most existing risk stratification systems predicting mortality in emergency departments or admission units are complex in clinical use or have not been validated to a level where use is considered appropriate. We aimed to develop and validate a simple system that predicts seven-day mortality of acutely admitted medical patients using routinely collected variables obtained within the first minutes after arrival.This observational prospective cohort study used three independent cohorts at the medical admission units at a regional teaching hospital and a tertiary university hospital and included all adult (≥ 15 years patients. Multivariable logistic regression analysis was used to identify the clinical variables that best predicted the endpoint. From this, we developed a simplified model that can be calculated without specialized tools or loss of predictive ability. The outcome was defined as seven-day all-cause mortality. 76 patients (2.5% met the endpoint in the development cohort, 57 (2.0% in the first validation cohort, and 111 (4.3% in the second. Systolic blood Pressure, Age, Respiratory rate, loss of Independence, and peripheral oxygen Saturation were associated with the endpoint (full model. Based on this, we developed a simple score (range 0-5, ie, the PARIS score, by dichotomizing the variables. The ability to identify patients at increased risk (discriminatory power and calibration was excellent for all three cohorts using both models. For patients with a PARIS score ≥ 3, sensitivity was 62.5-74.0%, specificity 85.9-91.1%, positive predictive value 11.2-17.5%, and negative predictive value 98.3-99.3%. Patients with a score ≤ 1 had a low mortality (≤ 1%; with 2, intermediate mortality (2-5%; and ≥ 3, high mortality (≥ 10%.Seven-day mortality can be predicted upon admission with high sensitivity and specificity and excellent negative predictive values.

Content validity--establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 1--eliciting concepts for a new PRO instrument.

Science.gov (United States)

Patrick, Donald L; Burke, Laurie B; Gwaltney, Chad J; Leidy, Nancy Kline; Martin, Mona L; Molsen, Elizabeth; Ring, Lena

2011-12-01

The importance of content validity in developing patient reported outcomes (PRO) instruments is stressed by both the US Food and Drug Administration and the European Medicines Agency. Content validity is the extent to which an instrument measures the important aspects of concepts that developers or users purport it to assess. A PRO instrument measures the concepts most significant and relevant to a patient's condition and its treatment. For PRO instruments, items and domains as reflected in the scores of an instrument should be important to the target population and comprehensive with respect to patient concerns. Documentation of target population input in item generation, as well as evaluation of patient understanding through cognitive interviewing, can provide the evidence for content validity. Developing content for, and assessing respondent understanding of, newly developed PRO instruments for medical product evaluation will be discussed in this two-part ISPOR PRO Good Research Practices Task Force Report. Topics include the methods for generating items, documenting item development, coding of qualitative data from item generation, cognitive interviewing, and tracking item development through the various stages of research and preparing this tracking for submission to regulatory agencies. Part 1 covers elicitation of key concepts using qualitative focus groups and/or interviews to inform content and structure of a new PRO instrument. Part 2 covers the instrument development process, the assessment of patient understanding of the draft instrument using cognitive interviews and steps for instrument revision. The two parts are meant to be read together. They are intended to offer suggestions for good practices in planning, executing, and documenting qualitative studies that are used to support the content validity of PRO instruments to be used in medical product evaluation. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR

Validation of the Continuum of Care Conceptual Model for Athletic Therapy

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Mark R. Lafave

2015-01-01

Full Text Available Utilization of conceptual models in field-based emergency care currently borrows from existing standards of medical and paramedical professions. The purpose of this study was to develop and validate a comprehensive conceptual model that could account for injuries ranging from nonurgent to catastrophic events including events that do not follow traditional medical or prehospital care protocols. The conceptual model should represent the continuum of care from the time of initial injury spanning to an athlete’s return to participation in their sport. Finally, the conceptual model should accommodate both novices and experts in the AT profession. This paper chronicles the content validation steps of the Continuum of Care Conceptual Model for Athletic Therapy (CCCM-AT. The stages of model development were domain and item generation, content expert validation using a three-stage modified Ebel procedure, and pilot testing. Only the final stage of the modified Ebel procedure reached a priori 80% consensus on three domains of interest: (1 heading descriptors; (2 the order of the model; (3 the conceptual model as a whole. Future research is required to test the use of the CCCM-AT in order to understand its efficacy in teaching and practice within the AT discipline.

Development and face validation of strategies for improving consultation skills.

Science.gov (United States)

Lefroy, Janet; Thomas, Adam; Harrison, Chris; Williams, Stephen; O'Mahony, Fidelma; Gay, Simon; Kinston, Ruth; McKinley, R K

2014-12-01

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of written feedback. To systematically develop, validate and maximise the utility of a comprehensive list of strategies for improvement of consultation skills through a process involving both medical students and their clinical primary and secondary care tutors. Modified Delphi study with tutors, modified nominal group study with students with moderation of outputs by consensus round table discussion by the authors. 35 hospital and 21 GP tutors participated in the Delphi study and contributed 153 new or modified strategies. After review of these and the 205 original strategies, 265 strategies entered the nominal group study to which 46 year four and five students contributed, resulting in the final list of 249 validated strategies. We have developed a valid and comprehensive set of strategies which are considered useful by medical students. This list can be immediately applied by any school which uses the Calgary Cambridge Framework to inform the content of formative feedback on consultation skills. We consider that the list could also be mapped to alternative skills frameworks and so be utilised by schools which do not use the Calgary Cambridge Framework.

