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Concept: Likert scale


Objective To determine if a simple stimulation method increases the rate of infant voiding for clean catch urine within five minutes.Design Randomised controlled trial.Setting Emergency department of a tertiary paediatric hospital, Australia.Participants 354 infants (aged 1-12 months) requiring urine sample collection as determined by the treating clinician. 10 infants were subsequently excluded.Interventions Infants were randomised to either gentle suprapubic cutaneous stimulation (n=174) using gauze soaked in cold fluid (the Quick-Wee method) or standard clean catch urine with no additional stimulation (n=170), for five minutes.Main outcome measures The primary outcome was voiding of urine within five minutes. Secondary outcomes were successful collection of a urine sample, contamination rate, and parental and clinician satisfaction with the method.Results The Quick-Wee method resulted in a significantly higher rate of voiding within five minutes compared with standard clean catch urine (31% v 12%, P<0.001), difference in proportions 19% favouring Quick-Wee (95% confidence interval for difference 11% to 28%). Quick-Wee had a higher rate of successful urine sample collection (30% v 9%, P<0.001) and greater parental and clinician satisfaction (median 2 v 3 on a 5 point Likert scale, P<0.001). The difference in contamination between Quick-Wee and standard clean catch urine was not significant (27% v 45%, P=0.29). The number needed to treat was 4.7 (95% confidence interval 3.4 to 7.7) to successfully collect one additional urine sample within five minutes using Quick-Wee compared with standard clean catch urine.Conclusions Quick-Wee is a simple cutaneous stimulation method that significantly increases the five minute voiding and success rate of clean catch urine collection.Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000754549.

Concepts: Infant, Clinical trial, Sample size, Randomized controlled trial, Pediatrics, Normal distribution, Likert scale, Urinalysis


BACKGROUND: Methylsulfonylmethane (MSM) has been reported to provide anti-inflammatory and antioxidant effects in both animal and man. Strenuous resistance exercise has the potential to induce both inflammation and oxidative stress. Using a pilot (proof of concept) study design, we determined the influence of MSM on markers of exercise recovery and performance in healthy men. METHODS: Eight, healthy men (27.1 +/- 6.9 yrs old) who were considered to be moderately exercise-trained (exercising <150 minutes per week) were randomly assigned to ingest MSM at either 1.5 grams per day or 3.0 grams per day for 30 days (28 days before and 2 days following exercise). Before and after the 28 day intervention period, subjects performed 18 sets of knee extension exercise in an attempt to induce muscle damage (and to be used partly as a measure of exercise performance). Sets 1--15 were performed at a predetermined weight for 10 repetitions each, while sets 16--18 were performed to muscular failure. Muscle soreness (using a 5-point Likert scale), fatigue (using the fatigue-inertia subset of the Profile of Mood States), blood antioxidant status (glutathione and Trolox Equivalent Antioxidant Capacity [TEAC]), and blood homocysteine were measured before and after exercise, pre and post intervention. Exercise performance (total work performed during sets 16--18 of knee extension testing) was also measured pre and post intervention. RESULTS: Muscle soreness increased following exercise and a trend was noted for a reduction in muscle soreness with 3.0 grams versus 1.5 grams of MSM (p = 0.080), with a 1.0 point difference between dosages. Fatigue was slightly reduced with MSM (p = 0.073 with 3.0 grams; p = 0.087 for both dosages combined). TEAC increased significantly following exercise with 3.0 grams of MSM (p = 0.035), while homocysteine decreased following exercise for both dosages combined (p = 0.007). No significant effects were noted for glutathione or total work performed during knee extension testing (p > 0.05). CONCLUSION: MSM, especially when provided at 3.0 grams per day, may favorably influence selected markers of exercise recovery. More work is needed to extend these findings, in particular using a larger sample of subjects and the inclusion of additional markers of exercise recovery and performance.

