Assessment of gender-specific preventive cardiovascular knowledge among house staff: Potential impact on cardiovascular management

Background: Gender differences in cardiovascular prevention and treatment may be related to physicians' level of postgraduate training and gender.Objectives: This study was designed to assess resident physician knowledge concerning general and gender-specific preventive cardiology topics and to determine whether there were differences in that knowledge based on the physicians' level of postgraduate training or gender.Methods: A 29-item true/false questionnaire was administered to residents in a large, university-based internal medicine residency program. All questions were drawn from evidence-based practice guidelines, and a subset of questions pertained to gender-specific issues in cardiovascular disease prevention. Scores on the overall test and gender-specific subset were computed as a percentage of correct answers. Differences were compared by postgraduate year (PGY) of training and physician gender.Results: Of the 190 eligible residents, 159 (88 men, 67 women, 4 not specified) completed the questionnaire. Overall test scores differed significantly by PGY (PGY-1, 83.4% correct answers; PGY-2, 52.9%; PGY-3, 65.3%; P < 0.001 for each paired comparison), but did not differ significantly by physician gender (males, 73.5%; females, 70.0%). Performance on gender-specific items also differed by PGY (PGY-1, 72.2% vs PGY-2, 20.0%; P < 0.001; and PGY-1, 72.2% vs PGY-3, 45.1%; P < 0.001). Knowledge of gender-specific preventive cardiology did not differ significantly by physician gender (males, 56.4%; females, 49.0%).Conclusions: Residents in PGY-1 had better knowledge of preventive cardiology as assessed using this questionnaire than did residents in PGY-2 or PGY-3. Knowledge of general and gender-specific cardiology topics was not related to physician gender.     

Effect of a Diabetes Curriculum on Internal Medicine Resident Knowledge

ObjectiveTo determine the effect of a year-long, multifaceted diabetes curriculum on the knowledge of internal medicine residents.MethodsIn this controlled, prospective study, diabetes knowledge assessment was performed with a published questionnaire to measure baseline knowledge, determine change in knowledge at 1 year, and compare resident knowledge with attending knowledge. The questionnaire was administered to residents at the beginning and end of the 2007-2008 academic year. As controls, internal medicine attendings and diabetes care providers were also given the questionnaire. The educational curriculum over the course of the year included order sets, pocket cards, lectures, and rounds. Although all residents were exposed to the education intervention, teaching targeted the postgraduate year (PGY)-1 residents.ResultsOf 91 participating residents, 85 (93%) completed at least 1 questionnaire for a total of 103 questionnaires. Baseline and year-end assessments were completed by 18 residents. Among 25 attendings, 22 (88%) completed questionnaires. Eleven diabetes care providers participated. PGY-3 residents scored 72 ± 10% and PGY-2 residents scored 72 ± 8%, which was significantly greater than the PGY-1 residents’ score of 62 ± 12% (P = .004 and P = .006, respectively). Lectures were associated with knowledge improvement over time (P = .04). The mean attending score of 67 ± 13% was not significantly different from the residents’ scores. Diabetes care providers had the highest score (92 ± 7%).ConclusionsInpatient diabetes education targeted to PGY-1 residents modestly improves resident knowledge, especially in the targeted population. Traditional educational methods may not be adequate, and improved education is needed for trainees and attendings to provide optimal diabetes care. Strategies to improve resident education may include developing more comprehensive lectures that address fundamental concepts, focusing on all PGY levels, frequent consultation with diabetologists, and case-based discussions. (Endocr Pract. 2010;16:408-417)     

Diabetes knowledge: Are resident physicians and Nurses adequately prepared to manage diabetes?

