Empathy in group psychoanalytic psychotherapy: questionnaire development

The aim of this study is to develop a questionnaire that can observe empathy in group psychoanalytic psychotherapy and examine the structure of its factors. A questionnaire comprised of 160 items in five-point Likert-type scale was developed through analysis of communication and interaction related to empathizing during group sessions. The questionnaire was applied on 256 patients from 40 therapy groups in 9 cities in Croatia. All 20 group analysts are trained in the Institute for Group Analysis in Zagreb. The patients were selected based on group analysis criteria. After item discrimination and principal component analysis limited to five factors were assessed, 80 items were isolated, 20 of which made a control scale for socially desirable responses. Two parallel questionnaire forms were developed: Group-Analysis-Empathy 1 (GA-Em1) and Group-Analysis-Empathy 2 (GA-Em2). A new, reliable and valid questionnaire for empathy observation employable in group psychotherapy was designed. The following factors were isolated by means of factor analysis: 1. Emotional disclosure and sensibility; 2. Containing and metabolizing; 3. Immersion; 4. Resonance and responsiveness; 5. Insight. A new questionnaire on empathy in group-analytical psychotherapy can measure the capacity for emotional communication among group members and between the group and the group analyst - conductor.     

Application of NHG guidelines in patients referred for stable chest pain syndromes

Purpose. Guidelines of the Dutch Association of General Practitioners (NHG) dictate the evaluation, treatment, and referral process of patients with stable chest pain syndromes (CPS). Adherence to this guideline was assessed in a consecutive group of patients referred to our hospital. Methods. We retrospectively studied the records of 296 subjects referred to our outpatient department in 2007 for evaluation of stable CPS. Referral letters were checked for completeness (past and present history, mentioning of risk factors for cardiovascular disease, physical examination, listing of medication) and used to judge adherence to the guideline. In a subset of patients, additional information regarding the referral process was gathered by telephone interview. Results. The referral letter was complete in only 67 patients (23%); items most often not reported were physical examination (63%) and cardiovascular risk factors (62%). Judging from the referral letter, 23 patients (8%) were evaluated in accordance with the NHG guideline prior to their referral. In patients in whom the final diagnosis of angina pectoris was made by the cardiologist, this was 20%. Seventy-nine patients were contacted by telephone after their work-up by the cardiologist; 36 of them (44%) reported being referred at their first visit to their primary physician, while 14 (18%) were referred at their own request. Conclusion: Prior to referral, only a minority of patients with stable CPS were evaluated and treated in accordance with NHG guidelines. Furthermore, their referral letter was often incomplete. (Neth Heart J 2010;18:178-82.)     

De <Emphasis Type="Italic">BPSD-DS</Emphasis> evaluatieschaal voor dementiegerelateerde gedragsveranderingen bij mensen met downsyndroom

Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N?=?149), with questionable dementia (DS?+?TD, N?=?65) and with diagnosed dementia (DS?+?AD, N?=?67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS?+?AD group and lowest in the DS group. Interestingly, among DS?+?TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study.     

Development of a picture‐scale‐questionnaire to assess liking for fatty,salty, sweet,and umami seasonings compared to a sensory evaluation for Japanese consumers

PrefQuest is a web‐based questionnaire that measures the liking for sweet, fatty‐sweet, salty, and fatty‐salty sensations using combinations of images of French food items. We adapted the original PrefQuest questionnaire for Japanese respondents (J‐PrefQuest). J‐PrefQuest comprises 17 Japanese food items categorized into four sensations: fatty, salty, sweet, and umami. Participants responded by indicating their preferred level of seasoning for each food item on a 6‐point scale. Segmentation of 161 respondents identified groups who preferred: (a) high amount of umami seasonings; (b) low amount of umami seasonings; (c) high amount of fatty and low amount of salty seasonings. To validate the questionnaire, 70 female university students were recruited for a sensory evaluation of five levels of seasoning used for six food items on a 9‐point hedonic scale before completing the questionnaire. The validity of J‐PrefQuest questionnaire was then analyzed by comparing the two results.