A conceptual framework for homeostasis: development and validation.

Science.gov (United States)

McFarland, Jenny; Wenderoth, Mary Pat; Michael, Joel; Cliff, William; Wright, Ann; Modell, Harold

2016-06-01

We have developed and validated a conceptual framework for understanding and teaching organismal homeostasis at the undergraduate level. The resulting homeostasis conceptual framework details critical components and constituent ideas underlying the concept of homeostasis. It has been validated by a broad range of physiology faculty members from community colleges, primarily undergraduate institutions, research universities, and medical schools. In online surveys, faculty members confirmed the relevance of each item in the framework for undergraduate physiology and rated the importance and difficulty of each. The homeostasis conceptual framework was constructed as a guide for teaching and learning of this critical core concept in physiology, and it also paves the way for the development of a concept inventory for homeostasis. Copyright © 2016 The American Physiological Society.

Assessing the Knowledge and Attitudes of Medical Students and Graduates about Clinical Governance

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Rana Gholamzadeh nikjoo

2015-08-01

Full Text Available Background and Objectives : In order to implement clinical governance successfully, it should be perceived positively and there must be a positive attitude towards it. The current policy of the Ministry of Health and Medical Education about clinical governance requires assessing the knowledge and attitudes of medical students to identify their educational needs and the necessary steps needed to be taken in educational planning, designing and modification of the courses. This study aimed to evaluate the knowledge and attitudes of medical students and graduates about clinical governance in 1391. Materials and Methods : This is a descriptive–analytic study. This research was conducted on 159 students from different medical fields simple random sampling method. For data collecting, a researcher-made questionnaire was used which its validity was confirmed by using content validity and construct validity. To determine the reliability of the questionnaire, internal consistency and Cronbach's Alpha were used for field of knowledge (0.78 and attitude (0.68. For data analysis, SPSS version 11.5 software was applied using exploratory factor analysis method. Results : 64% of the participants were female and 36% were male. 71% of the participants were in the health care management field and 29% from other medical fields. Mean and standard deviation of knowledge and attitude scores were 64.2 ± 5.8 and 13.06 ± 3.02 respectively. Comparing the students' and graduates’ knowledge and attitudes with their educational level showed no significant correlation. (P> 0.05 Although, there was a significant correlation between educational level and attitude (P = 0.001. In higher levels of education, students' attitude towards clinical governance reduced. Conclusion : The knowledge of medical students and graduates was estimated average to high about clinical governance but their attitude was very poor. This reflects negative views of medical students despite the

Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department.

Science.gov (United States)

Baten, Verena; Busch, Hans-Jörg; Busche, Caroline; Schmid, Bonaventura; Heupel-Reuter, Miriam; Perlov, Evgeniy; Brich, Jochen; Klöppel, Stefan

2018-05-08

Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. We implemented the bCAM into practice in a German interdisciplinary high-volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrolled. The bCAM showed 93.8% specificity (95% confidence interval [CI] = 90.0%-96.5%) and 65.2% sensitivity (95% CI = 49.8%-78.7%). Positive and negative likelihood ratios were 10.5 and 0.37, respectively, while the odds ratio was 28.4. Delirium was missed in 10 of 16 cases, since the bCAM did not indicate altered levels of consciousness and disorganized thinking. The level of agreement with the criterion standard increased for patients with low cognitive performance. This was the first study evaluating the bCAM for a German ED and when performed by EPs during routine work. The bCAM showed good specificity, but only moderate sensitivity. Nevertheless, application of the bCAM most likely improves the delirium detection rate in German EDs. However, it should only be applied by trained physicians to maximize diagnostic accuracy and hence improve the bCAM's sensitivity. Future studies should refine the bCAM. © 2018 by the Society for Academic Emergency Medicine.

[Development of the scale of strategies for enhancing self-esteem among medical school students].

Science.gov (United States)

Kim, Jin-Ju; Jang, Eun-Young; Park, Yong-Chon

2013-06-01

From the point of view that medical students are under the pressure of academic achievement and vulnerable to subjective distress, there is need for evaluate their strategies for enhancing self-esteem when they failed academically. This study was to develop the scale for enhancing self-esteem and to confirm the convergent, discriminant and criteria validity. Data were collected from 279 students at a medical school in Seoul. The scale of strategies for enhancing self-esteem (SSES) comprised comparison with inferior, doubting academic failure, accepting failure, and attribution to incidental factors. Also, to confirm the validities, participants responded to items measuring self-esteem, narcissism, 5 personality factors, depression and adjustment. By explanatory factor analysis of SSES, composed of three factors-comparison, doubting, and acceptance-and in the confirmatory factor analysis, 3 dimensions were best fit. Notably, comparison and doubting strategies were positively associated with depression and negatively associated with adjustment. In contrast, acceptance strategies were negatively associated with depression and positively associated with adjustment. Additionally, comparison and doubting strategies were positively associated with narcissism. The SSES of medical school students after academic failure yields 3 dimensions reliably and consistently. Also, it shows satisfactory convergent and concurrent validities.

