Les critères STOPP/START.v2 : adaptation en langue française. [STOPP/START.v2 criteria: Adaptation into French language]

Objectif STOPP/START est un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez la personne de 65 ans ou plus. La version initiale de 2008 vient d'être mise à jour et améliorée par ses auteurs. Nous en présentons l'adaptation et la validation en langue française. Méthodes L'adaptation en français de l'outil STOPP/START.v2 a été réalisée par deux experts, confirmée par la méthode de traduction-inverse, et finalisée d'après les commentaires de neufs évaluateurs francophones, gériatres, pharmaciens cliniciens, et médecin généraliste de quatre pays (France, Belgique, Suisse, Canada). La validation a été complétée par une analyse de concordance inter-juge (CCI) des critères STOPP/START.v2 appliqués à dix vignettes cliniques standardisées. Résultats Les 115 critères de STOPP/START.v2 en français sont, par rapport à la version originale anglaise, identiques par leur classification mais adaptés en termes de présentation (critères START.v2 commençant par la condition clinique, et accompagnés par une justification du caractère inapproprié de l'omission) voire de formulation de certains critères. Cette adaptation en français est validée par (i) la traduction-inverse montrant le respect du sens clinique de la version originale, (ii) l'identification semblable des critères lorsque appliqués à dix vignettes cliniques par les neuf évaluateurs, et (iii) le haut niveau de concordance de ces neuf évaluations tant pour STOPP.v2 (CCI 0,849) que pour START.v2 (CCI 0,921). Conclusion L'adaptation en langue française des critères STOPP/START.v2 fournit aux cliniciens un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez les personnes de 65 ans et plus qui est logique, fiable et facile à utiliser. Objective STOPP/START is a screening tool to detect potentially inappropriate prescribing in persons aged 65 or older. Its Irish authors recently updated and improved the initially published version of 2008. We present the adaptation and validation into French language of this updated tool. Methods STOPP/START.v2 was adapted into French by two experts, then confirmed by a translation-back translation method and finalised according to the comments of nine French-speaking assessors - geriatricians, pharmacologists and a general physician - from four countries (France, Belgium, Switzerland, and Canada). The validation was completed by an inter-rater reliability (IRR) analysis of the STOPP/START.v2 criteria applied to 10 standardized clinical vignettes. Results In comparison to the original English version, the 115 STOPP/START.v2 criteria in French language classify in identical manner, but the presentation has been adjusted (START.v2 first specifies the clinical condition followed by an explanation of the inappropriateness of the prescription or omission). This adaptation into French language was validated by means of (i) the translation/back-translation, which showed that the French version complied with the clinical meaning of the original criteria; (ii) the similar screening results when applied by the nine specialists to the 10 cases; and (iii) the high level of inter-rater reliability of these 9 evaluations, for both STOPP (IRR 0.849) and START.v2 (IRR 0.921). Conclusion The adaptation into French of the STOPP/START.v2 criteria provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients aged 65 and older that is more logical, more reliable and easier to use.

The Strengths and Difficulties Questionnaire (SDQ-Fin) among Finnish children and adolescents

