Development and validation of a rapid psychosocial well-being screening tool in patients with metastatic breast cancer.

Objective: The aim of this study was to develop and validate a rapid psychosocial well-being screening tool for metastatic breast cancer patients (MBC-PsySoc-Well-being). Methods: Applying a mixed method approach, the study was conducted in two phases. Phase 1, a focus group method was employed for item development, and three focus group sessions were conducted, with patients, caregivers, and medical professionals, respectively. Phase 2, validity and reliability testing were performed. Five experts reviewed items for content validity. Construct validity, criterion-related validity, internal consistency, and test-retest reliability were conducted among a sample of 53 patients with metastatic breast cancer. Results: Six themes were qualitatively analyzed based on focus group participants' responses. Eight items were then developed based on these themes. The index of Item-Objective Congruence scored by the experts ranged from 0.6 to 1.0. An exploratory factor analysis yielded three factors: Being curious and active in information seeking, Enthusiasm to return to a normal life, and Adjusting to positive lifestyle. The total scores of MBC-PsySoc-Well-being and the European Organization for Research and Treatment of Cancer's Quality of Life Core Questionnaire (EORTC QLQ-C30) were moderately correlated (r = 0.404, P = 0.003). Cronbach's α coefficient of the overall scale was 0.686. Pearson correlation coefficients of items between two tests within 14-day ranged from 0.410 to 0.673. Conclusion: This study represents an initiative to develop a rapid psychosocial well-being screening tool for patients with metastatic breast cancer. The results from validity and reliability testing indicate that the scale is moderately suitable for application to patients with metastatic breast cancer. However, a larger scale study should be further administered to confirm the validity and reliability of the measurement.

Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study.

BACKGROUND: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. OBJECTIVE: This study aimed to explore usability issues emerging from users' interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. METHODS: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. RESULTS: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. CONCLUSIONS: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated.

Whole-body vibration: is there a causal relationship to specific imaging findings of the spine?

STUDY DESIGN: Systematic review. OBJECTIVE: To perform a systematic review of the available literature for those studies that evaluated the role of whole-body vibration (WBV) on the spine, using imaging modalities as well as an estimation of WBV exposure. SUMMARY OF BACKGROUND DATA: Numerous comparative studies have reported a possible association between the occurrence of spinal symptoms and exposure to WBV. These exposures have commonly been examined in the work environment largely through self-reported questionnaires only. From a scientific perspective, the majority of studies emphasize symptoms and lack objective medical evidence, such as spinal imaging, to help establish a specific spinal disorder. Because both neck and low back pain comprise symptoms that can arise from a host of factors including age, a casual link between spinal disorders and WBV cannot be affirmed. METHODS: MEDLINE and EMBASE were searched for studies related to WBV and spinal symptoms, diagnosis, and/or disorders. Our searches were limited to studies published prior to August 2011. The resulting 700 citations (after excluding 354 duplicates) were then screened by 3 independent reviewers on the basis of the following predetermined inclusion and exclusion criteria: inclusion-clinical studies with imaging evaluation (radiographs, computed tomographic scans, and/or magnetic resonance images) and documented WBV exposure (occupation, amount of WBV, and/or duration); exclusion-reliance solely on self-reporting of symptoms (neck pain, low back pain, and/or sciatica), those articles based on a clinical diagnosis without use of imaging, and in vitro/animal/biomechanical studies. RESULTS: Only 7 studies met the inclusion criteria for this systematic review. Included were 5 retrospective cohort and 2 cross-sectional studies. Although mixed results and conclusions were found, the majority of studies did not identify an association between WBV exposure and an abnormal spinal imaging finding indicating damage of the spine. We should also stress that each included study has limitations secondary to quantifying WBV exposure accurately, both as a single encounter and as a total exposure over years. CONCLUSION: Based on our results from this systematic review, no causality can be shown between WBV and abnormal spinal imaging findings. With the conflicting data available in the literature, WBV has not been established as a cause for objective spinal pathological changes on a scientific basis.