The Inter-Rater and Intra-Rater Reliability of the Actual Aquatic Skills Test (AAST) for Assessing Young Children’s Motor Competence in the Water

As children’s actual aquatic skills are important for the prevention of drowning as well as their engagement in lifelong aquatic physical activity, researchers and practitioners should be able to assess this vital concept accurately and reliably. Therefore, this study aimed to investigate the inter-rater and intra-rater reliability of the Actual Aquatic Skills Test (AAST), consisting of 17 different test items for the assessment of young children’s motor competence in the water. Six raters received a training and evaluation session on scoring the AAST, after which five of them assessed four test videos (of various children (n = 38) performing the test items) twice, with one to two weeks in between (i.e., test and re-test). Inter-rater and intra-rater reliability were determined per test video and for the different AAST test items across videos using Gwet’s Agreement Coefficient 2 (Gwet’s AC2). The Gwet’s AC2 for inter-rater reliability at the test varied from 0.414 to 1.000, indicating a moderate to perfect agreement between raters. For intra-rater reliability, it ranged from 0.628 to 1.000, demonstrating a good to perfect agreement between test and re-test scoring. In conclusion, the AAST is a promising tool to reliably assess young children’s actual aquatic skills in an indoor swimming pool.

SUpporting wellbeing through PEeR-Befriending (SUPERB) feasibility trial: fidelity of peer-befriending for people with aphasia

ObjectiveTo evaluate systematically the fidelity of a peer-befriending intervention for people with aphasia.DesignSUpporting wellbeing through Peer-befriending (SUPERB) was a feasibility randomised controlled trial comparing usual care to usual care +peer-befriending. This paper reports on the fidelity of all intervention aspects (training and supervision of providers/befrienders; intervention visits) which was evaluated across all areas of the Behaviour Change Consortium framework.SettingCommunity.ParticipantsPeople with aphasia early poststroke and low levels of distress, randomised to the intervention arm of the trial (n=28); 10 peer-befrienders at least 1-year poststroke.InterventionPeer-befrienders were trained (4–6 hours); and received regular supervision (monthly group while actively befriending, and one-to-one as and when needed) in order to provide six 1-hour peer-befriending visits over 3 months.Main measuresMetrics included number and length of training, supervision sessions and visits. All training and supervision sessions and one (of six) visits per pair were rated against fidelity checklists and evaluated for inter-rater and intrarater reliability (Gwets AC1 agreement coefficient). Per-cent adherence to protocol was evaluated.ResultsAll peer-befrienders received 4–6 hours training over 2–3 days as intended. There were 25 group supervision sessions with a median number attended of 14 (IQR=8–18). Twenty-six participants agreed (92.8%) to the intervention and 21 (80.8%) received all six visits (median visit length 60 min). Adherence was high for training (91.7%–100%) and supervision (83%–100%) and moderate-to-high for befriending visits (66.7%–100%). Where calculable, inter-rater and intrarater reliability was high for training and supervision (Gwets AC1 >0.90) and moderate-to-high for intervention visits (Gwets AC1 0.44–1.0).ConclusionPlanning of fidelity processes at the outset of the trial and monitoring throughout was feasible and ensured good-to-high fidelity for this peer-befriending intervention. The results permit confidence in other findings from the SUPERB trial.Trial registration numberNCT02947776.

Developing a Model for Evaluating Patient Experience in Educational Hospitals of Mashhad University of Medical Sciences

Background: Understanding the "patient experience" is a key step in moving towards patient-centered care. The purpose of this study is to design a patient experience evaluation model to evaluate the effective components in the patient experience in hospitals of Mashhad University of Medical Sciences. Methods: This was a comparative descriptive study conducted using databases and information resources and based on a comprehensive review, and the models used in other parts of the world were extracted based on the research protocol and entered into a comparative matrix. The reliability of the extracted framework was verified using the agreement coefficient of the parties. In order to validate the model, the questions were prepared in the form of a questionnaire and validated by the specialists of Mashhad University of Medical Sciences during two-round Delphi using SPSS 16 software. Results: In this study, 10 models were obtained for evaluating patient experience in different countries, each of which was composed of several dimensions and some of them had overlap. The models included American model (8 dimensions), Swedish model (10 dimensions), British first model (7 dimensions), British second model (8 dimensions), Scotland model (6 dimensions), Hong Kong model (9 dimensions), Norway first model (6 dimensions), Norway second model (5 dimensions), India model (10 dimensions), and the model of Ethiopia (5 dimensions). The final model with 10 dimensions and 29 sub- dimensions was approved and validated. Conclusion: The results showed that the suitable pattern for Iran had 10 dimensions and 29 sub-dimensions. Among the dimensions, respect for the patient's privacy and dignity had the highest score and the way patients are discharged from the hospital had the lowest score.