Objective: The psychometric properties of The Strengths and Difficulties Questionnaire (SDQ-Fin), a Finnish version of a brief screening instrument were studied. Emotional and behavioural problems of 7- to 15-year-olds measured by the SDQ were reported, as well as the occurrence of self-reported eating disturbance symptoms and alcohol use among adolescents. Methods and samples: The cross-sectional school survey included 25 items of the SDQ-Fin, items about eating disturbance, alchol use and child psychiatric help-seeking. The study consists of three community samples: 1. The SDQ-Fin parent (n = 703) and teacher (n = 376) versions of 7 – 12 –year-olds, and self-report versions (n = 528) of 11 – 16 years-olds were obtained, and 2. the parent (n = 81) and self-report versions of 15-16 –year olds (n = 129) were obtained in Laitila and Pyhäranta. 3. The self-report versions of 13 – 16 – year-olds (n = 1458) in Salo and Rovaniemi were obtained. Results: The psychometric properties of the SDQ-Fin were for the most part comparable with the other European SDQ research results. The internal consistency (Cronbach’s alpha = 0.71 in all informants’ reports) and inter-rater reliability (between the pairs of reports r = 0.38 - 0.44) were adequate. The concurrent validity (r = 0.75 between the SDQ and the CBCL total scores; r = 0.71 between the SDQ and the YSR total scores) was sufficient. Factor analysis of the SDQ self-report generally confirmed the postulated structure for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The response rates, means and cut-off points of the SDQ self-report scores were similar to those found, e.g. in Norway and in Britain. A high level of psychological problems, especially emotional and conduct problems and hyperactivity-inattention, were associated with high level of eating disturbance symptoms and alcohol use. Conclusion: The results showed that the psychometric properties of the SDQ-Fin are adequate and provide additional confirmation of the usefulness of the SDQ-Fin for, e.g. screening, epidemiological research and clinical purposes.

Fast spin echo imaging of carotid artery dynamics.

PURPOSE: We propose the use of a retrospectively gated cine fast spin echo (FSE) sequence for characterization of carotid artery dynamics. The aim of this study was to compare cine FSE measures of carotid dynamics with measures obtained on prospectively gated FSE images. METHODS: The common carotid arteries in 10 volunteers were imaged using two temporally resolved sequences: (i) cine FSE and (ii) prospectively gated FSE. Three raters manually traced a common carotid artery area for all cardiac phases on both sequences. Measured areas and systolic-diastolic area changes were calculated and compared. Inter- and intra-rater reliability were assessed for both sequences. RESULTS: No significant difference between cine FSE and prospectively gated FSE areas were observed (P = 0.36). Both sequences produced repeatable cross-sectional area measurements: inter-rater intraclass correlation coefficient (ICC) = 0.88 on cine FSE images and 0.87 on prospectively gated FSE images. Minimum detectable difference (MDD) in systolic-diastolic area was 4.9 mm(2) with cine FSE and 6.4 mm(2) with prospectively gated FSE. CONCLUSION: This cine FSE method produced repeatable dynamic carotid artery measurements with less artifact and greater temporal efficiency compared with prospectively gated FSE. Magn Reson Med 74:1103-1109, 2015. © 2014 Wiley Periodicals, Inc.

Setting priorities in clinical and health services research: Properties of an adapted and updated method

Objectives: The objectives of this study is to review the set of criteria of the Institute of Medicine (IOM) for priority-setting in research with addition of new criteria if necessary, and to develop and evaluate the reliability and validity of the final priority score. Methods: Based on the evaluation of 199 research topics, forty-five experts identified additional criteria for priority-setting, rated their relevance, and ranked and weighted them in a three-round modified Delphi technique. A final priority score was developed and evaluated. Internal consistency, test–retest and inter-rater reliability were assessed. Correlation with experts’ overall qualitative topic ratings were assessed as an approximation to validity. Results: All seven original IOM criteria were considered relevant and two new criteria were added (“potential for translation into practice”, and “need for knowledge”). Final ranks and relative weights differed from those of the original IOM criteria: “research impact on health outcomes” was considered the most important criterion (4.23), as opposed to “burden of disease” (3.92). Cronbach’s alpha (0.75) and test–retest stability (interclass correlation coefficient = 0.66) for the final set of criteria were acceptable. The area under the receiver operating characteristic curve for overall assessment of priority was 0.66. Conclusions: A reliable instrument for prioritizing topics in clinical and health services research has been developed. Further evaluation of its validity and impact on selecting research topics is required

Imagery or video feedback : which is the "route" to strategic improvement?