Practical applications

Measuring personal preference or “liking” for the taste of food items is important as such information may contribute to the prevention of various diseases and improve the quality of life of consumers. We developed a simple questionnaire with pictures to evaluate the liking for fatty, salty, sweet, and umami sensations of Japanese respondents. This questionnaire focuses on typical seasonings added to different Japanese food items and provides objective information about liking different food sensations. Thus, it has application as an important screening tool to identify respondents who may need to make their food consumption behavior more healthy. Moreover, following minor modifications, this questionnaire could also be used in other Asian countries where plain white rice is the stable food.     

30-Day Mortality in Acute Pulmonary Embolism: Prognostic Value of Clinical Scores and Anamnestic Features

Purpose

Identification of high-risk patients with pulmonary embolism is vital. The aim of the present study was to examine clinical scores, their single items, and anamnestic features in their ability to predict 30-day mortality.

Materials and Methods

A retrospective, single-center study from 06/2005 to 01/2010 was performed. Inclusion criteria were presence of pulmonary embolism, availability of patient records and 30-day follow-up. The following clinical scores were calculated: Acute Physiology and Chronic Health Evaluation II, original and simplified pulmonary embolism severity index, Glasgow Coma Scale, and euroSCORE II.

Results

In the study group of 365 patients 39 patients (10.7%) died within 30 days due to pulmonary embolism. From all examined scores and parameters the best predictor of 30-day mortality were the Glasgow Coma scale (≤ 10) and parameters of the circulatory system including presence of mechanical ventilation, arterial pH (< 7.335), and systolic blood pressure (< 99 mm Hg).

Conclusions

Easy to ascertain circulatory parameters have the same or higher prognostic value than the clinical scores that were applied in this study. From all clinical scores studied the Glasgow Coma Scale was the most time- and cost-efficient one.     

Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the United Kingdom: development of a patient questionnaire.

OBJECTIVE: To develop a reliable, valid measure of patient satisfaction with out of hours care suitable for large scale service evaluation. DESIGN: Focus group meetings and semistructured interviews with patients to identify issues of importance to patients and possible questionnaire items; interviews and two pilot studies to test and identify new questionnaire items; modification or removal of items to eliminate ambiguity and reduce non-response and skewed responses; questionnaire survey of out of hours care. SETTING: Greater Manchester and Leicester. SUBJECTS: 11 general practice patients participated in the focus groups and 28 in the semistructured interviews; 41 in the preliminary interviews; 41 and 378 in the postal pilots; and 1466 in the survey of out of hours care. RESULTS: A 32 item questionnaire was developed. Component analysis indicated seven scales (satisfaction with communication and management, doctor''s attitude, continuity of care, delay until visit, access to out of hours care, initial contact person, telephone advice) related to overall satisfaction and containing issues identified as important to patients. Levels of reliability were satisfactory, Cronbach''s alpha correlation coefficient exceeding 0.60 for all scales. CONCLUSION: A reliable, valid measure of patient satisfaction has been developed, suitable for large scale evaluation of out of hours care.     

Determining Possible Professionals and Respective Roles and Responsibilities for a Model Comprehensive Elder Abuse Intervention: A Delphi Consensus Survey

Objective

We have undertaken a multi-phase, multi-method program of research to develop, implement, and evaluate a comprehensive hospital-based nurse examiner elder abuse intervention that addresses the complex functional, social, forensic, and medical needs of older women and men. In this study, we determined the importance of possible participating professionals and respective roles and responsibilities within the intervention.

Methods

Using a modified Delphi methodology, recommended professionals and their associated roles and responsibilities were generated from a systematic scoping review of relevant scholarly and grey literatures. These items were reviewed, new items added for review, and rated/re-rated for their importance to the intervention on a 5-point Likert scale by an expert panel during a one day in-person meeting. Items that did not achieve consensus were subsequently re-rated in an online survey.

