Validation of an assessment, medical problem-oriented plan, and care plan tools for demonstrating the clinical pharmacist's activities.

Background: Identifying, preventing, and resolving medical problems are some of the most central functions of clinical pharmacy (CP) and pharmaceutical care (PC) practitioners. Usually, the practitioners and researchers find a challenging to link the problem and the appropriate intervention to be included in the care plan. A comprehensive, well-structured, validated, simple use and standardized tool, which fulfill these requirements in daily clinical practice, are currently rare. Purpose: To design and validate a comprehensive medical problem-oriented plan (MPOP) classification system in addition to assessment and care plan tools for use in practicing, researching, and teaching CP and PC. Materials and methods: The methodology was composed of five steps: literature searching and classification of the problems; developing the assessment of treatments and care plan templates; implementing the tutorial; validation; completion and evaluation of the final version. Results: The classification system (MPOP tool) is an open hierarchical structure, where higher levels are broadly defined, consisting of 5 main categories, and lower levels become more specific. In the MPOP tool's final version, a total of 24 major subcategories were distributed to the major five categories as 4 (Indication), 5 (Effectiveness), 7 (Safety), 3 (Patient), and 5 (Miscellaneous). Different minor subcategories (subcategory 2, n = 62) and 95 plans (interventions) were determined. Each of the subcategories and plans includes a notes section that represents a specific detail. There was strong agreement on using the MPOP tool between the two authors (κ = 1.000, p < 0.0005) and between three random clinical pharmacists out of 17 (κ = 0.947, 95% CI, 0.840 to 1.055, p < 0.0005). The validity and reliability statistics demonstrate that the Alsayed_v1 tools are extremely appropriate. The majority of users expressed high satisfaction with all the assessment, MPOP, and care plan tools. Conclusion: The Alsayed_v1 tools introduced in this paper were applied to actual patient cases and were validated. These tools include: assessment of treatments, MPOP, and care plan. Including the interventions in the classification system is important especially in PC research where the type of recommendations should be documented to assess the value and impact of the service and saves the time of practitioners in typing the appropriate interventions. By applying the steps within these Alsayed tools, the clinical pharmacists can actively provide the best practice to achieve the optimal patient outcome.

Children's electronic screen time exposure and its relationship to dental anxiety and behavior.

Objectives: The purpose of this study was to assess the association between electronic screen time and dental anxiety and behaviour among children aged six to twelve years during dental examination, prophylaxis, and topical fluoride application. Material and methods: This was a cross-sectional study which included 402 paediatric dental patients aged six to twelve years who came to King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The data was collected from September 2020 to December 2021. Self-constructed questionnaire was used to collect data from the patient and his/her guardian. It was comprised of eight demographic questions as well as 13 multiple-choice questions regarding the patients' screen time. Child dental anxiety was assessed by using Abeer Children Dental Anxiety Scale (ACDAS). Assessment of child's behaviour was done by using Frankl Behavioural Rating Scale. Results: This study had a response rate of 100%. Out of the 402 participants, 248 (61.7%) were found to have anxiety while 154 (38.3%) were not. Of all participants 274 (68.2%) were cooperative and 128 (31.8%) were not. A Significant relationship between anxiety and behavioural problems during a dental visit and the participant's total exposure hours to electronic devices was found (p < 0.001). Children exposed to electronics at the age of two years or before displayed more anxiety and uncooperative behaviour (p < 0.001). Conclusions: early exposure to electronic screens, especially for entertainment purposes and longer exposure can be associated with increased dental anxiety and uncooperative behaviour in children age 6-12 years. Recommendations: Parents should be educated about the risks of permitting their children to use electronic devices and encouraged to replace such devices with activities that incorporate physical activity.

Development of a mobile tele-education system to assist remote otolaryngology learning during COVID-19 pandemic.