ObjectiveTo assess and compare the diabetes knowledge of nurses and residents in surgery, internal medicine, and family practice.MethodsA 21-question survey based on current diabetes standards of care was developed and administered. The results were stratified by type of participant and analyzed statistically.ResultsA total of 52 internal medicine residents (IMR), 21 family practice residents (FPR), 42 surgery residents (SR), and 48 registered nurses (RN) participated. The survey had good overall internal consistency (Cronbach α of 0.78) and test-retest reliability (Pearson correlation coefficient of 0.71). The total mean percent correct for all participants was 61%. The total scores of IMR, FPR, and RN groups were similar (69%, 64%, and 66%) and significantly greater (P < 0.001) than the SR score (44%). Collectively, all survey participants averaged less than 50% correct on several items. The IMR scored higher than the SR and FPR on several items. The nurses outscored the physicians on items regarding insulin preparations, treatment of hypoglycemia, and perioperative insulin management. A subgroup of 13 RN with additional diabetes training earned the highest total score (82%).ConclusionOur novel survey was shown to be a statistically valid tool for assessment of diabetes knowledge. IMR, FPR, and inpatient RN have similar but insufficient levels of knowledge about diabetes. SR may have a more profound deficit of diabetes knowledge. Previous additional diabetes training among nurses was associated with greater diabetes knowledge. Most nurses and residents require additional education in order to provide optimal care to patients with diabetes. (Endocr Pract. 2007;13: 17-21)     

Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine

ObjectiveTo develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills.DesignDevelopment and validation of an assessment instrument and before and after study.SettingVarious postgraduate short courses in evidence based medicine in Germany.ParticipantsThe instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds.InterventionIntensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups.ResultsThe questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention.ConclusionsThe instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.

What is already known on this topic

Numerous observational studies have investigated the impact of teaching evidence based medicine to healthcare professionals, with conflicting resultsMost of the studies were of poor methodological quality

What this study adds

An instrument assessing basic knowledge and skills required for practising evidence based medicine was developed and validatedAn intensive 3 day course on evidence based medicine for doctors from various backgrounds and training level led to a clinically meaningful improvement of knowledge and skills     

A Systematic Review of Instruments to Assess Organizational Readiness for Knowledge Translation in Health Care

Background

The translation of research into practices has been incomplete. Organizational readiness for change (ORC) is a potential facilitator of effective knowledge translation (KT). However we know little about the best way to assess ORC. Therefore, we sought to systematically review ORC measurement instruments.

Methods

We searched for published studies in bibliographic databases (Pubmed, Embase, CINAHL, PsychINFO, Web of Science, etc.) up to November 1^st, 2012. We included publications that developed ORC measures and/or empirically assessed ORC using an instrument at the organizational level in the health care context. We excluded articles if they did not refer specifically to ORC, did not concern the health care domain or were limited to individual-level change readiness. We focused on identifying the psychometric properties of instruments that were developed to assess readiness in an organization prior to implementing KT interventions in health care. We used the Standards for Educational and Psychological Testing to assess the psychometric properties of identified ORC measurement instruments.

Findings

We found 26 eligible instruments described in 39 publications. According to the Standards for Educational and Psychological Testing, 18 (69%) of a total of 26 measurement instruments presented both validity and reliability criteria. The Texas Christian University –ORC (TCU-ORC) scale reported the highest instrument validity with a score of 4 out of 4. Only one instrument, namely the Modified Texas Christian University – Director version (TCU-ORC-D), reported a reliability score of 2 out of 3. No information was provided regarding the reliability and validity of five (19%) instruments.

Conclusion

Our findings indicate that there are few valid and reliable ORC measurement instruments that could be applied to KT in the health care sector. The TCU-ORC instrument presents the best evidence in terms of validity testing. Future studies using this instrument could provide more knowledge on its relevance to diverse clinical contexts.     

Development and Validation of the Scan of Postgraduate Educational Environment Domains (SPEED): A Brief Instrument to Assess the Educational Environment in Postgraduate Medical Education

Introduction

Current instruments to evaluate the postgraduate medical educational environment lack theoretical frameworks and are relatively long, which may reduce response rates. We aimed to develop and validate a brief instrument that, based on a solid theoretical framework for educational environments, solicits resident feedback to screen the postgraduate medical educational environment quality.