Medical students' attitude of their success rate in clerkship period in Birjand University of Medical Sciences

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Mohammad Reza Hadjyabady

2002-07-01

Full Text Available Background With regard to accelerated progresses in the world of science and technology, as well as changes in the needs of the society, medical education should be a developing process. One of the main factors that can promote education from a static to a dynamic and effective state is evaluation. Purpose The purpose of the present survey is to determine the rate of success of medical students passing their clerkship in Birjand University of Medical Sciences from their own views of attaining educational goals of Urology Department. Methods The study is descriptive-analytical and has been performed on 50 medical students in Birjand University of Medical Sciences. Having determined the validity as well as the reliability of the question­naires, we used them to collect the data. Results Participants were 37 men (74% and 13 women (26%. T-test demonstrated a significant statical difference between male and female students in practical management of cases in urology ward (p<0.03. significant. Better practical performance was evident when the students take practical approach, in addition to looking and listening. Also, if students used various methods of teaching and learning, they would better manage cases. Conclusion The rate of medical students' success in their clerkship period for educational goals of urology was good. However, providing required facilities for giving instructions on clinical skills such as educational clinical workshops, clinical skill workshops and clinical skills centre, educational films and bed­ side practice under supervision of professors, will promote the fulfilment of educational goals. Key word educational goals, medical students, urology ward

National programmes for validating physician competence and fitness for practice: a scoping review.

Science.gov (United States)

Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

2016-04-15

To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Scoping review. MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000-2014). Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin--defined as that of the primary author--included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build on current evidence or theory. Terminology is highly variable across programmes

Using standardized patients to assess communication skills in medical and nursing students

LENUS (Irish Health Repository)

Ryan, C Anthony

2010-03-17

Abstract Background A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS). Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE\\'s) in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE\\'s and a previously validated global rating scale for CCS. Methods Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5) and sixty four nursing students (Year 2\\/3 of 4) were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE\\'s for the students. Students who did not pass the assessment were referred for remediation CCS learning. Results Almost three quarters of medical students (33\\/46; 72%) and 81% of nursing students (56\\/64) passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language. Conclusions A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.

Using standardized patients to assess communication skills in medical and nursing Students

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Burgoyne Louise

2010-03-01

Full Text Available Abstract Background A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS. Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE's in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE's and a previously validated global rating scale for CCS. Methods Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5 and sixty four nursing students (Year 2/3 of 4 were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE's for the students. Students who did not pass the assessment were referred for remediation CCS learning. Results Almost three quarters of medical students (33/46; 72% and 81% of nursing students (56/64 passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language. Conclusions A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.

Systems Engineering for Space Exploration Medical Capabilities

Science.gov (United States)

Mindock, Jennifer; Reilly, Jeffrey; Rubin, David; Urbina, Michelle; Hailey, Melinda; Hanson, Andrea; Burba, Tyler; McGuire, Kerry; Cerro, Jeffrey; Middour, Chris;

Attitude toward Plagiarism among Iranian Medical Faculty Members

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Seyed Hassan Emami-Razavi

2012-11-01

Full Text Available The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members ofTehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 ± 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 ± 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 ± 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1. It is essential to provide materials (such as workshops, leaflets and mandatory courses to make Iranian medical faculty members familiar with medicalresearch ethics issues such as plagiarism.

Rapid development of medical imaging tools with open-source libraries.

Science.gov (United States)

Caban, Jesus J; Joshi, Alark; Nagy, Paul

2007-11-01

Rapid prototyping is an important element in researching new imaging analysis techniques and developing custom medical applications. In the last ten years, the open source community and the number of open source libraries and freely available frameworks for biomedical research have grown significantly. What they offer are now considered standards in medical image analysis, computer-aided diagnosis, and medical visualization. A cursory review of the peer-reviewed literature in imaging informatics (indeed, in almost any information technology-dependent scientific discipline) indicates the current reliance on open source libraries to accelerate development and validation of processes and techniques. In this survey paper, we review and compare a few of the most successful open source libraries and frameworks for medical application development. Our dual intentions are to provide evidence that these approaches already constitute a vital and essential part of medical image analysis, diagnosis, and visualization and to motivate the reader to use open source libraries and software for rapid prototyping of medical applications and tools.

Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

Science.gov (United States)

Boehnke, Kevin F; Litinas, Evangelos; Clauw, Daniel J

2016-06-01

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Validity of Type D personality in Iceland

DEFF Research Database (Denmark)

Svansdottir, Erla; Karlsson, Hrobjartur D; Gudnason, Thorarinn

2012-01-01

was 26-29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D......Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed...... the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D...

Measuring racial microaggression in medical practice.

