Project description:ObjectiveTo determine the frequency with which specific Coma Recovery Scale-Revised (CRS-R) subscale scores co-occur as a means of providing clinicians and researchers with an empirical method of assessing CRS-R data quality.DesignWe retrospectively analyzed CRS-R subscale scores in hospital inpatients diagnosed with disorders of consciousness (DOCs) to identify impossible and improbable subscore combinations as a means of detecting inaccurate and unusual scores. Impossible subscore combinations were based on violations of CRS-R scoring guidelines. To determine improbable subscore combinations, we relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database (ie, frequency of occurrence=0%) were also considered improbable.SettingSpecialized DOC program and university hospital.ParticipantsPatients diagnosed with DOCs (N=1190; coma: n=76, vegetative state: n=464, minimally conscious state: n=586, emerged from minimally conscious state: n=64; 794 men; mean age, 43±20y; traumatic etiology: n=747; time postinjury, 162±568d).InterventionsNot applicable.Main outcome measureImpossible and improbable CRS-R subscore combinations.ResultsOf the 1190 CRS-R profiles analyzed, 4.7% were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2% (41/336) of possible subscore combinations were classified as improbable.ConclusionsClinicians and researchers should take steps to ensure the accuracy of CRS-R scores. To minimize the risk of diagnostic error and erroneous research findings, we have identified 9 impossible and 36 improbable CRS-R subscore combinations. The presence of any one of these subscore combinations should trigger additional data quality review.
Project description:BackgroundTrust in the healthcare system is a major contributor for racial disparities in health and health care. We aimed to formally translate and cross-culturally adapt the Korean version of the Revised Health Care System Distrust (HCSD-K) scale with a sample of Korean American women and examine the psychometric properties of the HCSD-K scale.MethodsTen Korean American women participated in the cognitive interview. A self-administered questionnaire was completed by 196 Korean American women aged 50⁻74 years. Instrument adaptation was performed using committee-based translation and cognitive interviewing. Construct validity, convergent validity, and internal consistency were examined to evaluate the psychometric properties of the HCSD-K scale.ResultsThe translated instrument was found to be semantically sound. A confirmatory factor analysis revealed a two-factor structure with an excellent fit. Convergent validity was supported by correlations between the HCSD-K scale and both the Perceived Discrimination in Health Care and Trust in Physician scales. Cronbach's alpha for the total HCSD-K was 0.83.ConclusionThe nine-item HCSD-K scale demonstrated satisfactory reliability and validity. It is an appropriate instrument for measuring healthcare system distrust in Korean American women. Further study is needed to confirm the study results in a gender-mixed Korean population.
Project description:To describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness.Data were retrospectively extracted from the medical records of patients enrolled in a specialized disorders of consciousness (DOC) program. Sensitivity and specificity analyses were completed using CRS-R-derived diagnoses of minimally conscious state (MCS) or emerged from minimally conscious state (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the test criterion. A receiver operating characteristic curve was constructed to demonstrate the optimal CRS-R total cutoff score for maximizing sensitivity and specificity.Specialized DOC program.Patients enrolled in the DOC program (N=252, 157 men; mean age, 49y; mean time from injury, 48d; traumatic etiology, n=127; nontraumatic etiology, n=125; diagnosis of coma or vegetative state, n=70; diagnosis of MCS or EMCS, n=182).Not applicable.Sensitivity and specificity of CRS-R total scores in detecting conscious awareness.A CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS, and a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (ie, were diagnosed with vegetative state or coma). The area under the curve in the receiver operating characteristic curve analysis is .98.A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false-negative diagnostic error in 22% of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria. A cutoff score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93% of cases. The optimal total score cutoff will vary depending on the user's objective.
Project description:This study developed a Japanese version of the Revised Version of the Compound Psychological Capital Scale (CPC-12R) and tested its reliability and construct validity. The participants were 1,000 young adults (500 university students and 500 employees) recruited through an internet survey. Confirmatory factor analysis showed that the four first-order factors (hope, optimism, resilience, and self-efficacy) and one second-order factor (PsyCap) model of the previous study is appropriate for the Japanese context. In addition, Cronbach's α and omega-higher-order of CPC-12R were sufficient. The measurement invariance analysis suggested sufficient scalar invariances for the employees and university students and across genders. The Japanese version of the CPC-12R had moderate positive correlations with job satisfaction, work engagement, conscientiousness, and extraversion, as well as a moderate negative correlation with negative emotionality. These findings provide evidence for sufficient reliability and construct validity of the Japanese version of the CPC-12R.
Project description:BackgroundTo develop a Korean version of the original English version of the convalescence and recovery evaluation (CARE) questionnaire. The linguistic validation of the CARE questionnaire was tested on Korean patients who underwent abdominal and pelvic surgery.MethodsThe CARE questionnaire was translated and validated linguistically in the following steps. Permission to translate the Korean version of the original version, forward translation into the Korean, reconciliation, backward translation into English, cognitive debriefing through patient interviews, and finally proofreading.ResultsThe forward translation was carried out by two independent bilingual translators with non-medical backgrounds. In the translation step to Korean, the terms "bloated and gassy" and "trouble concentrating" were adjusted to make them easier to understand. Backward translation was performed by another translator who was not included in the forward translation. At the backward-translation stage, the Korean version was accepted without any objection, almost matching the original version except for a few words. Cognitive debriefing by means of patient interviews was performed with 10 patients admitted to the department of urology for renal, bladder, and prostate cancer for cancer treatment. There was no difficulty in understanding the content of the questionnaire. Because most of the terms were clear and understandable, no further changes were made in the panel discussion.ConclusionsThe Korean version of the CARE questionnaire has been verified and is ready for use. Additional testing steps are required for the psychometric performance of the Korean version of CARE.