Methods

Stepwise, we developed a screening instrument, using existing instruments to assess educational environment quality and adopting a theoretical framework that defines three educational environment domains: content, atmosphere and organization. First, items from relevant existing instruments were collected and, after deleting duplicates and items not specifically addressing educational environment, grouped into the three domains. In a Delphi procedure, the item list was reduced to a set of items considered most important and comprehensively covering the three domains. These items were triangulated against the results of semi-structured interviews with 26 residents from three teaching hospitals to achieve face validity. This draft version of the Scan of Postgraduate Educational Environment Domains (SPEED) was administered to residents in a general and university hospital and further reduced and validated based on the data collected.

Results

Two hundred twenty-three residents completed the 43-item draft SPEED. We used half of the dataset for item reduction, and the other half for validating the resulting SPEED (15 items, 5 per domain). Internal consistencies were high. Correlations between domain scores in the draft and brief versions of SPEED were high (>0.85) and highly significant (p<0.001). Domain score variance of the draft instrument was explained for ≥80% by the items representing the domains in the final SPEED.

Conclusions

The SPEED comprehensively covers the three educational environment domains defined in the theoretical framework. Because of its validity and brevity, the SPEED is promising as useful and easily applicable tool to regularly screen educational environment quality in postgraduate medical education.     

Derivation of the short form of the Oral Health Impact Profile in Spanish (OHIP-EE-14)

doi: 10.1111/j.1741‐2358.2012.00613.x
Derivation of the short form of the Oral Health Impact Profile in Spanish (OHIP‐EE‐14) Background and Objective: The Oral Health Impact Profile is the most frequently used and validated of the Oral Health Quality of Life instruments. Several short versions have been developed; and a validation of the OHIP‐49 in Spanish has been published. The objective was to develop the short version of the Oral Health Impact Profile in Spanish (OHIP‐EE‐14). Methods: Cross‐sectional study. One hundred and thirty‐one persons aged ≥60 years attending a social centre for the elderly, residents of a nursing home and persons seeking dental care at a dental school in Mexico City were interviewed and examined. The validity of each of the 49 questions was evaluated, and, to construct the short version, 14 items were selected. The perceived need for dental treatment, number of teeth, presence of coronal caries, root caries, presence of dental plaque and utilisation of removable prosthesis were measured. Internal consistency, repeatability and discriminant validity were calculated. Results: The OHIP‐EE‐14 was reliable (Cronbach’s‐α = 0.918, ICC = 0.825). Significant associations were found between OHIP‐EE‐14 and the number of teeth and perceived need for dental treatment. Conclusions: The OHIP‐EE‐14 is a reliable and valid instrument and can be used in subjects aged 60 years and over from Mexico City.     

The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

ObjectivesTo develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.MethodsThe OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥50 years of age and pharmacists were included in the study.ResultsA total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean±SD accuracy rate was 0.60±0.22 (range: 0.26-0.94). The Cronbach’s α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman’s rho: 0.761-0.990, p<0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9±8.7vs63.6±17.4, p<0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.ConclusionThe OPAAT was found to be a valid and reliable instrument for assessing patient’s knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.     