Science.gov (United States)

Almond, Amanda Lee

2017-08-01

The purpose of this study was to validate the already existing Racial Microaggression in Counseling Scale (RMCS) when the term 'therapist' was replaced with 'physician', thus constituting the modification as the Racial Microaggression in Medical Practice Scale (RMMPS). Racial microaggressions work at reinforcing inferior social status on a cognitive level. Unlike overt racism, messages behind microaggression are subtler and more every day. A lack of acceptance, respect, and regard emerges from interactions in medical contexts as there are layers of in-group and out-group statuses at play (e.g. physician-patient, Black-White, expert-lay, and Westernized-alternative). The layer focused on in this study was that of race or skin color. A sample of racial minorities in the Northeast (n = 91) was investigated both quantitatively and qualitatively to validate the modification and future use of a RMMPS. The scale was related to the racial incongruence between patient and provider. Qualitative findings support the original concepts and themes used when developing the 10-item measure in a counseling setting. Psychometric findings for the scale also supported its factorial structure using generalizability theory estimates. Future implications of this research relate to health behavior, trustworthiness, and health outcomes of minority patients. Its potential for use among various practitioners, educators, and researchers is also discussed.

[Validity of a standard questionnaire to assess physical activity for specific medical checkups and health guidance].

Science.gov (United States)

Kawakami, Ryoko; Miyachi, Motohiko

2010-10-01

This study aimed to determine the validity of a standard questionnaire to assess amount of physical activity (PA) and cardiorespiratory fitness (VO2peak). A total of 483 men and women, aged 20 to 69 years, participated. The standard questionnaire included 3 items about exercise, PA, and walking speed. All questions were designed to require an answer of Yes or No. Subjects were classified into one of four groups regarding the number of Yes answers to the three questions, giving activity levels of 0 to 3. The amount of PA was measured objectively with a tn-axial accelerometer which could also calculate daily step counts, and the amounts of PA under 3 metabolic equivalents (METs) and at 3 METs or more. VO2peak. was measured by incremental cycle exercise tests with indirect calorimetry. The daily step counts, the amount of PA at 3 METs or more, and the VO2peak. were significantly higher in subjects who answered Yes to each question than in those who answered No. Sensitivity and specificity of each question were 62-73% and 45-71% for the amount of PA established with the "Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR2006)". The sum of sensitivity and specificity was the highest when the cutoff value was activity level 2 (sensitivity 73%, specificity 68%). Sensitivity and specificity for VO2max established by EPAR2006 were lower than those for the amount of PA. These results suggest that only answering simple questions with a standard questionnaire is sufficient for estimation of PA levels for specific medical checkups and health guidance, even though the accuracy is somewhat limited.

Health physics limitations for radiation protection of patients and medical staff

International Nuclear Information System (INIS)

Golikov, V.Ya.; Ermolina, E.P.

1997-01-01

Norm-setting documents regulating the requirements to radiation safety during medical x-ray and radiological procedures are reviewed. Besides the Federal Law On Radiation Safety of the Population and Radiation Safety Norms-96, the authors comment on the norm-setting documents issued later and supplementing the above documents. The authors emphasize the obligatory licensing during medical use of ionizing radiation sources. Effective dose is introduced as the criterion of radiation safety of the patients and staff during prophylactic x-ray examinations. Principles of normsetting, validation, and optimization of medical exposures and criteria of radiation safety of patients are discussed

The Evolution of Medical Training Simulation in the U.S. Military.

Science.gov (United States)

Linde, Amber S; Kunkler, Kevin

2016-01-01

The United States has been at war since 2003. During that time, training using Medical Simulation technology has been developed and integrated into military medical training for combat medics, nurses and surgeons. Efforts stemming from the Joint Programmatic Committee-1 (JPC-1) Medical Simulation and Training Portfolio has allowed for the improvement and advancement in military medical training by focusing on research in simulation training technology in order to achieve this. Based upon lessons learned capability gaps have been identified concerning the necessity to validate and enhance combat medial training simulators. These capability gaps include 1) Open Source/Open Architecture; 2) Modularity and Interoperability; and 3) Material and Virtual Reality (VR) Models. Using the capability gaps, JPC-1 has identified important research endeavors that need to be explored.

Compositional and enumerative designs for medical language representation.

Science.gov (United States)

Rassinoux, A M; Miller, R A; Baud, R H; Scherrer, J R

1997-01-01

Medical language is in essence highly compositional, allowing complex information to be expressed from more elementary pieces. Embedding the expressive power of medical language into formal systems of representation is recognized in the medical informatics community as a key step towards sharing such information among medical record, decision support, and information retrieval systems. Accordingly, such representation requires managing both the expressiveness of the formalism and its computational tractability, while coping with the level of detail expected by clinical applications. These desiderata can be supported by enumerative as well as compositional approaches, as argued in this paper. These principles have been applied in recasting a frame-based system for general medical findings developed during the 1980s. The new system captures the precise meaning of a subset of over 1500 medical terms for general internal medicine identified from the Quick Medical Reference (QMR) lexicon. In order to evaluate the adequacy of this formal structure in reflecting the deep meaning of the QMR findings, a validation process was implemented. It consists of automatically rebuilding the semantic representation of the QMR findings by analyzing them through the RECIT natural language analyzer, whose semantic components have been adjusted to this frame-based model for the understanding task.