The implementation of imagery and video feedback programs has become an important tool for aiding athletes in achieving peak performance (Halliwell, 1990). The purpose of the study was to determine the effect of strategic imagery training and video feedback on immediate performance. Participants were two university goaltenders. An alternating treatment design (ATD; Barlow & Hayes, 1979; Tawney & Gast, 1984) was employed. The strategies were investigated using three plays originating from the right side by a right-handed shooting defenceman from the blueline. The baseline condition consisted of six practices and was used to establish a stable and "ideal" measure of performance. The intervention conditions included alternating the use of strategic imagery (Cognitive general; Paivio, 1985) and video feedback. Both participants demonstrated an increase in the frequency of Cognitive general use. Specific and global performance measures were assessed to determine the relative effectiveness of the interventions. Poor inter-rater reliability resulted in the elimination of specific performance measures. Consequently, only the global measure (i.e., save percentage) was used in subsequent analyses. Visual inspection of participant save percentage was conducted to determine the benefits of the intervention. Strategic imagery training resulted in performance improvements for both participants. Video feedback facilitated performance for Participant 2, but not Participant 1. Results are discussed with respect to imagery and video interventions and the challenges associated with applied research. KEYWORDS: imagery, video, goaltenders, alternating treatment design.

The Effectiveness of the precision fluency shaping program controlling stuttering behaviour in adults

This study was done to test the effectiveness of the Precision Fluency Shaping Program in controlling stuttering behaviour in adults. Two sites were chosen, each using the Precision Fluency Shaping Program to treat stuttering. At each clinic, a Speech Patbologist made a random selection of the subjects' pre- and post-therapy video-taped interviews, totalling 20 in all. During the interviews, the clients were asked questions and re~d a short passage to determine the frequency of stuttering in natural conversation and in reading. Perceptions of Stuttering Inventory questionnaires vvere also filled in before and after therapy. Two judges were trained to identify stuttering behaviour, and were given an inter-rater reliability test at selected intervals throughout the study. Protocols",:m.a;d;6 of each interview tape, were scored for (a) stuttering behaviour and (b) words spoken or read. An Analysis of Variance Repeated Measures Test was used to compare before and after scores of conversations, readings, and Perceptions of Stuttering Inventory to determine whether the Precision Fluency Shaping Program controlled stuttering behaviour significantly. A Pearson R Correlation Test was also administered to determine if a relationship existed bet\veen Perceptions of Stuttering Inventory and (i) conversation and (ii) reading scores.

Validité de construit d’un test d’évaluation de la stabilité lombo-pelvienne, le soulèvement actif de la jambe tendue (SAJT) version objective

Introduction : L’évaluation clinique du contrôle neuromusculaire des muscles du tronc est criante en réhabilitation et en entraînement. L’objectif principal de cette étude a été d’évaluer la reproductibilité intra et inter-évaluateur d’un test clinique le soulèvement actif de la jambe tendue (SAJT) chez une population active et saine. Méthode : Chaque sujet (18 joueurs de tennis) a été testé à deux reprises par 2 physiothérapeutes avec le SAJT. Résultats : La reproductibilité intra-évaluateur s’est avérée élevée à très élevée (ICC = 0.81 à 0.93) tandis la reproductibilité inter-évaluateur s’est avérée cliniquement non viable. Conclusion : À notre connaissance, le SAJT est le premier test clinique reproductible évaluant le contrôle neuromusculaire du tronc avec des compensations musculaires et cinétiques chez des sujets actifs et sains. Une formation plus importante des évaluateurs aurait certainement amélioré la reproductibilité inter-évaluateur.