Classificação de pacientes pediátricos para o cuidado de enfermagem: validação de instrumento reestruturado

Objetivo: Validar um conteúdo reestruturado de instrumento de classificação de pacientes internados pediátricos para classificá-los segundo a complexidade. Métodos: Estudo metodológico, convergente assistencial, realizado em um hospital escola. Foram utilizadas a técnica Delphi e a escala Likert, e o consenso foi ≥0,70. Dez juízes analisaram 15 indicadores de cuidado. Dois juízes avaliaram a confiabilidade em cem pacientes. Resultados: No terceiro ciclo Delphi, dez juízes validaram o conteúdo do instrumento reestruturado com 16 indicadores, com consenso geral de 95,8%. A confiabilidade de dois juízes apresentou intervalo de confiança geral de 0,96, Kappa de Cohen geral de 0,88 e Gwet’s agreement coefficient 1 equivalente a 0,96. A classificação como alta dependência se deu em 39,5%, semi-intensivo em 29,9%, intensivo em 16%, intermediário em 14,4% e cuidado mínimo em 0,2%. Conclusão: O instrumento reestruturado para classificar pacientes pediátricos internados de alta complexidade foi validado após a terceira fase Delphi.Descritores: Classificação; Estudo de Validação; Enfermagem Pediátrica Classification of pediatric patients for nursing care: restructured instrument validationObjective: To validate the restructured content of a hospitalized pediatric patient classification instrument to classify them according to their complexity. Methods: Methodological study, convergent care in a teaching hospital. Delphi technique was used, as well as a Likert scale, with consensus of ≥0.70. Ten judges analyzed 15 indicators of care. Two judges evaluated reliability in on hundred patients. Results: In the third Delphi cycle, ten judges validated the content of the restructured instrument with 16 indicators, with overall consensus of 95.8%. The interobserver reliability of two judges showed a general confidence interval of 0.96, general Cohen Kappa of 0.88 and Gwet’s agreement coefficient 1 equivalent to 0.96. Classification as highly dependent occurred in 39.5%, as semi-intensive in 29.9%, intensive in 16%, intermediate in 14.4% and minimum care in 0.2%. Conclusion: The restructured instrument to classify hospitalized pediatrics patients of high complexity was validated after the third Delphi phase.Keywords: Classification; Validation Study; Pediatric Nursing Clasificación de pacientes pediátricos para el cuidado de enfermería: validación de instrumento reestructuradoObjetivo: Validar el contenido reestructurado de instrumento de classificación de pacientes pediátricos hospitalizados para clasificarlos según la complejidad. Métodos: Estudio metodológico, convergente asistencial en hospital escuela. Fueron utilizadas la técnica Delphi y la escala de Likert y el consenso fue ≥0,70. Diez juezes analisaron 15 indicadores de cuidado, dois evaluaron la confiabilidad en cien pacientes. Resultados: Dez juezes validaron el contenido del instrumento con 16 indicadores, con un consenso general del 95,8%. La confiabilidad interobservadores de dos juezes presentó intervalo de confiança general de 0,96; Kappa del Cohen general de 0,88 y Gwet’s agreement coefficient 1 equivalente a 0,96. La clasificación como alta dependencia fue 39,5%, como semi-intensivo en 29,9%, intensivo en 16%, intermediario en 14,4% y cuidado mínimo en 0,2%. Conclusión: El instrumento reestructurado para clasificar pacientes pediátricos hospitalizados de alta complejidad fue validado después de la tercera fase Delphi.Descriptores: Clasificación; Estudio de Validación; Enfermería Pediátrica

Blended learning program for the development of skills in the aspiration of artificial airways

Objective: to develop and validate a blended learning program, of the inverted classroom type, on the aspiration of artificial airways. Method: applied and methodological research that involved technological production for teaching a Nursing Intervention, based on Vygotsky’s theoretical frameworks and on the Nursing Process. For elaboration and validation, a classic instructional design model was followed. The general and pedagogical requirements were validated, as well as those for videos and interface. For the analysis, the Content Validity Index and the First-order agreement coefficient were used. Results: 34 experts participated, 27 of whom were nurses and seven were professionals in Information Technology. In the nurses’ opinion, the general and pedagogical requirements obtained a Content Validity Index of 0.99 and 0.98 was obtained for the videos and for the interface. The interface for the IT professionals was 0.94. All requirements showed almost perfect agreement. Conclusion: the teaching program was elaborated and validated by experts and constitutes an innovative proposal to train nurses. The mediation of teaching by means of duly validated technologies can favor learning and reaching positive results in the development of skills in the practice of aspiration of artificial airways.

Adaptation of an instrument to classify neonatal patients into care categories

ABSTRACT Objective: To adapt and validate a patient classification instrument for neonatal units. Method: Methodological study, with adaptation of the Pediatric Patients Classification Instrument for neonatal patients. After content validation by judges, the instrument was tested for reliability, applied to 33 neonates by two nurses, simultaneously. To assess the agreement among nurses regarding the scores of each patient on the classification scale, an intraclass agreement coefficient was applied. To assess the agreement regarding the classification in care categories, the weighted Kappa coefficient was calculated. Results: The adapted instrument consisted of a total of nine indicators, with three care categories: high dependence on care, semi-intensive care and intensive care. The Content Validity Index varied between 0.85 and 0.92 for items of the instrument. The intraclass agreement was 0.87 and the weighted Kappa for care categories was 0.56. Conclusion: An instrument that allows neonatal patients to be classified into care categories, with satisfactory reliability was validated to support the dimensioning of the nursing team.