Validation of epilepsy diagnoses in the Danish National Hospital Register

DEFF Research Database (Denmark)

Christensen, Jakob; Vestergaard, Mogens; Olsen, Jørn

2007-01-01

PURPOSE: To validate the diagnosis of epilepsy in the Danish National Hospital Register. METHODS: We randomly selected 200 patients registered with epilepsy in the Danish National Hospital Register between 1977 and 2002 and validated the diagnosis according to the guidelines developed...... by the International League Against Epilepsy. RESULTS: We reviewed the medical records of 188 (94%) persons from 57 departments at 41 hospitals. The epilepsy diagnoses were confirmed in 153 patients, providing a positive predictive value for epilepsy of 81% (95% confidence interval (95% CI): 75-87%). Among the 35...... for syndrome classification was 60% (95% CI: 44-74%) for epilepsy with complex focal seizures and 35% (95% CI: 22-51%) for primary generalized epilepsy. CONCLUSION: The validity of the epilepsy diagnoses in the Danish National Hospital Register has a moderate to high positive predictive value for epilepsy...

Large-scale international validation of the ADO index in subjects with COPD

DEFF Research Database (Denmark)

Puhan, Milo A; Hansel, Nadia N; Sobradillo, Patricia

2012-01-01

BACKGROUND: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. OBJECTIVE: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV(1) to predict 3......-IV. MEASUREMENTS: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity......-to-moderate risk of 3-year mortality than FEV(1) alone. INTERPRETATION: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions....

Validation of the Greek translation of the Dundee Ready Education Environment Measure (DREEM).

Science.gov (United States)

Dimoliatis, I D K; Vasilaki, E; Anastassopoulos, P; Ioannidis, J P A; Roff, S

2010-04-01

The educational environment makes an important contribution to student learning. The DREEM questionnaire is a validated tool assessing the environment. To translate and validate the DREEM into Greek. Forward translations from English were produced by three independent Greek translators and then back translations by five independent bilingual translators. The Greek DREEM.v0 that was produced was administered to 831 undergraduate students from six Greek medical schools. Cronbach's alpha and test-retest correlation were used to evaluate reliability and factor analysis was used to assess validity. Questions that increased alpha if deleted and/or sorted unexpectedly in factor analysis were further checked through two focus groups. Questionnaires were returned by 487 respondents (59%), who were representative of all surveyed students by gender but not by year of study or medical school. The instrument's overall alpha was 0.90, and for the learning, teachers, academic, atmosphere and social subscales the alphas were 0.79 (expected 0.69), 0.78 (0.67), 0.69 (0.60), 0.68 (0.69), 0.48 (0.57), respectively. In a subset of the whole sample, test and retest alphas were both 0.90, and mean item scores highly correlated (peducation environment and for informing policy. Factor analysis and focus group input suggest it is a valid tool. Reasonable school differences suggest the instrument's sensitivity.

Psychometric properties of the medical outcomes study: social support survey among methadone maintenance patients in Ho Chi Minh City, Vietnam: a validation study.

Science.gov (United States)

Khuong, Long Quynh; Vu, Tuong-Vi Thi; Huynh, Van-Anh Ngoc; Thai, Truc Thanh

2018-02-14

Social support plays a crucial role in the treatment and recovery process of patients engaging in methadone maintenance treatment (MMT). However, there is a paucity of research about social support among MMT patients, possibly due to a lack of appropriate measuring tools. This study aimed to evaluate the psychometric properties of the Vietnamese version of the Medical Outcomes Study: Social Support Survey (MOS-SSS) among MMT patients. A cross-sectional survey of 300 patients was conducted in a methadone clinic in Ho Chi Minh City, Vietnam. MMT patients who agreed to participate in the study completed a face-to-face interview in a private room. The MOS-SSS was translated into Vietnamese using standard forward-backward process. Internal consistency was measured by Cronbach's alpha. The intra-class correlation coefficient was used to determine the test-retest reliability of the MOS-SSS in 75 participants two weeks after the first survey. Concurrent validity of the MOS-SSS was evaluated by correlations with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Perceived Stigma of Addiction Scale (PSAS). Construct validity was investigated by confirmatory factor analysis. The MOS-SSS had good internal consistency with Cronbach's alpha from 0.95 to 0.97 for the four subscales and 0.97 for the overall scale. The two-week test-retest reliability was at moderate level with intra-class correlation coefficients of 0.61-0.73 for the four subscales and 0.76 for the overall scale. Strong significant correlations between the MOS-SSS and the MSPSS (r = 0.77; p SSS was established since a final four-factor model fitted the data well with Comparative Fit Index (0.97), Tucker-Lewis Index (0.97), Standardized Root Mean Square Residual (0.03) and Root Mean Square Error of Approximation (0.068; 90% CI = 0.059-0.077). The MOS-SSS is a reliable and valid tool for measuring social support in Vietnamese MMT patients. Further studies among methadone patients at

Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service.