社区居民乙肝防控知识知晓情况调查及乙肝歧视的影响因素分析

目的:了解社区居民乙肝防控知识知晓情况并分析乙肝歧视的影响因素。方法:采用分层整群随机抽样方法选取天津市鸿顺里社区1276名居民进行问卷调查,每人发放一份问卷,回收后统计居民乙肝防控知识的知晓情况及乙肝歧视现状,并通过多因素Logistic回归分析乙肝歧视的影响因素。结果:共回收1214份有效问卷,回收率为95.14%(1214/1276),乙肝5条主要传播途径中知晓经血液传播最高为70.18%(852/1214),知晓经共用牙刷及剃须刀传播为48.76%(592/1214),知晓经母婴传播为37.73%(458/1214),知晓经性生活传播为34.68%(421/1214),知晓经污染的医疗器械传播为34.18%(415/1214),5条传播途径均知晓为27.92%(339/1214);90.77%(1102/1214)的调查者知晓"乙肝是否具有传染性",乙肝知识的总体知晓率为21.91%(266/1 214)。79.90%(970/1214)的调查对象不愿意和乙肝患者恋爱/结婚,60.96%(740/1214)的调查对象不愿意和乙肝患者共同进餐;无歧视、中轻度歧视及重度歧视的比例分别为24.87%(302/1214)、50.91%(618/1214)及24.22%(294/1214);不同年龄、职业、文化程度、月收入人群之间乙肝歧视程度的差异具有统计学意义(P<0.05)。Logistic回归分析显示年龄、职业、文化程度、月收入均是造成乙肝歧视的影响因素。结论:天津市鸿顺里社区居民的乙肝防控知识知晓率较低且歧视现象严重,应加强对乙肝知识的宣传教育,纠正对乙肝的歧视心态。     

Endpiece: Three different talks

ObjectivesTo characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases.DesignObservational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question.SettingEastern Iowa.ParticipantsRandom sample of 103 family doctors.ResultsParticipants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?” Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search.ConclusionsFamily doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.

Key messages

• Questions that doctors have about the care of their patients could help guide the content of medical information sources and medical training
• In this study of US family doctors, participants frequently had questions about patient care but did not pursue answers to most questions (64%)
• On average, participants spent less than 2 minutes seeking an answer to a question
• The most common resources used to answer questions included textbooks and colleagues; formal literature searches were rarely performed
• The most common generic questions were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?”

     

Attitudes,Perceptions, and Practices Among Endocrinologists Managing Obesity

ObjectiveObesity has been globally recognized as a critically important disease by professional medical organizations, in addition to the World Health Organization and American Medical Association, but health care systems, medical teams, and the public have been slow to embrace this concept.MethodsThe American Association of Clinical Endocrinology staff drafted a survey, and 2 endocrinologists independently reviewed the survey’s questions and modified the survey instrument. The survey included questions related to practice and patient demographics, awareness about obesity, treatment of obesity, barriers to improving obesity outcomes, digital health, cognitive behavioral therapy, lifestyle medicine, antiobesity medications, weight stigma, and social determinants of health. The survey was emailed to 493 endocrinologists, with 305 (62%) completing the study.ResultsOf the responders, 98% agreed that obesity is a disease, whereas 2% neither agreed nor disagreed. Of the respondents, 53% were familiar with the term “adiposity-based chronic disease” and 13% were certified by the American Board of Obesity Medicine. Of the respondents, 57% used published obesity guidelines as a resource for treating patients with obesity. Most endocrinologists recommended dietary and lifestyle changes, but fewer prescribed an antiobesity medication or recommended bariatric surgery. American Board of Obesity Medicine-certified endocrinologists were more likely to use a multidisciplinary approach.ConclusionSelf-reported knowledge and practices in the management of obesity highlight the importance of a multimodal approach to obesity and foster collaboration among health care professionals. It is necessary to raise awareness about obesity among clinicians, identify knowledge gaps, and create educational tools to address those gaps.     