Concepts: Antioxidant, Oxidative stress, Muscle, Physical exercise, Weight training, Exercise physiology, Likert scale, Oxygen radical absorbance capacity


BACKGROUND: Negative affect and difficulties in its regulation have been connected to several adverse psychological consequences. While several questionnaires exist, it would be important to have a theory-based measure that includes clinically relevant items and shows good psychometric properties in healthy and patient samples. This study aims at developing such a questionnaire, combining the two Gross [1] scales Reappraisal and Suppression with an additional response-focused scale called Externalizing Behavioral Strategies covering clinically relevant items. METHODS: The samples consisted of 684 students (mean age = 23.3, SD = 3.5; 53.6% female) and 369 persons with mixed mental disorders (mean age = 36.0 SD = 14.6; 71.2% female). Items for the questionnaire were derived from existing questionnaires and additional items were formulated based on suggestions by clinical experts. All items start with “When I don’t feel well, in order to feel better…”. Participants rated how frequently they used each strategy on a 5-point Likert scale. Confirmatory Factor Analyses were conducted to verify the factor structure in two separate student samples and a clinical sample. Group comparisons and correlations with other questionnaires were calculated to ensure validity. RESULTS: After modification, the CFA showed good model fit in all three samples. Reliability scores (Cronbach’s alpha) for the three NARQ scales ranged between .71 and .80. Comparisons between students and persons with mental disorders showed the postulated relationships, as did comparisons between male and female students and persons with or without Borderline Personality Disorder. Correlations with other questionnaires suggest the NARQ’s construct validity. CONCLUSIONS: The results indicate that the NARQ is a psychometrically sound and reliable measure with practical use for therapy planning and tracking of treatment outcome across time. We advocate the integration of the new response-focused strategy in the Gross’s model of emotion regulation.

Concepts: Psychometrics, Factor analysis, Reliability, Mental disorder, Borderline personality disorder, Emotion, Personality disorder, Likert scale


BACKGROUND: The Hamilton Depression Rating Scale (HAM-D) is commonly used as a screening instrument, as a continuous measure of change in depressive symptoms over time, and as a means to compare the relative efficacy of treatments. Among several abridged versions, the 6-item HAM-D6 is used most widely in large degree because of its good psychometric properties. The current study compares both self-report and clinician-rated versions of the Hebrew version of this scale. METHODS: A total of 153 Israelis 75 years of age on average participated in this study. The HAM-D6 was examined using confirmatory factor analytic (CFA) models separately for both patient and clinician responses. RESULTS: Reponses to the HAM-D6 suggest that this instrument measures a unidimensional construct with each of the scales' six items contributing significantly to the measurement. Comparisons between self-report and clinician versions indicate that responses do not significantly differ for 4 of the 6 items. Moreover, 100% sensitivity (and 91% specificity) was found between patient HAM-D6 responses and clinician diagnoses of depression. CONCLUSION: These results indicate that the Hebrew HAM-D6 can be used to measure and screen for depressive symptoms among elderly patients.

Concepts: Hospital, Measurement, Type I and type II errors, Psychometrics, Major depressive disorder, Measuring instrument, Likert scale, Montgomery-Åsberg Depression Rating Scale


OBJECTIVE:To determine the self-reported practices and attitudes surrounding concussion diagnosis and management in a single, large pediatric care network.METHODS:A cross-sectional survey was distributed to pediatric primary care and emergency medicine providers in a single, large pediatric care network. For all survey participants, practices and attitudes about concussion diagnosis and treatment were queried.RESULTS:There were 145 responses from 276 eligible providers, resulting in a 53% response rate, of which 91% (95% confidence interval [CI]: 86%-95%) had cared for at least 1 concussion patient in the previous 3 months. A Likert scale from 1 “not a barrier” to 5 “significant barrier” was used to assess providers' barriers to educating families about the diagnosis of concussion. Providers selected 4 or 5 on the scale for the following barriers and frequencies: inadequate training to educate 16% (95% CI: 11%-23%), inadequate time to educate 15% (95% CI: 12%-24%), and not my role to educate 1% (95% CI: 0.4%-5%). Ninety-six percent (95% CI: 91%-98%) of providers without a provider decision support tool (such as a clinical pathway or protocol) specific to concussion, and 100% (95% CI: 94%-100%) of providers without discharge instructions specific to concussion believed these resources would be helpful.CONCLUSIONS:Although pediatric primary care and emergency medicine providers regularly care for concussion patients, they may not have adequate training or infrastructure to systematically diagnose and manage these patients. Specific provider education, decision support tools, and patient information could help enhance and standardize concussion management.