Science.gov (United States)

Powell, Douglas; McLeroy, Robert D; Riesberg, Jamie; Vasios, William N; Miles, Ethan A; Dellavolpe, Jeffrey; Keenan, Sean; Pamplin, Jeremy C

One of the core capabilities of prolonged field care is telemedicine. We developed the Virtual Critical Care Consult (VC3) Service to provide Special Operations Forces (SOF) medics with on-demand, virtual consultation with experienced critical care physicians to optimize management and improve outcomes of complicated, critically injured or ill patients. Intensive-care doctors staff VC3 continuously. SOF medics access this service via phone or e-mail. A single phone call reaches an intensivist immediately. An e-mail distribution list is used to share information such as casualty images, vital signs flowsheet data, and short video clips, and helps maintain situational awareness among the VC3 critical care providers and other key SOF medical leaders. This real-time support enables direct communication between the remote provider and the clinical subject matter expert, thus facilitating expert management from near the point of injury until definitive care can be administered. The VC3 pilot program has been extensively tested in field training exercises and validated in several real-world encounters. It is an immediately available capability that can reduce medical risk and is scalable to all Special Operations Command forces. 2016.

Validation of the ISAAC Standardized Questionnaire Used by Schoolchildren from Mexicali, Baja California, Mexico

OpenAIRE

Gorozave-Car, Karla; Barraza-Villarreal, Albino; Escamilla-Núñez, Consuelo; Hernandez-Cadena, Leticia; Sanín-Aguirre, Luz Helena; Cortez-Lugo, Marlene; Blanco-Muñoz, J.; Riojas-Rodríguez, Horacio; Moreno-Macias, Hortensia; Romieu, Isabelle

2013-01-01

Background. In Mexico, several studies have been conducted under the ISAAC methodology; nevertheless, no validation studies of the ISAAC questionnaire based on objective clinical testing in our country have been published. Aims of the Study. To validate the ISAAC questionnaire, used in a study of prevalence of allergic diseases, based on medical, respiratory, and allergic evaluations of schoolchildren being 11 to 16 years old in Mexicali, Mexico. Material and Methods. We conducted a cross-sec...

Sterilization of health care products - Ethylene oxide - Part 1: Requirements for development, validation and routine control of a sterilization process for medical devices

International Nuclear Information System (INIS)

2007-01-01

This part of ISO 11135 describes requirements that, if met, will provide an ethylene oxide sterilization process intended to sterilize medical devices, which has appropriate microbicidal activity. Furthermore, compliance with the requirements ensures that this activity is both reliable and reproducible so that it can be predicted, with reasonable confidence, that there is a low level of probability of there being a viable microorganism present on product after sterilization. Specification of this probability is a matter for regulatory authorities and may vary from country to country. The paper provides information on scope, normative references, terms and definitions, quality management systems, sterilizing agent characterization, process and equipment characterization, product definition, process definition, validation, routine monitoring and control, product release from sterilization and maintaining process effectiveness followed by Annex A (Determination of lethal rate of the sterilization process - Biological indicator/bioburden approach), Annex B (Conservative determination of lethal rate of the sterilization process - Overkill approach, annex C (General guidance) and a bibliography.

Medical end-of-life practices among Canadian physicians: a pilot study.

Science.gov (United States)

Marcoux, Isabelle; Boivin, Antoine; Mesana, Laura; Graham, Ian D; Hébert, Paul

2016-01-01

Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study. In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes. Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1% (n = 76). Most respondents (64 [84%]) completed the mail questionnaire. All the criteria for success were met. It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study

Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program.

Science.gov (United States)

Wheat, John R; Leeper, James D; Murphy, Shannon; Brandon, John E; Jackson, James R

2018-02-01

To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P rural physicians, respectively. The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians. © 2017 National Rural Health Association.

Anatomy education environment measurement inventory: A valid tool to measure the anatomy learning environment.

Science.gov (United States)

Hadie, Siti Nurma Hanim; Hassan, Asma'; Ismail, Zul Izhar Mohd; Asari, Mohd Asnizam; Khan, Aaijaz Ahmed; Kasim, Fazlina; Yusof, Nurul Aiman Mohd; Manan Sulong, Husnaida Abdul; Tg Muda, Tg Fatimah Murniwati; Arifin, Wan Nor; Yusoff, Muhamad Saiful Bahri

2017-09-01

Students' perceptions of the education environment influence their learning. Ever since the major medical curriculum reform, anatomy education has undergone several changes in terms of its curriculum, teaching modalities, learning resources, and assessment methods. By measuring students' perceptions concerning anatomy education environment, valuable information can be obtained to facilitate improvements in teaching and learning. Hence, it is important to use a valid inventory that specifically measures attributes of the anatomy education environment. In this study, a new 11-factor, 132-items Anatomy Education Environment Measurement Inventory (AEEMI) was developed using Delphi technique and was validated in a Malaysian public medical school. The inventory was found to have satisfactory content evidence (scale-level content validity index [total] = 0.646); good response process evidence (scale-level face validity index [total] = 0.867); and acceptable to high internal consistency, with the Raykov composite reliability estimates of the six factors are in the range of 0.604-0.876. The best fit model of the AEEMI is achieved with six domains and 25 items (X 2  = 415.67, P education environment in Malaysia. A concerted collaboration should be initiated toward developing a valid universal tool that, using the methods outlined in this study, measures the anatomy education environment across different institutions and countries. Anat Sci Educ 10: 423-432. © 2017 American Association of Anatomists. © 2017 American Association of Anatomists.

Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments

Science.gov (United States)

Pérez-Escamilla, Beatriz; Franco-Trigo, Lucía; Moullin, Joanna C; Martínez-Martínez, Fernando; García-Corpas, José P

2015-01-01

Background Low adherence to pharmacological treatments is one of the factors associated with poor blood pressure control. Questionnaires are an indirect measurement method that is both economic and easy to use. However, questionnaires should meet specific criteria, to minimize error and ensure reproducibility of results. Numerous studies have been conducted to design questionnaires that quantify adherence to pharmacological antihypertensive treatments. Nevertheless, it is unknown whether questionnaires fulfil the minimum requirements of validity and reliability. The aim of this study was to compile validated questionnaires measuring adherence to pharmacological antihypertensive treatments that had at least one measure of validity and one measure of reliability. Methods A literature search was undertaken in PubMed, the Excerpta Medica Database (EMBASE), and the Latin American and Caribbean Health Sciences Literature database (Literatura Latino-Americana e do Caribe em Ciências da Saúde [LILACS]). References from included articles were hand-searched. The included papers were all that were published in English, French, Portuguese, and Spanish from the beginning of the database’s indexing until July 8, 2013, where a validation of a questionnaire (at least one demonstration of the validity and at least one of reliability) was performed to measure adherence to antihypertensive pharmacological treatments. Results A total of 234 potential papers were identified in the electronic database search; of these, 12 met the eligibility criteria. Within these 12 papers, six questionnaires were validated: the Morisky–Green–Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); and Martín–Bayarre–Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach’s α, varied from 0

Perceptions among general medical practitioners toward implementation of medication reconciliation program for patients discharged from hospitals in Penang, Malaysia.

Science.gov (United States)

Hassali, Mohamed Azmi Ahmad; Al-Haddad, Mahmoud; Shafie, Asrul Akmal; Tangiisuran, Balamurugan; Saleem, Fahad; Atif, Muhammad; Al-Qazaz, Harith

2012-06-01

This study aims to explore the perceptions of general practitioners (GPs) from the state of Penang toward the feasibility of implementing the medication reconciliation program in Malaysia. A cross-sectional descriptive study using a validated, self-completed anonymous 18-item questionnaire was undertaken over a period of 2 months in 2010. The study was conducted in the state of Penang, Malaysia. A letter consisting of survey questionnaires and prepaid return envelope were mailed to 429 GPs identified from the Private Medical Practice Control Department Registry. A total of 86 responses were received with response rate of 20.1%. Majority (90.1%) of the respondents agreed that medication reconciliation can be a feasible strategy to improve medication safety, and 97.7% confirmed that having an accurate up-to-date list of the patient's previous medication will be useful in the rational prescribing process. However, about half (56.9%) of them felt that standardization of the medication reconciliation process in all clinics will be difficult to achieve. Three quarters (73.2%) of the respondents believed that the involvement of GPs alone is insufficient, and 74.5% agreed that this program should be expanded to community pharmacy setting. More than 90% of the respondents agreed upon the medication reconciliation card proposed by the researchers. General practitioners in Penang are generally in favor of the implementation of medication reconciliation program in their practice. Because medication reconciliation has been shown to reduce many medicine-related problems, it is thus worth considering the feasibility of nationwide implementation of such program.

Development and validation of an instrument for measuring the quality of teamwork in teaching teams in postgraduate medical training (TeamQ).

Science.gov (United States)

Slootweg, Irene A; Lombarts, Kiki M J M H; Boerebach, Benjamin C M; Heineman, Maas Jan; Scherpbier, Albert J J A; van der Vleuten, Cees P M

2014-01-01

Teamwork between clinical teachers is a challenge in postgraduate medical training. Although there are several instruments available for measuring teamwork in health care, none of them are appropriate for teaching teams. The aim of this study is to develop an instrument (TeamQ) for measuring teamwork, to investigate its psychometric properties and to explore how clinical teachers assess their teamwork. To select the items to be included in the TeamQ questionnaire, we conducted a content validation in 2011, using a Delphi procedure in which 40 experts were invited. Next, for pilot testing the preliminary tool, 1446 clinical teachers from 116 teaching teams were requested to complete the TeamQ questionnaire. For data analyses we used statistical strategies: principal component analysis, internal consistency reliability coefficient, and the number of evaluations needed to obtain reliable estimates. Lastly, the median TeamQ scores were calculated for teams to explore the levels of teamwork. In total, 31 experts participated in the Delphi study. In total, 114 teams participated in the TeamQ pilot. The median team response was 7 evaluations per team. The principal component analysis revealed 11 factors; 8 were included. The reliability coefficients of the TeamQ scales ranged from 0.75 to 0.93. The generalizability analysis revealed that 5 to 7 evaluations were needed to obtain internal reliability coefficients of 0.70. In terms of teamwork, the clinical teachers scored residents' empowerment as the highest TeamQ scale and feedback culture as the area that would most benefit from improvement. This study provides initial evidence of the validity of an instrument for measuring teamwork in teaching teams. The high response rates and the low number of evaluations needed for reliably measuring teamwork indicate that TeamQ is feasible for use by teaching teams. Future research could explore the effectiveness of feedback on teamwork in follow up measurements.