Analysis

Those items that achieved a mean Likert rating of 4+ (rated important to very important), and an interquartile range<1 in the first or second round, and/or for which 80% of ratings were 4+ in the second round were retained for the model elder abuse intervention.

Results

Twenty-two of 31 recommended professionals and 192 of 229 recommended roles and responsibilities rated were retained for our model elder abuse intervention. Retained professionals were: public guardian and trustee (mean rating = 4.88), geriatrician (4.87), police officer (4.87), GEM (geriatric emergency management) nurse (4.80), GEM social worker (4.78), community health worker (4.76), social worker/counsellor (4.74), family physician in community (4.71), paramedic (4.65), financial worker (4.59), lawyer (4.59), pharmacist (4.59), emergency physician (4.57), geriatric psychiatrist (4.33), occupational therapist (4.29), family physician in hospital (4.28), Crown prosecutor (4.24), neuropsychologist (4.24), bioethicist (4.18), caregiver advocate (4.18), victim support worker (4.18), and respite care worker (4.12).

Conclusion

A large and diverse group of multidisciplinary, intersectoral collaborators was deemed necessary to address the complex needs of abused older adults, each having important roles and responsibilities to fulfill within a model comprehensive elder abuse intervention.     

TOPICOP?: A New Scale Evaluating Topical Corticosteroid Phobia among Atopic Dermatitis Outpatients and Their Parents

Background

The fear of using topical corticosteroids, usually called topical corticophobia, is a frequent concern for atopic dermatitis patients and/or their parents. Assessing patients’ atopic dermatitis and their parents’ topical corticosteroid phobia is an essential step to improving adherence to treatment. Because topical corticophobia appears to be a complex phenomenon, its evaluation by binary responses (yes/no) is too simplistic. Thus, a scale is needed, which is capable of identifying the subtleties of topical corticosteroid phobia.

Objectives

To develop and validate a scale, TOPICOP©, measuring worries and beliefs about topical corticosteroids among atopic dermatitis outpatients and their parents.

Methods

An initial statistical validation of TOPICOP was carried out, collecting qualitative data about patients’ topical corticophobia behaviors and beliefs using focus-group methodology. Then, 208 outpatients or their parents from five French centers completed a self-administered questionnaire built from focus-group results. The scale-development process comprised an explanatory principal component analysis, Cronbach’s α-coefficients and structural equation modeling.

Results

The validated questionnaire comprised 12 items, covering two important dimensions relative to “worries” (6 items) and “beliefs” (6 items). Psychometric properties showed that items had very good communality (>0.60) within their own dimension. The final two-factor solution accounted for 47.3% of the variance. Cronbach’s α-coefficients were, respectively, 0.79 and 0.78. Structural equation modeling strongly supported the possibility of calculating a global score.

Conclusions

TOPICOP© is the first scale aimed at assessing topical corticophobia in adult patients and parents of children with eczema. TOPICOP® has excellent psychometric properties and should be easy to use in everyday clinical practice for clinicians and researchers. Further studies are needed to confirm our results and validate TOPICOP© in other cultures.     

Apathy, but not depression, reflects inefficient cognitive strategies in Parkinson's disease

Background

The relationship between apathy, depression and cognitive impairment in Parkinson''s disease (PD) is still controversial. The objective of this study is to investigate whether apathy and depression are associated with inefficient cognitive strategies in PD.

Methods

In this prospective clinical cohort study conducted in a university-based clinical and research movement disorders center we studied 48 PD patients. Based on clinical evaluation, they were classified in two groups: PD with apathy (PD-A group, n = 23) and PD without apathy (PD-NA group, n = 25). Patients received clinical and neuropsychological evaluations. The clinical evaluation included: Apathy Evaluation Scale-patient version, Hamilton Depression Rating Scale-17 items, the Unified Parkinson''s Disease Rating Scale and the Hoehn and Yahr staging system; the neuropsychological evaluation explored speed information processing, attention, working memory, executive function, learning abilities and memory, which included several measures of recall (immediate free, short delay free, long delay free and cued, and total recall).