Project description:Objective: The aim of this study was to develop a general method to estimate the minimal number of repeated examinations needed to detect patients with random responsiveness, given a limited rate of missed diagnosis. Methods: Basic statistical theory was applied to develop the method. As an application, 100 patients with disorders of consciousness (DOC) were assessed with the Coma Recovery Scale-Revised (CRS-R). DOC patients were supposed to be examined for 13 times over 20 days, while anyone who was diagnosed as a minimally conscious state (MCS) in a round would no longer be examined in the subsequent rounds. To test the validation of this method, a series of the stochastic simulation was completed by computer software under all the conditions of possible combinations of three kinds of distributions for p, five values of p, and four sizes of the sample and repeated for 100 times. Results: A series of formula was developed to estimate the probability of a positive response to a single examination given by a patient and the minimal number of successive examinations needed based on the numbers of patients detected in the first i (i =1, 2,.) rounds of repeated examinations. As applied to the DOC patients assessed with the CRS-R, with a rate of missed diagnosis < 0.0001, the estimate of the minimal number of examinations was six in traumatic brain injury patients and five in non-traumatic brain injury patients. The outcome of the simulation showed that this method performed well under various conditions possibly occurring in practice. Interpretation: The method developed in this paper holds in theory and works well in application and stochastic simulation. It could be applied to any other kind of examinations for random responsiveness, not limited to CRS-R for detecting MCS; this should be validated in further research.
Project description:BackgroundPrevious studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC).MethodsPatients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed.ResultsIn this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS.ConclusionsThe rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.Trial registrationClinicalTrials.gov ID: NCT04139239 ; Registered 24 October 2019 - Retrospectively registered.
Project description:ObjectiveCoronavirus disease 2019 (COVID-19) has psychological effects such as anxiety and depression as well as direct infection in people. The Fear of COVID-19 scale is a scale that can measure anxiety related to COVID-19 in a short time. The purpose of this study was to verify the reliability and validity the Korean version of Fear of COVID-19 scale (KF-COVID-19S).MethodsThe data of total 186 normal adults and 17 patients were finally used for the statistical analysis. For internal consistency, Cronbach's α was calculated. For concurrent and discriminant validity, the correlations with the Hospital Anxiety and Depression scale (HADS), Patient Health Questionnaire-15 (PHQ-15), World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOLBREF) were analyzed. For construct validity, exploratory and confirmatory factor analysis were conducted.ResultsCronbach alpha was 0.88. The two-factor model (factor 1: Physical fear, factor 2: Emotional fear) showed significantly positive correlations and appeared to be "good" fitness (CFI=0.906, IFI=0.907, NFI=0.902).ConclusionThe KF-COVID-19S can be a useful scale that can measure the physical and emotional fears associated with COVID-19 in a short time. Because the psychiatric patients are a more vulnerable group to the fear, it is thought that the KF-COVID-19S will help to determine the patient's level of anxiety and make a therapeutic plan for the underlying mental disorder.
Project description:The Nociception Coma Scale is a nociception behaviour observation tool, developed specifically for patients with disorders of consciousness (DOC) due to (acquired) brain injury. Over the years, the clinimetric properties of the NCS and its revised version (NCS-R) have been assessed, but no formal summary of these properties has been made. Therefore, we performed a systematic review on the clinimetric properties (i.e. reliability, validity, responsiveness and interpretability) of the NCS(-R). We systematically searched CENTRAL, CINAHL, Embase, PsycInfo and Web of Science until August 2015. Two reviewers independently selected the clinimetric studies and extracted data with a structured form. Included studies were appraised on quality with the COSMIN checklist. Eight studies were found eligible and were appraised with the COSMIN checklist. Although nearly all studies lacked sample size calculation, and were executed by the same group of authors, the methodological quality ranged from fair to excellent. Important aspects of reliability, construct validity and responsiveness have been studied in depth and with sufficient methodological quality. The overview of clinimetric properties in this study shows that the NCS and NCS-R are both valid and useful instruments to assess nociceptive behaviour in DOC patients. The studies provide guidance for the choice in NCS-R cut-off value for possible pain treatment and cautions awareness of interprofessional differences in NCS-R measurements.SignificanceThis systematic review provides a structured overview of the clinimetric properties of the Nociception Coma Scale (-Revised) and provides insights for a solid evidence-based nociception behaviour assessment and treatment plan.
Project description:Study designA prospective study.PurposeTo evaluate the reliability and validity of the adapted Korean version of the Neck Pain and Disability Scale (NPDS).Overview of literatureThe validity of Korean version of NPDS has not been completely demonstrated yet.MethodsTranslation/retranslation of the English version of NPDS was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale (VAS) measure of pain, NPDS and the previously validated Short Form-36 (SF-36) were mailed to 91 patients, who had been surgically treated for degenerative cervical disease. Eighty-one patients responded to the first mailing of questionnaires and 69 of the first time responder returned their second survey. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's ? were conducted. Concurrent and construct validity were also evaluated by comparing the responses of NPDS with the results of VAS and responses of SF-36.ResultsFactor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The NPDS showed excellent test/re-test reliability. Internal consistency of Cronbach's ? was found to be very good. The NPDS was correlated with the VAS. The Korean version of NPDS showed good significant correlation with SF-36 total score and with single SF-36 domains scores.ConclusionsThe adapted Korean version of the NPDS was successfully translated and is considered suitable for outcome assessments in the Korean-speaking patients with neck pain.