Using patients' charts to assess medical trainees in the workplace: a systematic review.

Science.gov (United States)

Al-Wassia, Heidi; Al-Wassia, Rolina; Shihata, Shadi; Park, Yoon Soo; Tekian, Ara

2015-04-01

The objective of this review is to summarize and critically appraise existing evidence on the use of chart stimulated recall (CSR) and case-based discussion (CBD) as an assessment tool for medical trainees. Medline, Embase, CINAHL, PsycINFO, Educational Resources Information Centre (ERIC), Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original articles on the use of CSR or CBD as an assessment method for trainees in all medical specialties. Four qualitative and three observational non-comparative studies were eligible for this review. The number of patient-chart encounters needed to achieve sufficient reliability varied across studies. None of the included studies evaluated the content validity of the tool. Both trainees and assessors expressed high level of satisfaction with the tool; however, inadequate training, different interpretation of the scoring scales and skills needed to give feedback were addressed as limitations for conducting the assessment. There is still no compelling evidence for the use of patient's chart to evaluate medical trainees in the workplace. A body of evidence that is valid, reliable, and documents the educational effect in support of the use of patients' charts to assess medical trainees is needed.

Multidisciplinary strategy to reduce errors with the use of medical gases.

Science.gov (United States)

Amor-García, Miguel Ángel; Ibáñez-García, Sara; Díaz-Redondo, Alicia; Herranz Alonso, Ana; Sanjurjo Sáez, María

2018-05-01

Lack of awareness of the risks associated with the use of medical  gases amongst health professionals and health organizations is concerning. The  objective of this study is to redefine the use process of medical gases in a  hospital setting. A sentinel event took place in a clinical unit, the incorrect administration of a medical gas to an inpatient. A multidisciplinary  causeroot analysis of the sentinel event was carried out. Different improvement points were identified for each error detected and so we defined a  good strategy to ensure the safe use of these drugs. 9 errors were identified and the following improvement actions were  defined: storage (gases of clinical use were separated from those of industrial  use and proper identification signs were placed), prescription (6 protocols were  included in the hospital´s Computerized Physician Order Entry software),  validation (pharmacist validation of the prescription to ensure appropriate use of  these), dispensation (a new protocol for medical gases dispensation and  transportation was designed and implemented) and administration (information  on the pressure gauges used for each type of gas was collected and reviewed).  72 Signs with recommendations for medical gases identification and  administration were placed in all the clinical units. Specific training on the safe  use of medical gases and general safety training was imparted. The implementation of a process that integrates all phases of use  of medical gases and applies to all professionals involved is presented here as a  strategy to increase safety in the use of these medicines. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Validity of the Greek version of the PHQ 15-item Somatic Symptom Severity Scale in patients with chronic medical conditions and correlations with emergency department use and illness perceptions.

Science.gov (United States)

Hyphantis, Thomas; Kroenke, Kurt; Papatheodorou, Eugenia; Paika, Vassiliki; Theocharopoulos, Nicholaos; Ninou, Aggeliki; Tomenson, Barbara; Carvalho, Andre F; Guthrie, Elspeth

2014-11-01

The PHQ-15 is a brief measure assessing the severity of somatic symptoms and is widely used in different health care settings. We aimed to assess the psychometric properties of its Greek version in patients with chronic physical illnesses seeking urgent or unscheduled care in the Accident and Emergency Department (AED). The PHQ-15 was translated into Greek using back-translation, and it was administered to 303 patients with diabetes, COPD and rheumatic diseases visiting our AED during a one-year period. Patients were interviewed with the MINI. Depressive (PHQ-9) and somatization symptoms (SCL-12), illness perceptions (B-IPQ) and health-related quality of life (WHOQOL-BREF) were also assessed to test criterion and concurrent validity. The Greek version of the PHQ-15 showed acceptable internal consistency. Convergent validity was established by the strong associations observed between PHQ-15 scores and functional status, depressive symptom severity and AED visits during the previous year. PHQ-15 scores were also associated with the patients' concerns about personal and treatment illness's control and their beliefs regarding the number of bodily symptoms attributed to their illness (illness identity). The highly acceptable convergent and discriminant validity of the five individual bodily symptoms assessed by both the PHQ-15 and SCL-12 is a further construct validity indicator. The present findings support the applicability of the Greek version of PHQ-15 in assessing common somatic symptoms either medically explained or unexplained in patients seeking care in the AED, further confirming that it can be considered suitable for use in a broad range of populations in clinical research. Copyright © 2014 Elsevier Inc. All rights reserved.

Medical Identity Theft in the Emergency Department: Awareness is Crucial

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