Towards the identification of a neighbourhood park typology : a conceptual and methodological exploration

Peu d’études ont évalué les caractéristiques des parcs pouvant encourager l’activité physique spécifiquement chez les jeunes. Cette étude vise à estimer la fiabilité d’un outil d’observation des parcs orienté vers les jeunes, à identifier les domaines conceptuels des parcs capturés par cet outil à l’aide d’une opérationnalisation du modèle conceptuel des parcs et de l’activité physique et à identifier différents types de parcs. Un total de 576 parcs ont été évalués en utilisant un outil d’évaluation des parcs. La fiabilité intra-juges et la fiabilité inter-juges de cet outil ont été estimées. Une analyse exploratoire par composantes principales (ACP) a été effectuée en utilisant une rotation orthogonale varimax et les variables étaient retenues si elles saturaient à ≥0.3 sur une composante. Une analyse par grappes (AG) à l’aide de la méthode de Ward a ensuite été réalisée en utilisant les composantes principales et une mesure de l’aire des parcs. L’outil était généralement fiable et l’ACP a permis d'identifier dix composantes principales qui expliquaient 60% de la variance totale. L’AG a donné un résultat de neuf grappes qui expliquaient 40% de la variance totale. Les méthodes de l’ACP et l’AG sont donc faisables avec des données de parcs. Les résultats ont été interprétés en utilisant l’opérationnalisation du modèle conceptuel.

Clinical methods for quantifying body segment posture: a literature review

Purpose. Clinicians commonly assess posture in persons with musculoskeletal disorders and tend to do so subjectively. Evidence-based practice requires the use of valid, reliable and sensitive tools to monitor treatment effectiveness. The purpose of this article was to determine which methods were used to assess posture quantitatively in a clinical setting and to identify psychometric properties of posture indices measured from these methods or tools. Methods. We conducted a comprehensive literature review. Pertinent databases were used to search for articles on quantitative clinical assessment of posture. Searching keywords were related to posture and assessment, scoliosis, back pain, reliability, validity and different body segments. Results. We identified 65 articles with angle and distance posture indices that corresponded to our search criteria. Several studies showed good intra- and inter-rater reliability for measurements taken directly on the persons (e.g., goniometer, inclinometer, flexible curve and tape measurement) or from photographs, but the validity of these measurements was not always demonstrated. Conclusion. Taking measurements of all body angles directly on the person is a lengthy process and may affect the reliability of the measurements. Measurement of body angles from photographs may be the most accurate and rapid way to assess global posture quantitatively in a clinical setting.

Family interventions in psychosis: a scale to measure therapist adherence

The efficacy of family interventions in psychosis is well documented. UK and USA schizophrenia treatment guidelines advocate the practice of family interventions within routine clinical services. However, less attention has been paid to the study of treatment fidelity and the tools used in its assessment. This study reports the inter-rater reliability of a new scale: Family Intervention in Psychosis-Adherence Scale (FIPAS). This measure is designed to assess therapist adherence to the Kuipers et al. (2002) family intervention in psychosis treatment manual. Reliability ratings were based on a sample of thirteen audiotapes drawn from a randomized controlled trial of family intervention. The results indicated that the majority of items of the FIPAS had acceptable levels of inter-rater reliability. The findings are discussed in terms of their implications for the training and monitoring of the effectiveness of practitioners for family interventions in psychosis.

Pathways to inflated responsibility beliefs in adolescent obsessive-compulsive disorder: a preliminary investigation

Background: An inflated sense of responsibility is characteristic of obsessive-compulsive disorder (OCD). No previous studies have investigated its origins. Five potential pathways to inflated responsibility beliefs have been proposed; these are tested in this study. Method: A novel measure, the Origins Questionnaire for Adolescents (OQA), was developed to assess experiences on these five pathways. Reliability of the OQA was investigated. The experiences on the five pathways to inflated responsibility beliefs of sixteen adolescents with a history of OCD were compared to sixteen adolescents with no history of OCD. Parents also reported on adolescents’ experiences on the five pathways. Results: Inter-rater reliability was high. The internal consistency of the subscales were only partly satisfactory. The groups differed on one pathway; the clinical group reported a higher sense of responsibility for significant incidents with a negative outcome prior to onset of OCD. Conclusions: An inflated sense of responsibility, in combination with the occurrence of specific incidents, might act as a vulnerability factor for development of OCD. Future research should consider how to measure the subtle effects of experiences of responsibility over the course of development.