Findings

PD-A and PD-NA groups did not differ in age, disease duration, treatment, and motor condition, but differed in recall (p<0.001) and executive tasks (p<0.001). Immediate free recall had the highest predictive value for apathy (F =  10.94; p = 0.002). Depression and apathy had a weak correlation (Pearson index  = 0.3; p<0.07), with three items of the depression scale correlating with apathy (Pearson index between .3 and.4; p<0.04). The depressed and non-depressed PD patients within the non-apathetic group did not differ.

Conclusion

Apathy, but not depression, is associated with deficit in implementing efficient cognitive strategies. As the implementation of efficient strategies relies on the fronto-striatal circuit, we conclude that apathy, unlike depression, is an early expression of executive impairment in PD.     

害虫研究与防治中的生态学尺度

尺度已成为生态学上的一个重要概念和研究热点 ,但在害虫防治中尚未引起足够的重视 .本文从生态学尺度概念和等级理论出发 ,分析了不同尺度水平上害虫研究的方法、内容、关键问题及研究成果对害虫防治的意义 .在对害虫发生为害特征、害虫种群动力学原理、农业生态系统结构的演变、害虫防治的社会化、害虫防治技术的发展等因素的分析的基础上 ,指出害虫防治策略在时空尺度上拓展的趋势和必要性 .     

Automated UMLS-Based Comparison of Medical Forms

Medical forms are very heterogeneous: on a European scale there are thousands of data items in several hundred different systems. To enable data exchange for clinical care and research purposes there is a need to develop interoperable documentation systems with harmonized forms for data capture. A prerequisite in this harmonization process is comparison of forms. So far – to our knowledge – an automated method for comparison of medical forms is not available. A form contains a list of data items with corresponding medical concepts. An automatic comparison needs data types, item names and especially item with these unique concept codes from medical terminologies. The scope of the proposed method is a comparison of these items by comparing their concept codes (coded in UMLS). Each data item is represented by item name, concept code and value domain. Two items are called identical, if item name, concept code and value domain are the same. Two items are called matching, if only concept code and value domain are the same. Two items are called similar, if their concept codes are the same, but the value domains are different. Based on these definitions an open-source implementation for automated comparison of medical forms in ODM format with UMLS-based semantic annotations was developed. It is available as package compareODM from http://cran.r-project.org. To evaluate this method, it was applied to a set of 7 real medical forms with 285 data items from a large public ODM repository with forms for different medical purposes (research, quality management, routine care). Comparison results were visualized with grid images and dendrograms. Automated comparison of semantically annotated medical forms is feasible. Dendrograms allow a view on clustered similar forms. The approach is scalable for a large set of real medical forms.     

生态补偿理论、方法研究进展

对近年来国内外生态补偿的概念内涵、理论依据、补偿标准、补偿模式和补偿效应评价等多方面研究内容做了梳理和评析,进而对国内生态补偿研究提出几点展望,包括生态补偿的GIS时空分配模型、风险式补偿和差别化补偿、补偿模式的系统整合研究、模式选择模型和补偿预期效率研究、补偿社会经济效果和环境影响评价研究,并结合我国建设生态友好型社会和区域共同发展的需要角度,提出了开展符合我国生态国情的区域生态补偿理论与方法研究的必要性和基本内容.     

Development of the Assessment of Belief Conflict in Relationship-14 (ABCR-14)

Purpose

Nurses and other healthcare workers frequently experience belief conflict, one of the most important, new stress-related problems in both academic and clinical fields.

Methods

In this study, using a sample of 1,683 nursing practitioners, we developed The Assessment of Belief Conflict in Relationship-14 (ABCR-14), a new scale that assesses belief conflict in the healthcare field. Standard psychometric procedures were used to develop and test the scale, including a qualitative framework concept and item-pool development, item reduction, and scale development. We analyzed the psychometric properties of ABCR-14 according to entropy, polyserial correlation coefficient, exploratory factor analysis, confirmatory factor analysis, average variance extracted, Cronbach’s alpha, Pearson product-moment correlation coefficient, and multidimensional item response theory (MIRT).