Traditional Knowledge and Management of Umbu (<Emphasis Type="Italic">Spondias tuberosa</Emphasis>, Anacardiaceae): An Endemic Species from the Semi–Arid Region of Northeastern Brazil

Traditional Knowledge and Management of Umbu ( Spondias tuberosa , Anacardiaceae): An Endemic Species from the Semi–Arid Region of Northeastern Brazil. Spondias tuberosa, or umbu, is an arboreal species that is important both as an alternative economic and subsistence resource for rural communities in the semi–arid, northeastern regions of Brazil. The aim of this work was to study the knowledge, uses, local gathering practices, and management systems of S. tuberosa that are part of the traditions of the communities in this region. An ethnobotanical survey was conducted in two stages in a rural community in the state of Pernambuco. In the first stage, all of the dwellings were visited and both the men and the women who were responsible for their house were interviewed. In the second stage, people who were identified as having a direct relationship with the resource were questioned more thoroughly about the species. Knowledge of S. tuberosa is equally distributed in the community; there are no significant differences in knowledge between men and women, or across age groups. The food category is the most important for both human and animal nourishment. The main forms of local management are tolerance and gathering of fruit. Fruit gathering is directly affected by, in order of importance, taste (sweet–sour), size, and quantity of fruit pulp. The usefulness of S. tuberosa contributes considerably to the tolerance of this species in both managed areas and as part of the native vegetation.     

我院两类人员333制并轨培养效果评价

??目的 了解住院医师和专业学位研究生333制并轨培养的效果。方法 对实施333制管理模式前后的住院医师与专业学位研究生进行年度考核,比较考核成绩。结果 实施333制管理模式前,专业学位研究生考核成绩与住院医师有统计学差异,经过一年的并轨培养,专业学位研究生考核成绩显著提高,与同年住院医师考核结果无统计学差异。结论 专业学位研究生在住院医师规范化培训基地与住院医师进行并轨培养,能够提高专业学位研究生的临床能力。     

Weather conditions affect the collective roosting behaviour of the Cattle Egret Bubulcus ibis

ABSTRACT

Capsule: Collective roosting behaviour of the Cattle Egret Bubulcus ibis was influenced by the weather and the season.

Aims: To document the roosting behaviour of the Cattle Egret and assess the relationship between weather conditions and four components of the roosting behaviour including the population size, duration of roost occupancy, the timing of roost gathering and the rate of arrival at roost.

Methods: We recorded the number and arrival times of individuals occupying a communal roost site in northeast Algeria in 2013–2014 between December and April.

Results: There was a seasonal decline of the flock size and rate of arrival and a seasonal increase in the duration of gathering. Weather conditions affected all variables assessed in roosting behaviour such that bad weather lowered the number of individuals in the roost, lengthened the duration and advanced the timing of gathering, and reduced the rate of gathering in the roost.

Conclusion: Our study highlights the importance of weather conditions in shaping the collective roosting behaviour of a gregarious species. Our results suggest that future changes in climatic conditions might influence the collective behaviour of the Cattle Egret in particular and gregarious birds in general.     

Risk Knowledge in Relapsing Multiple Sclerosis (RIKNO 1.0) - Development of an Outcome Instrument for Educational Interventions

Background

Adequate risk knowledge of patients is a prerequisite for shared decision making but few attempts have been made to develop assessment tools. Multiple Sclerosis (MS) is a chronic inflammatory disease of young adults with an increasing number of partially effective immunotherapies and therefore a paradigmatic disease to study patient involvement.

Objective/methods

Based on an item bank of MS risk knowledge items and patient feedback including perceived relevance we developed a risk knowledge questionnaire for relapsing remitting (RR) MS (RIKNO 1.0) which was a primary outcome measure in a patient education trial (192 early RRMS patients).

Results

Fourteen of the RIKNO 1.0 multiple-choice items were selected based on patient perceived relevance and item difficulty indices, and five on expert opinion. Mean item difficulty was 0.58, ranging from 0.14 to 0.79. Mean RIKNO 1.0 score increased after the educational intervention from 10.6 to 12.4 (p = 0.0003). Selected items were particularly difficult (e.g. those on absolute risk reductions of having a second relapse) and were answered correctly in only 30% of the patients, even after the intervention.

Conclusion

Despite its high difficulty, RIKNO 1.0 is a responsive instrument to assess risk knowledge in RRMS patients participating in educational interventions.     