Background: Developing clinical thinking competence (CTC) is crucial for physicians, but effective methods for cultivation and evaluation are a significant challenge. Classroom teaching and paper-and-pencil tests are insufficient, and clinical field learning is difficult to implement, especially during the COVID-19 pandemic. Simulation learning is a useful alternative, but existing methods, e.g., OSCE, 3D AR/VR, and SimMan, have limitations in terms of time, space, and cost. Objective: This study aims to present the design and development of an Otolaryngology Mobile Tele-education System (OMTS) to facilitate CTC learning, and to evaluate the system's usability with senior otolaryngology experts. Methods: The OMTS system utilizes the convenience of mobile learning and the touch function of mobile devices to assist users (medical students or post-graduate physicians) in learning CTC remotely. Clinical knowledge and system functions in the OMTS system are defined by senior experts based on required CTC learning cases. Through simulated clinical case scenarios, users can engage in interactive clinical inquiry, practice required physical and laboratory examinations, make treatment decisions based on simulated responses, and understand and correct learning problems through a diagnostic report for effective learning. Usability testing of the OMTS system was evaluated by three senior otolaryngology experts using measurements of content validity, system usability, and mental workload during their available time and location. Results: Statistical results of experts' evaluation showed that the OMTS system has good content validity, marginal-to-acceptable system usability, and moderate mental workload. Experts agreed that the system was efficient, professional, and usable for learning, although the practicality of the clinical inquiry and hands-on practice functions could be improved further. Conclusions: Based on the OMTS system, users can efficiently hands-on practice and learn clinical cases in otolaryngology, and understand and correct their problems according to the diagnostic report. Therefore, the OMTS system can be expected to facilitate CTC learning according to experts' evaluation.

Validation of an instrument for perceived factors affecting fruit and vegetable intake based on Pender's health promotion model.

Increasing fruit and vegetable (F&V) intake has a protective role against chronic conditions such as cardiovascular disease, cancer and diabetes. The present study aimed to validate an instrument for measuring the perception of effective factors on consumption behaviour of F&V based on Pender's health promotion model (HPM).This cross-sectional validation survey has consisted of five steps: literature review in order to plan and develop an instrument, face validity assessment, content validity assessment, reliability assessment and construct validity assessment with the cooperation of experts in health education, nutritionists and the target group (government employees). In the present study, reliability and validity of constructs were determined through Cronbach's alpha and exploratory factor analysis, respectively, in SPSS 22. The mean impact score was acceptable for 96·42 % of items in face validity. The mean scores of content validity ratio (CVR), content validity index (CVI) and reliability were 0·92, 0·97 and 0·96, respectively. According to the principal component analysis with varimax rotation, 104 items were identified in 15 factors contributing to 61·17 % of the model cumulative variance. Given the favourable scores of the research instrument in face validity, content validity and reliability as well as its ability to predict the extracted factors from the model, it can be used as a suitable instrument in future studies.

A Quality Improvement Initiative to Increase the Opportunity of Play Activities and Reduce the Screen Time Among Children Admitted in Hospital Setting of a Tertiary Care Centre, North India.

OBJECTIVE: To increase the time spent by children on play activities and reduce screen time on daily basis from baseline to 25% over the period of 10 wks in hospital setting of a tertiary care centre, North India. METHODS: The quality improvement design was chosen and the study was conducted in the pediatric surgery and medicine wards of a tertiary care centre in North India. The participants of the study were children admitted in the medical and surgical wards, their caregivers and health care personnel (both nurses and physicians) working in the respective wards. The study was conducted in three phases: planning, development and implementation phase. In planning phase, the baseline assessment of outcome and process measures was performed and the root cause analysis was done which revealed that there was problem with the procedure and policy. This is why day-to-day play implementation procedure protocol development and implementation was chosen as a change based on Eisenhower's matrix. In development phase, day-to-day play implementation procedure protocol was developed and was implemented in the units by using PDSA (Plan, Do, Study and Act) model. Three PDSA cycles were conducted. The outcome measures were 'the time spent by the child on play activities on daily basis' (calculated by the time spent by child in play/total time the child was awake in a day) and 'the reduction in screen time' (calculated by the average time spend by the child on android based phone in a day). The process measures were day-to-day play implementation score, time spent by child on play activities and screen time on daily basis during hospitalization. The data was collected by the team members and the investigator. RESULTS: At the end of all PDSAs, the day-to-day play implementation score and time spent on play activities increased by 50% and 20% respectively and the screen time reduced to 73%. Though the outcome measures were nearly achieved, the continuous efforts are still required to ensure sustainability and future incorporation of play in day-to-day routine of hospital care. CONCLUSION: This QI initiative helped in increasing the play opportunities and reducing the screen time in wards. Hence, both the process and outcome measure were nearly achieved, whereas sustainability remained an issue.

Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire.

BACKGROUND: Primary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose. METHODS: The development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items. RESULTS: The final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance. CONCLUSIONS: The newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.

Developing and using a dengue patient care guideline for patients admitted from households to primary care units and the district hospital: A community participatory approach in Southern Thailand.

BACKGROUND: Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care. METHODS: 26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions. RESULTS: The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data. CONCLUSION: The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.

Reliability and validity of Chinese version of a tool to assess the quality of life in idiopathic pulmonary fibrosis in patients with interstitial lung disease.

OBJECTIVE: This paper aims to determine the reliability and validity of the Chinese version of a tool that assesses the quality of life in idiopathic pulmonary fibrosis (cATAQ-IPF) in patients with interstitial lung disease (ILD). METHODS: We used the process of scale introduction to establish cATAQ-IPF. The content validity of the scale was evaluated by six experts. A total of 92 patients with ILD completed the cATAQ-IPF, St. George's respiratory questionnaire (SGRQ), and The Medical Research Council dyspnoea scale at the baseline, and 15 patients completed cATAQ-IPF at the follow-up period 2 weeks later. Thus, yielding data were used to assess various psychometric properties of cATAQ-IPF. Intraclass correlation coefficient (ICC), Cronbach's α coefficient, content validity index (CVI), item-level CVI (I-CVI), Pearson's coefficients, criterion-relation validity, and known-group validity were used for data analysis. RESULTS: The cATAQ-IPF showed excellent test-retest reliability (ICC = 0.95), except for the therapy domain (Cronbach's α = 0.60) and acceptable internal consistency (Cronbach's α = 0.96 for the total). The scale-level CVI was 0.80, and the I-CVI was in the range of 0.78-1.00. The total cATAQ-IPF score was strongly correlated with the SGRQ total score (r = 0.71, P < 0.01). The cATAQ-IPF score of patients with ILD was 250.74 ±â€¯47.39, and that of patients with IPF was 287.90 ±â€¯22.56. Patients with IPF possessed considerable impairments in health-related quality of life according to the cATAQ-IPF score (t = 4.94, P < 0.01). CONCLUSIONS: The cATAQ-IPF is a reliable and valid instrument for the evaluation of quality of life of Chinese patients with various forms of ILD.

Improvement of General Disaster Preparedness Belief Scale Based on Health Belief Model.

IntroductionThe Health Belief Model (HBM) can be used as a guide in enhancing the peoples' awareness, improving the motivation, and providing tools that address beliefs and attitudes toward general disaster preparedness (GDP). METHODS: The aim of this study was to improve and re-test all psychometric properties of the published General Disaster Preparedness Belief (GDPB) scale based on HBM carried out in the general population. This scale development study measured by 58 items was prepared under the same structure of the developed GDPB scale that measured 31 items before. This expanded scale was applied to 973 individuals. Firstly, the data from application of the expanded scale was examined under Exploratory Factor Analysis (EFA). Then, the estimations obtained from Confirmatory Factor Analysis (CFA) for the expanded scale with 45 items were compared with the estimations obtained from the previous scale with 31 items. RESULTS: The EFA lead to the removal of 13 items and the retention of 45 items. The items which the factor loadings were below 0.30 and which gave the factor loadings for more dimension were excluded from the data set. A model measured six dimensions with 45 items was hypothesized: six items under perceived susceptibility, four items under perceived severity, six items under perceived benefits, 14 items under perceived barriers, five items under cues to action, and 10 items under self-efficacy. For CFA results, all estimations for factor loadings were significant. The scale with 45 items obtained in this study fit because Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Adjusted Goodness of Fit Index (AGFI) were over 0.95. CONCLUSION: These results suggest that the scale with 45 items shows improvement in the scale with 31 items. This study indicates that the GDPB scale with 45 items based on HBM has acceptable validity and reliability. This tool can be used in disaster preparedness surveys. InalE, DoganN. Improvement of General Disaster Preparedness Belief scale based on Health Belief Model. Prehosp Disaster Med. 2018;33(6):627-636.