Results

The results of the analysis supported a three-factor model consisting of 14 items. The validity and reliability of ABCR-14 was suggested by evidence from high construct validity, structural validity, hypothesis testing, internal consistency reliability, and concurrent validity. The result of the MIRT offered strong support for good item response of item slope parameters and difficulty parameters. However, the ABCR-14 Likert scale might need to be explored from the MIRT point of view. Yet, as mentioned above, there is sufficient evidence to support that ABCR-14 has high validity and reliability.

Conclusion

The ABCR-14 demonstrates good psychometric properties for nursing belief conflict. Further studies are recommended to confirm its application in clinical practice.     

The measurement of subjective response to stressful life events

A scale was developed to assess subjective responses to stressful life events. Over 400 subjects (divided between psychiatric patients and nonpatients) completed the 14-item response-to-stress scale for events perceived as personally important. Optimal scale item weights were assigned on the basis of Nishisato's dual scaling procedure. Four items, typically associated with responses to stress, did not contribute to the item-weight solution and were dropped from the scale. Factor analyses showed that responses to stress loaded on one bipolar factor composed of four emotional distress items and six control-management items. In contrast to previous methods developed to assess response to stress, there was less than 4% overlap between the subjective response to stress mean scores and the total number of events endorsed by each subject. Also, the correlations between simple event counts and symptom index scores were smaller than those between the subjective stress-response scores and the symptom variable. The influence of demographic factors on both the patients' and nonpatients' responses to stress were analyzed.     

Development and Validation of a Tuberculosis Medication Adherence Scale

Background

Medication adherence is critical in Tuberculosis (TB) treatment success, but existing tools are inadequate in identifying non-adherents, reasons for non-adherence or interventions to improve adherence. This study intended to fill the gap by developing and validating a TB medication adherence scale (TBMAS).

Methods

An initial 41-item TBMAS was designed through review of literature, consultation from an 8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as external criteria for medication adherence. After removing redundant and cross-loading items, the internal consistency, reliability and validity of TBMAS in identifying non-adherents were examined.

Results

The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded in nine distinct factors that explained 65% of cumulative variance among respondents. Cronbach''s alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent validity was supported by statistically significant associations between TBMAS scores and adherence measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in identifying non-adherents.

Conclusion

TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying TB patients with poor adherence and potential causes for non-adherence.     

Development of the AGREE II,part 2: assessment of validity of items and tools to support application

Background

We established a program of research to improve the development, reporting and evaluation of practice guidelines. We assessed the construct validity of the items and user’s manual in the β version of the AGREE II.

Methods

We designed guideline excerpts reflecting high-and low-quality guideline content for 21 of the 23 items in the tool. We designed two study packages so that one low-quality and one high-quality version of each item were randomly assigned to each package. We randomly assigned 30 participants to one of the two packages. Participants reviewed and rated the guideline content according to the instructions of the user’s manual and completed a survey assessing the manual.

Results

In all cases, content designed to be of high quality was rated higher than low-quality content; in 18 of 21 cases, the differences were significant (p < 0.05). The manual was rated by participants as appropriate, easy to use, and helpful in differentiating guidelines of varying quality, with all scores above the mid-point of the seven-point scale. Considerable feedback was offered on how the items and manual of the β-AGREE II could be improved.

