Effect of problem-based learning on severity classification agreement by triage nurses

Background Differences in the classification results among triage nurses in the emergency room can be improved by training or applying an algorithm. This study aimed to confirm whether the agreement among triage nurses could be improved through learner-led problem-based learning. Methods This study had a single-group time series design to investigate the effect of problem-based learning led by triage nurses on the agreement of Korean Triage and Acuity Scale classification results for patients who visited the emergency department. We extracted 300 patients each in May and August 2018 before learning began and 300 patients each in May and August 2019 after learning. Results After problem-based learning was applied, the self-efficacy of triage nurses for emergency patient classification increased statistically significantly compared to before learning (7.88 ± 0.96, p < .001), and the weighted kappa coefficient was also found to be almost perfectly agreement (0.835, p < .001). Conclusions In this study, problem-based learning improved the inter-rater agreement of Korean Triage and Acuity Scale classification results and self-efficacy of triage nurses. Therefore, problem-based learning can contribute to patient safety in the emergency department by enhancing the expertise of triage nurses and increasing the accuracy of triage classification.

Translation, reliability, and validity of Japanese version of the Respiratory Distress Observation Scale

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases and is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” However, Japanese intensive care units (ICUs) do not routinely screen for dyspnea, as no validated Japanese version of the Respiratory Distress Observation Scale (RDOS) is available. Therefore, we aimed to translate the English version of this questionnaire into Japanese and assess its validity and reliability. To translate the RDOS, we conducted a prospective observational study in a 12-bed ICU of a universal hospital that included 42 healthcare professionals, 10 expert panels, and 128 ventilated patients. The English version was translated into Japanese, and several cross-sectional web-based questionnaires were administered to the healthcare professionals. After completing the translation process, a validity and reliability evaluation was performed in the ventilated patients. Inter-rater reliability was evaluated using Cohen’s weighted kappa coefficient. Criterion validity was ascertained based on the correlation between RDOS and the dyspnea visual analog scale. The area under the receiver operating characteristic curve analysis was used to evaluate the ability of the RDOS to identify patients with self-reported dyspnea. The average content validity index at the scale level was 0.95. Data from the 128 patients were collected and analyzed. Cohen’s weighted kappa coefficient and the correlation coefficient between the two scales were 0.76 and 0.443 (95% confidence intervals 0.70–0.82 and 0.23–0.62), respectively. For predicting self-reported dyspnea, the area under the receiver operating characteristic curve was 0.81 (95% confidence interval 0.67–0.97). The optimal cutoff used was 1, with a sensitivity and specificity of 0.89 and 0.61, respectively. Our findings indicated that the Japanese version of the RDOS is acceptable for face validity, understandability, criterion validity, and inter-rater reliability in lightly sedated mechanically ventilated patients, indicating its clinical utility.

Development of a clinical tool for rating the body function categories of the ICF generic-30/rehabilitation set in Japanese rehabilitation practice and examination of its interrater reliability

Background The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component “body functions” and 21 from the component “activities and participation”. This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. Methods The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters’ feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. Results The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. Conclusions In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.

Differences between risk situations identified using a self-reported questionnaire and an observational method

Background: This study investigates work-related musculoskeletal disorders risk estimation by frequently as used as ergonomic methods in the field. Objective: To identify the difference in risk estimation by an in-house observational method and a self-reported questionnaire, and to evaluate the complementary aspects of these methods. Methods: A sample of 15 operators who worked on the assembly workstations was selected from a truck manufacturing plant. The risk assessment of these workstations (28 scenarios) was performed by the observational method and the self-reported questionnaire. The agreement between both methods to identify risk situations was measured with the weighted Kappa coefficient. Results: The observational method and the self-reported questionnaire deployed on the same activity estimated different risk situations. Conclusion: This analysis does not reveal that one tool is more powerful than the other one, but shows the probability of different risk estimation. The complementary effect of each method might be considered for further investigation concerning musculoskeletal risk factors.

Does reduced cough capacity in minor thoracic injury is associated with atelectasis development?

Context: Minor thoracic injury causes non-negligible pain that could reduce the cough capacity and can cause infectious problems and atelectasis. Objectives: To describe the association between atelectasis and cough capacity, and to assess the concordance of cough capacity perceptions between health professionals and the patient. Design:The data were collected from 2006 to 2012 in 4 Canadian emergency departments (ED). Participants: Patients with a chief complaint of minor thoracic injury, ≥ 16 years old, discharged home from the ED after an evaluation by the attending physician, were included. They have three visits, at the ED, 7-day and 14-day follow-up. The initial ED visit included medical evaluation, data collection and mandatory chest and rib radiography. Main outcome measures: The presence of atelectasis was noted at the initial ED and subsequent visits.Participants cough capacity was noted by a physician, a nurse and the patients himself at subsequentvisits and classified as good, diminished, weak /absent.Results: Among the 1474 patients, 8.89% (95% CI: 7.55 - 10.47), 7.33% (95% CI: 6.04 – 8.89) and 4.63% (95% CI: 3.51 – 6.09) had atelectasis at the initial visit, 7-day and 14-day follow-up visit respectively. Except for patients with weak or absent cough capacity at the 7-day visit, which had a 2.89 (95%CI: 2.05 – 4.05) folds atelectasis proportion relative to those with a good cough capacity, they were no associations between cough capacity and atelectasis. The weighted kappa coefficient suggests a moderate to substantial agreement between the cough capacity measured by patients and nurses (0.52 to 0.65).Conclusion: There was not strong evidence of an association between atelectasis and cough capacity and the best agreement between cough capacity perception was between nurses and patients.