Concepts: Medical terms, Education, Physician, Educational psychology, Normal distribution, Scale, Decision support system, Likert scale


Study Design. Validation of a translated, culturally adapted questionnaire.Objective. To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients.Summary of Background Data. The ODI is among the most popular questionnaires used to evaluate back pain related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated.Methods. The questionnaire was translated and culturally adapted by two independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland-Morris Disability Questionnaire (RMDQ), VAS for low back and leg and three Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled and 84 of 164 (53%) returned the retest booklet filled within 2-14 days after the baseline test. There were no differences between the two groups in demographic and clinical parameters. Test-retest reliability, internal consistency and construct validity were investigated.Results. The mean ODI (SD) was 48.45 (18.94), minimum 2, maximum 94. The Cronbach’s alpha for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the RMDQ score was very good (r = 0.607, P<0.001). The correlation with VAS-back was fair (r = 0.37, P<0.001) and with VAS-leg was good (r = 0.56, P<0.001). The tested ODI had excellent test-retest reliability, the Intraclass Correlation Coefficient was 0.97 and SEM was 3.54, the resulting MDC95% was 10.Conclusion. The results of this study indicate that the Polish version of the ODI is a reliable and valid instrument for the measurement of disability in Polish-speaking patients with lower back pain.

Concepts: Spinal disc herniation, Low back pain, Psychometrics, Reliability, Cronbach's alpha, Test-retest, Internal consistency, Likert scale


Aim:  Do different clothing styles have an influence on the doctor-patient-parent relationship and which kind of outfit is preferred by children and parents. Methods:  One hundred and seven children and 72 parents were visited by a paediatrician randomly wearing one of the three different outfits (casual, semiformal, formal) during a hospital stay. Parents and children between 6 and 18 years were then interviewed about their opinion by use of a semi-structured questionnaire, while children between 0 and 6 years were observed concerning their behaviour during the examination. Results:  Using a ‘likert scale’, the casual outfit received the best mark by 95.5% of parents (58.3% in the semiformal, 30.8% in the formal group). The degree of the parents' trust in the paediatrician was comparable in all three groups. In children between 6 and 18 years, the casual dress was rated highest in 100%. In children between 0 and 6 years, the outfit had no significant influence on the patients' behaviour. Conclusion:  Apparently, parents do not only tolerate a casual outfit, but even prefer it without any loss of trust. The same holds true for children between 6 and 18 years. For younger children, the paediatricians' outfit seems to play no major role.

Concepts: Motivation, Scale, Preference, Degree of a polynomial, Likert scale, Clothing, Dress code, Casual


BACKGROUND: In line with population ageing, the number of individuals with dementia is expected to increase. Nursing students are more likely to care for dementia patients during their clinical placements and once they qualify. Nevertheless, they may not be adequately prepared during their undergraduate programme. Furthermore, lack of support during their placements may negatively influence nursing students' attitudes. Measuring the level of knowledge and attitudes of nursing students could be an important step in providing evidence on the need of enhancing dementia care training in the nursing curriculum. OBJECTIVES: The aim of this study was to assess knowledge and attitudes of nursing students in Malta towards dementia and identify factors related to these attributes. Moreover, the students were asked to rate their training and educational needs from a list of topics about this subject area. DESIGN: A questionnaire survey. SETTING: Department of Nursing within the Faculty of Health Sciences at the University of Malta. PARTICIPANTS: 280 full-time diploma and degree nursing students who are currently in their first, second and third year of their undergraduate programme. METHOD: The data was collected using a questionnaire consisting of the Alzheimer’s disease Knowledge Scale and the Dementia Attitude Scale. A 3-point Likert scale was also used by students to rate their training and educational needs from a list of 20 topics related to dementia care. The data was analysed using quantitative methods. RESULTS: Maltese nursing students had an adequate knowledge and showed positive attitudes towards Alzheimer’s disease and dementia patients. Age, academic year, training and previous care of dementia patients during their clinical placement were all found to be associated with increased knowledge and positive attitudes. CONCLUSIONS: Knowledge and attitudes of nursing students in Malta towards persons with dementia could be improved by enhancing dementia care training and improving the clinical experience.