Interpretation

The validity of the items was established and the user’s manual was rated as highly useful by users. We used these results and those of our study presented in part 1 to modify the items and user’s manual. We recommend AGREE II (available at www.agreetrust.org) as the revised standard for guideline development, reporting and evaluation.For clinical practice guidelines to achieve their full potential as tools to assist in clinical, policy-related and system-level decisions,^1–3 they need to be of high quality and developed using rigorous methods.⁴ Thus, strategies are required to facilitate the development and reporting of guidelines and tools able to distinguish guidelines of varying quality. The AGREE Collaboration (Appraisal of Guidelines, Research and Evaluation) was the first to create a generic tool to assess the process of guideline development and reporting,^5,6 and it quickly became the standard for guideline evaluation.⁷As with any new assessment tool, ongoing development of the instrument was required to improve its measurement properties and advance the guideline enterprise. The AGREE Next Steps Consortium undertook a program of research to achieve these goals and create the next version of the tool, the AGREE II.⁸ The consortium completed two studies (parts 1 and 2). In part 1, also reported in this issue,⁹ we conducted an analysis of the performance of the new seven-point response scale, explored the usefulness of the AGREE items, and systematically identified ways in which the items and supporting document could be improved.In part 2, reported here, we aimed to test the construct validity of the items and evaluate the new supporting documentation, which was intended to facilitate efficient and accurate application of the tool.The validity of the original AGREE instrument was explored in three ways.⁵ Appraisers’ attitudes about the instrument’s usefulness and the helpfulness of the supporting documents (i.e., a user guide and training manual) were used as measures of face validity. The construct validity of the instrument was tested using three core hypotheses for each of the six domains; 3 of the possible 18 tests were supported. In retrospect, whether the hypotheses were generalizable across contexts was somewhat questionable. Finally, to establish criterion validity, correlations between users’ overall global endorsement and quality ratings of individual items were calculated. Whether global endorsements were a reasonable proxy gold standard was somewhat questionable. Further, for both the construct validity and the criterion validity, guidelines chosen in these studies were nominated by members of the research team as representing a range of quality, creating significant risks of bias.Together, these findings and methodological limitations illustrated the need for additional work to test and establish the instrument’s validity. The most fundamental concept of construct validity, in particular, had not been yet addressed —are guidelines known to be of higher quality rated more favourably using the AGREE instrument than guidelines known to be of lower quality? In addition, no study to date has tested specifically whether the instructions for applying the tool are perceived to be appropriate, implementable, and helpful in differentiating among guidelines of varying quality. These perceptions are important components that contribute to the face validity of the tool.We tested two specific research questions in this study. First, do the items in β-AGREE II differentiate between guideline content of known, varying quality? Second, is the new user’s manual perceived by users as appropriate, easy to apply and helpful in differentiating good quality guidelines from poor quality guidelines?     

ASSIST Applicability Scoring of Surgical trials. An Investigator-reported aSsessment Tool

Context

We aimed to develop a new tool for assessing and depicting the applicability of the results of surgical randomized controlled trials (RCTs) from the trial investigators'' perspective.

Methods

We identified all items related to applicability by a systematic methodological review, and then a sample of surgeons used these items in a web-based survey to evaluate the applicability of their own trial results. For each applicability item, participants had to indicate on a numerical scale that was simplified as a three-item scale: 1) items essential to consider, 2) items requiring attention, and 3) items inconsequential to the applicability of the results of their own RCT to clinical practice. For the final tool, we selected only items that were rated as being essential or requiring attention for at least 25% of the trials evaluated. We propose a specific process to construct the tool and to depict applicability in a graph. We identified all investigators of published and registered ongoing RCTs assessing surgery and invited them to participate in the web-based survey.

Results

148 surgeons assessed applicability for their own trial and participated in the process of item selection. The final tool contains 22 items (4 dedicated to patients, 5 to centers, 5 to surgeons and 8 to the intervention). We proposed a straightforward process of constructing the graphical tool: 1) a multidisciplinary team of investigators or other care providers participating in the trial could independently assess each item, 2) a consensus method could be used, and 3) the investigators could depict their assessment of the applicability of the trial results in 4 graphs related to patients, centers, surgeons and the intervention.

Conclusions

This investigator-reported assessment tool could help readers define under what conditions they could reasonably apply the results of a surgical RCT to their clinical practice.