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey

Background

Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i) the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii) the instruments'' potential for differentiating between faculty, and (iii) the number of residents'' evaluations needed per faculty to reliably use the instruments.

Methods and Materials

Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical) specialty training programs in the Netherlands. Two instruments—one completed by residents and one by faculty—for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents'' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses.

Results

A total of 403 (73.8%) residents completed 3575 evaluations of 570 medical faculty while 494 (78.5%) faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach''s alpha of 0.85 for residents'' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75), communication of goals (0.90/0.84), evaluation of residents (0.91/0.81), and feedback (0.91/0.85). Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents'' evaluations per faculty are needed for assessments to attain a reliability level of 0.90.

Conclusions

The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies, can detect between-faculty differences and supply potentially useful information for improving graduate medical education.     

A Systematic Map of Systematic Reviews in Pediatric Dentistry—What Do We Really Know?

ObjectivesTo identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.MethodsA systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps.ResultsOut of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low.ConclusionThere is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.     

Cultural Adaptation of a Survey to Assess Medical Providers’ Knowledge of and Attitudes towards HIV/AIDS in Albania

Though the HIV/AIDS epidemic in Southeastern Europe is one of low reported prevalence, numerous studies have described the pervasiveness of medical providers’ lack of knowledge of HIV/AIDS in the Balkans. This study sought to culturally adapt an instrument to assess medical providers’ knowledge of and attitudes towards HIV/AIDS in Albania. Cultural adaptation was completed through development of a survey from previously validated instruments, translation of the survey into Albanian, blinded back translation, expert committee review of the draft instrument, focus group pre-testing with community- and University Hospital Center of Tirana-based physicians and nurses, and test-retest reliability testing. Blinded back translation of the instrument supported the initial translation with slight changes to the idiomatic and conceptual equivalences. Focus group pre-testing generally supported the instrument, yet some experiential and idiomatic changes were implemented. Based on unweighted kappa and/or prevalence adjusted bias adjusted kappa (PABAK), 20 of the 43 questions were deemed statistically significant at kappa and/or PABAK ≥0.5, while 12 others did not cross zero on the 95% confidence interval for kappa, indicating their probable significance. Subsequently, an instrument to assess medical providers’ knowledge of and attitudes toward HIV/AIDS for an Albanian population was developed which can be expanded within Albania and potentially to other countries within the Balkans, which have an Albanian-speaking population.     

Using method triangulation to validate a new instrument (CPWQ-com) assessing cancer patients' satisfaction with communication

Purpose: Patients’ perceptions of care including the communication with health care staff is recognized as an important aspect of the quality of cancer care. Using mixed methods, we developed and validated a short instrument assessing this communication. Methods: Based on focus group interviews with 77 informants, an 8-item instrument was developed. This short instrument aimed at assessing overall aspects of the communication between cancer patients and health care staff. The items were validated first through cognitive interviews with patient–observer agreement with 52 cancer patients who completed the questions and then participated in tape-recorded open-ended interviews. Observer ratings of the interviews were compared with the patients’ written responses collected before interviews and kappa values were calculated. The comprehensibility of each item was subsequently elaborated in traditional cognitive interviews with 17 cancer patients. Finally, psychometric analyses took place with data from 1490 cancer patients. Results: The weighted kappas concerning patient–observer agreement ranged 0.31–0.88. Disagreements mainly consisted of the observer choosing the response category indicating the highest level of satisfaction whereas the patients had chosen the second highest level. Cognitive interviews showed that the questions were generally interpreted as intended. One item was excluded due to low validity. A sum scale of the remaining seven items had high reliability (Cronbach's alpha 0.89). Conclusions: Seven items performed well. They proved to be valid measures of satisfaction with communication with the health care staff and constitute a sum scale with high reliability. The cognitive interviews provided valuable insight into the patients’ perception of communication.