The concordance of endoscopic and histologic findings of 530 pediatric patients suspicious for celiac disease in a referral center, Isfahan, Iran

Introduction: The purpose of this study is evaluation of concordance of histologic and endoscopic findings in pediatrics referred to Imam Hossein children’s hospital, in Isfahan for evaluation of celiac disease. An accurate prediction of the likelihood of a histologic finding in the setting of a visually normal endoscopy can help prepare families for unanticipated results. Patients and Methods: This is a retrospective study conducted from 2015-2017. The sampling method is census and all eligible patients are included in the study. At the beginning of the work, obtaining consent for entering the project has been done through interviews. After that, patients information such as file number, age and gender according to the file were entered into the data gathering sheet. Data were analyzed using SPSS software version 22. Pvalue< 0.05 was considered significant. Results: Around 530 patients suspected of having celiac disease participated in the present study. The mean age of the subjects was 6.88 ± 4.31 years. Among them, 57.6% (305 patients) were girls and 42.4% (225 patients) were boys. According to the results, the kappa agreement coefficient is equal to 0.42. There was moderate agreement between endoscopy and pathology findings (kappa = 0.42). Conclusion: The results of the study and the kappa Cohen coefficient indicate the appropriateness of using endoscopy in patients with suspected celiac disease.

Reliability of a beef cattle locomotion scoring system for use in clinical practice

BackgroundLocomotion (lameness) scoring has been used and studied in the dairy industry; however, to the authors’ knowledge, there are no studies assessing the reliability of locomotion scoring systems when used with beef cattle.MethodsA four-point scoring system was developed and beef cattle filmed walking on a firm surface. Eight veterinary researchers, eight clinicians and eight veterinary students were shown written descriptors of the scoring system and four video clips for training purposes, before being asked to score 40 video clips in a random order. Participants repeated this task 4 days later.ResultsThe intra-observer agreement (the same person scoring on different days) was acceptable with weighted mean Kappa values of 0.84, 0.81 and 0.84 respectively for researchers, clinicians and students. The inter-observer agreement (different people scoring the same animal) was acceptable with weighted Gwet’s Agreement Coefficient values of 0.70, 0.69 and 0.64 for researchers, clinicians and students. Most disagreement occurred over scores one (not lame but imperfect locomotion) and two (lame, but not severe).ConclusionThis scoring system has the potential to reliably score lameness in beef cattle and help facilitate lameness treatment and control; however, some disagreements will occur especially over scores one and two.

Evaluating of HPV–DNA ISH as an adjunct to p16 testing in oropharyngeal cancer

Aim: Current guidelines recommend p16 immunohistochemistry (IHC) for testing human papillomavirus (HPV) in oropharyngeal carcinoma (OPSCC). We evaluated the value of adding DNA in situ hybridization (ISH) to p16 IHC. Methods: Fifty patients with OPSCC were analyzed. Concordance between HPV–DNA ISH and p16 IHC was measured by Gwet's agreement coefficient. Results: p16 IHC was positive in 35/48 (72.9%), negative in 8/48 (16.7%) patients. Wide spectrum DNA–ISH was positive in 9/23 (39%) and negative in 14/23 (60.9%) patients. High-risk 16/18 (HR) HPV DNA–ISH was positive in 11/23 (47.8%) and negative in 12 (52.2%) patients. The agreement between HPV DNA–ISH and p16 IHC is fair (Gwet's AC1 = 0.318). Conclusion: The agreement between p16 IHC and HPV–DNA ISH was fair. However, ISH sensitivity was low. Our findings add to the current data that p16 IHC testing is reliable and may be enough as a stand-alone test for HPV detection in OPSCC.

Does tackling form affect head acceleration in youth football players?

To reduce head impact exposure, a number of youth football organizations have begun teaching tackling technique. This study sought to develop and utilize a set of tackling form grading criteria for both tacklers and ball carriers as well as to relate tackling form to head acceleration outcome. It was hypothesized that players exhibiting better form would experience lower head accelerations in individual tackles. Three teams consisting of 67 players (20, 29, and 18 players per team; age 12.7 ± 0.95, age range 11–14 years, body mass 55.1 ± 16.2 kg) were instrumented with helmet-mounted accelerometer arrays for one season. Videos of close-range tackling drills were used to develop tackling form criteria. Two raters used these criteria to each score 105 impacts. Six of the seven categories were found to have good inter-rater reliability metrics (total percent agreement ≥ 79%, agreement coefficient ≥ 0.65). Bending at both the hips and knees, leading with the shoulder or arm, and initiating contact were found to reduce risk of high-magnitude (>40 g) head impacts in tacklers. Keeping the eyes up and avoiding dropping the head reduced the risk of high-magnitude head impacts in ball carriers. This study shows the potential effectiveness of training both tacklers and ball carriers in proper technique for collisions in youth football to minimize head impacts.