Concepts: Alzheimer's disease, Scientific method, Psychometrics, Dementia, Malta, Quantitative marketing research, Likert scale, Caregiving and dementia


OBJECTIVE: To compare the ergonomics and workload of the surgeon during single-site suturing while using the magnetic anchoring and guidance system (MAGS) camera vs a conventional laparoscope. METHODS: Seven urologic surgeons were enrolled and divided into an expert group (n = 2) and a novice group (n = 5) according to their laparoendoscopic single-site (LESS) experience. Each surgeon performed 2 conventional LESS and 2 MAGS camera-assisted LESS vesicostomy closures in a porcine model. A Likert scale (scoring 1-5) questionnaire assessing workload, ergonomics, technical difficulty, visualization, and needle handling, as well as a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire were used to evaluate the tasks and workloads. RESULTS: MAGS LESS suturing was universally favored by expert and novice surgeons compared with conventional LESS in workload (3.4 vs 4.2), ergonomics (3.4 vs 4.4), technical challenge (3.3 vs 4.3), visualization (2.4 vs 3.3), and needle handling (3.1 vs 3.9 respectively; P <.05 for all categories). Surgeon NASA-TLX assessments found MAGS LESS suturing significantly decreased the workload in physical demand (P = .004), temporal demand (P = .017), and effort (P = .006). External instrument clashing was significantly reduced in MAGS LESS suturing (P <.001). The total operative time of MAGS LESS suturing was comparable to that of conventional LESS (P = .89). CONCLUSION: MAGS camera technology significantly decreased surgeon workload and improved ergonomics. Nevertheless, LESS suturing and knot tying remains a challenging task that requires training, regardless of which camera is used.

Concepts: Surgery, Knot, Surgeon, Task, Likert scale, Abu al-Qasim al-Zahrawi, Rocket


PURPOSE:To determine whether children tolerate cyclopentolate 1% spray better than drops and to assess the adequacy of cycloplegia achieved by spray for objective refraction. METHODS:The effects of cyclopentolate 1% drops and spray on distress levels were assessed prospectively using a guardian questionnaire in consecutive patients 10 years of age or younger. Distress was graded at various points during the appointment using a Likert scale of 1 to 10 (1 = no distress, 10 = severe distress). The adequacy of cycloplegia in children receiving cyclopentolate spray and the waiting times were assessed via a Likert questionnaire completed by the examining physician. RESULTS:The guardians of 72 and 77 children who received cyclopentolate 1% drops or spray, respectively, completed the questionnaire. The children were divided in three age groups: 1 to 4 years, 5 to 7 years, and 8 to 10 years. Children 7 years or younger were significantly less distressed by administration of cyclopentolate 1% spray (P < .005). There was no statistical difference in distress levels in children older than 7 years (P = .9719). Thirteen of the 77 children who received cyclopentolate 1% spray did not have adequate cycloplegia to allow objective refraction. CONCLUSION:The results demonstrate cyclopentolate 1% spray is less distressing at the time of administration than cyclopentolate 1% drops for children 7 years or younger. However, the cycloplegia achieved is not adequate in a high percentage of children.[J Pediatr Ophthalmol Strabismus 20XX;XX(X):XX-XX.].

Concepts: Physician, Assessment, Psychometrics, Ophthalmology, Scale, Likert scale, Distressing, Distress