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

Tradução, adaptação cultural e avaliação psicométrica da prova cognitiva de leganés em uma população idosa brasileira com baixo nível de escolaridade

Introdução: The scales of cognitive screening are important tools for early detection of dementia, creating the possibility of developing measures to slow this process and assist in the management of the disease. Objective: To validate the Leganés Cognitive Test (Prueba Cognitive de Leganés) (PCL) for cognitive screening in low educated elderly Brazilians. Methods: The study sample was composed of 59 elderly residents from the city of Santa Cruz, Brazil with low schooling levels. Reliability was analyzed with a 2-day interval between assessments, and concurrent validity was assessed using the Mini Mental State Examination (MMSE). Results: According to the PCL, the prevalence of dementia was 11.8%. The scale items showed a moderate to strong correlation between domains (p <0.01), and inter-rater reliability exhibited ICC = 0.81, 95% CI (0.72-0.88). Factor analysis resulted in two factors: memory and orientation. Interscale agreement was considered poor (k = - 0.02), supporting the hypothesis of an educational impact on final MMSE scores. Conclusion: The results suggest that PCL has acceptable levels of reliability for use in low educated elderly Brazilians

The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results

OBJETIVO: Descrever o recrutamento de pacientes, instrumentos de avaliação, métodos para o desenvolvimento de estudos colaborativos multicêntricos e os resultados preliminares do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, que inclui sete centros universitários. MÉTODO: Este estudo transversal incluiu entrevistas semi-estruturadas (dados sociodemográficos, histórico médico e psiquiátrico, curso da doença e diagnósticos psiquiátricos comórbidos) e instrumentos que avaliam os sintomas do transtorno obsessivo-compulsivo (Escala para Sintomas Obsessivo-Compulsivos de Yale-Brown e Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown), sintomas depressivos (Inventário de Depressão de Beck), sintomas ansiosos (Inventário de Ansiedade de Beck), fenômenos sensoriais (Escala de Fenômenos Sensoriais da Universidade de São Paulo), juízo crítico (Escala de Avaliação de Crenças de Brown), tiques (Escala de Gravidade Global de Tiques de Yale) e qualidade de vida (questionário genérico de avaliação de qualidade de vida, Medical Outcome Quality of Life Scale Short-form-36 e Escala de Avaliação Social). O treinamento dos avaliadores consistiu em assistir cinco entrevistas filmadas e entrevistar cinco pacientes junto com um pesquisador mais experiente, antes de entrevistar pacientes sozinhos. A confiabilidade entre todos os líderes de grupo para os instrumentos mais importantes (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale ) foi medida após seis entrevistas completas. RESULTADOS: A confiabilidade entre avaliadores foi de 96%. Até março de 2008, 630 pacientes com transtorno obsessivo-compulsivo tinham sido sistematicamente avaliados. A média de idade (±SE) foi de 34,7 (±0,51), 56,3% eram do sexo feminino e 84,6% caucasianos. Os sintomas obsessivo-compulsivos mais prevalentes foram os de simetria e os de contaminação. As comorbidades psiquiátricas mais comuns foram depressão maior, ansiedade generalizada e transtorno de ansiedade social. O transtorno de controle de impulsos mais comum foi escoriação neurótica. CONCLUSÃO: Este consórcio de pesquisa, pioneiro no Brasil, permitiu delinear o perfil sociodemográfico, clínico e terapêutico do paciente com transtorno obsessivo-compulsivo em uma grande amostra clínica de pacientes. O Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo estabeleceu uma importante rede de colaboração de investigação clínica padronizada sobre o transtorno obsessivo-compulsivo e pode abrir o caminho para projetos semelhantes destinados a integrar outros grupos de pesquisa no Brasil e em todo o mundo.

Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)