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.

Test-retest Reliability of the BREAST-Q IS in the Australian Breast Device Registry

Background Patient Reported Outcome Measures (PROM) are increasingly used in healthcare to assess outcomes. The BREAST-Q Implant Surveillance (BREAST-Q IS) is a 5-question Patient Reported Outcome Measure (PROM) used by the Australian Breast Device Registry (ABDR) to monitor the performance of breast devices. Validation of this tool is needed to assess its utility in this setting. Objectives The objective of our study was to assess the test-retest reliability of the BREAST-Q IS among breast implant recipients within a registry setting. Methods A test-retest reliability study was undertaken. Patients who had breast augmentation or breast reconstruction and registered with the ABDR were eligible to participate. Two hundred and fifty surveys were distributed. The BREAST-Q IS was administered to the same group of participants on two separate occasions with a 2-week test interval. Participants were divided into two groups, breast augmentation and breast reconstruction. A weighted kappa coefficient was calculated to assess the degree of test-retest reliability of the BREAST-Q IS. Results Two hundred and seven participants completed both tests. Response rate was 82% (n=113) for the breast augmentation group and 94% (n=94) for the breast reconstruction group. All 5 questions on the BREAST-Q IS obtained weighted kappa scores above 0.74 among both groups. Conclusions The BREAST-Q IS has good-to-excellent test-retest reliability for use among breast implant recipients in a registry setting. Further validation of the BREAST-Q IS will be required to establish the BREAST-Q IS as a valid and reliable PROM tool for breast implant recipients following breast device surgery.

Development of a Clinical Tool for Rating the Body Function Categories of the ICF Generic-30/Rehabilitation Set in Japanese Rehabilitation Practice, and Examination of its Interrater Reliability

BackgroundThe International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool for assessing the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of 9 ICF categories from the component “body functions” and 21 from the component “activities and participation”. This study aimed to develop a rating reference guide for the 9 body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide.MethodsThe development of the first version of the rating reference guide involved the following steps: (1) A trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight on the use of the guide in practice. The reference guide was modified based on the raters’ feedback in the field test, and an interrater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights.ResultsThe first version of the rating reference guide was successfully developed and field tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.54 to 0.85. ConclusionsIn this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to excellent interrater agreement, which encourages the use of the ICF in rehabilitation practice.Trial registrationNot applicable.

The Rainbow Scale for the Assessment of the Cervicomental Angle: A Validated Scale

Background Aging of the neck results in an increased cervicomental angle, which can be treated by various surgical and nonsurgical procedures. To measure the success of these procedures, standardized validated objective photographic measurement tools are needed. However, no online standardized photographic measurement tools exist for the assessment of the cervicomental angle. Objectives The purpose of this study was to establish a validated and reliable measurement tool for the assessment of the cervicomental angle based on the Rainbow Scale. Methods A 5-point photographic rating scale was developed and created from 1 photograph with Adobe Photoshop. Fifteen reference photographs of women, 3 photographs per grade, were included for validation. Seven panelists (ie, plastic and maxillofacial surgeons) assessed the reference photographs 3 times with a minimal interval of 3 days in an online survey. Intra- and inter-observer agreements were calculated utilizing the weighted kappa coefficient. Results Mean intra-observer agreement was 0.93 (0.78-1.00). Mean interobserver agreement was 0.796 (0.574-0.961) for survey 1, 0.868 (0.690-0.960) for survey 2, and 0.820 (0.676-0.959) for survey 3. Conclusions The Rainbow Scale for the assessment of the cervicomental angle has been validated in an online fashion. The scale is reproducible and reliable and requires no learning curve. Potential applications include objective assessment of neck treatment planning and surgical outcome. Level of Evidence: 4

Comparison of Visual and Digital Color Measurement Methods on Anterior Natural Teeth

SummaryBackground/Aim: The purpose of this study was to evaluate compatibility between visual and digital color measurement methods.Material and Methods: The color measurement components of intact natural maxillary right central incisor and left canine teeth of eighty patients were measured with visually shade guide and, digitally, with digital device. The color matchings were performed for each teeth on labial surfaces divided into three regions: cervical, middle and incisal. Ligthness, MLR (M: means middle hue, L designates greener, R designates redder) and chroma levels were assessed for each tooth on divided regions respectively. Measurements were performed by the same and experinced dentist with healthy eyes. The data were analyzed with Kappa and weighted Kappa coefficient (p< 0.05).Results: The compatibility between visual and digital methods did not exist for MLR and chroma. The compatibility between both methods were determined only for ligthness of maxillary central and canine teeth at all regions of labial surfaces.Conclusions: There was compatibility only for ligthness of intact natural teeth at all regions with both methods.