Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis / Adaptação transcultural do instrumento Thirst Distress Scale (TDS) para o português brasileiro e propriedades psicométricas em pacientes em hemodiálise

Abstract Objective: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). Methods: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). Results: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). Conclusion: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Resumo Objetivo: Realizar a adaptação transcultural da escala Thirst Distress Scale (TDS) para o português brasileiro e estudar suas propriedades psicométricas em pacientes em hemodiálise (HD). Métodos: Foram realizadas traduções, retrotraduções, discussão com especialistas e avaliação psicométrica, com aplicação da versão final em 126 pacientes em HD e reteste em 70 pacientes da amostra inicial. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. Para analisar a concordância com a intensidade de sede, avaliada pela Escala Visual Analógica (EVA), foi utilizado o teste Kappa e a estratégia gráfica de Bland-Altman. Para avaliar a reprodutibilidade, foi realizado teste de correlação intraclasse (CCI). Resultados: Para obtenção da versão final da escala TDS em português brasileiro, intitulada TDS-BR, foi necessária adaptação de vocabulário em três itens e mudança de tempo verbal em seis itens. Houve boa compreensão da escala pelos pacientes em HD, consistência interna satisfatória (0,84, p<0,001), concordância moderada com a Escala Visual Analógica (EVA) (kappa=0,44; p<0,001) e reprodutibilidade quase perfeita (CCI=0,87; p<0,001). Conclusão: Os resultados obtidos indicam a aplicabilidade e confiabilidade do instrumento na língua portuguesa (Brasil). A ferramenta, por ser de fácil compreensão e baixo custo, além de ter boa aceitação, pode ser um instrumento relevante no manejo da sede de pacientes em HD.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis.

OBJECTIVE: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Advances in the Management of Perioperative Patients' Thirst.

In response to an increase in osmolarity or a decrease in plasma volume, surgical patients often experience thirst during the perioperative period. Thirst causes intense discomfort for patients, but perioperative nurses and health care providers have received minimal direction on how to address this concern. This article presents evidence related to the advances in the management of patients' thirst and discusses clinical strategies that perioperative personnel can safely implement for their patients during the preoperative and postoperative periods. The Thirst Study and Research Group at Londrina State University, Brazil, developed the Thirst Management Model to provide a standardized method for perioperative personnel. Four pillars comprise this model: identification of thirst, measurement of thirst, safety assessment for the management of thirst, and application of relief strategies. This evidence-based model should assist perioperative nurses with translating knowledge and scientific evidence into clinical practice to provide safe patient care.

The Relationship between %BML, Urine Color, Thirst Level and Urine Indices of Hydration Status.

INTRODUCTION: Dehydration is known to impair health, quality of daily life, and exercise performance [1]. While several methods are utilized to assess fluid balance, there is no gold standard to assess hydration status [2]. Cheuvront and Kenefick [3] suggested the use of a Venn diagram, which consists of % body mass weight (BML), urine color, and thirst level (WUT) to measure hydration status and fluid needs. However, no study to date has examined the relationship between the WUT criteria and hydration status measured by urine indices. OBJECTIVE: The purpose of this study was to investigate the relationships between urine-specific gravity (USG), urine osmolality (UOSM), and the WUT criteria. METHODS: Twenty-two females (mean ± SD; age, 20 ± 1 year; weight, 65.4 ± 12.6 kg) and twenty-one males (age, 21 ± 1 year; body mass, 78.7 ± 14.6 kg) participated in this study. First-morning body mass, urine color, USG, UOSM, and thirst level were collected for 10 consecutive days. First 3 days were utilized to establish a euhydrated baseline body weight. %BML >1%, urine color >5, and thirst level ≥5 were used as the dehydration thresholds. The number of markers that indicated dehydration levels was summed when each variable met each threshold. One-way ANOVA with Tukey pairwise comparison was used to assess the differences in USG and UOSM, followed by a calculation of effect size (ES). RESULTS: Figure 1 indicates the differences of UOSM based on the WUT criteria. For UOSM, "2 markers indicated" (mean [M] ± SD [ES], 705 ± 253 mOsmol [0.43], p = 0.018) was significantly higher than "1 marker indicated" (M ± SD, 597 ± 253 mOsmol). Additionally, "zero marker indicated" (509 ± 249 mOsmol) was significantly lower than "3 markers indicated" (M ± SD [ES], 761 ± 250 mOsmol, [1.01], p = 0.02) and "2 markers indicated" ([ES], [0.78], p = 0.004). However, there was no statistical difference between "3 markers indicated" ([ES], [0.65], p = 0.13) and "1 marker indicated." For USG, "3 markers indicated" (M ± SD [ES], 1.021 ± 0.007 [0.57], p = 0.025) and "2 markers indicated" (M ± SD [ES], 1.019 ± 0.010 [0.31], p = 0.026) were significantly higher than "1 marker indicated" (M ± SD, 1.016 ± 0.009). Additionally, "zero marker indicated" (1.014 ± 0.005) was significantly lower than "3 markers indicated" ([ES], [1.21], p = 0.005) and "2 markers indicated" ([ES], [0.54], p = 0.009). CONCLUSION: When 3 markers indicated dehydration levels, UOSM and USG were greater than euhydrated cut points. When 2 markers indicated dehydration levels, USG was higher than the euhydrated cut point. Additionally, UOSM and USG were significantly lower when zero or 1 marker indicated dehydration levels. Thus, the WUT criteria are a useful tool to assess hydration status. Athletes, coaches, sports scientists, and medical professions can use this strategy in the field settings to optimize their performance and health without consuming money and time.

[The tendency of applying medicines for the treatment of consumptive thirst in the period of Jin and Yuan dynasties].

In the period of Jin and Yuan dynasties, the system of syndrome differentiation and treatment in traditional Chinese medicine on consumptive thirst became more and more mature and the medication became gradually precise. By statistically analyzing the prescriptions and herbs for the treatment of consumptive thirst in 22 medical works of the Jin and Yuan dynasties, it is concluded that there are 7 categories with 20 kinds of major herbs applied. This kind of tendency of applying the medicines in consumptive thirst embodied the recognition that the syndrome classification and therapeutic methods by doctors of the Jin and Yuan dynasties, and reflected the cognition on the pathogenesis, site of lesions of consumptive thirst.

[Textual research of Liu Wan-su's works on consumptive thirst].

Liu Wan-su's San xiao lun (On Three Consumptions) was the earliest extant monograph dealing with the consumption thirst in traditional Chinese medicine (TCM). The other book, with the namesake of Liu Wan-su, Su wen bing ji qi yi bao ming ji (Collection for Preserving Life of Pathogenesis in Plain Questions), also included a section of consumption thirst. However, through comparison, the descriptions in both books were quite different and it seemed unlikely that it were written by the same author. Based on textural research of bibliography, it's hard to say if this is a true one. Further, comparison of the book with the texts of consumption thirst in Huang di su wen xuan ming lun fang (Elucidated Prescriptions and Expositions of Huangdi's Plain Questions), an authentic book of Liu, a consistency was found between San xiao lun and Huang di su wen xuan ming lun fang. It is very unlikely that Su wen bing ji qi yi bao ming ji was written by Liu because of its obvious different writing style.

Development of the thirst distress scale.

This article describes the development of a 6-item instrument that measures thirst distress. Items were developed following open-ended interviews with 10 subjects, a literature review, and development of a conceptual definition of thirst. A panel of experts established content validity. A convenience sample (N = 247) of adults receiving outpatient hemodialysis completed the scale. A panel of experts was used to assess content validity. Item analysis was used to select unrelated or redundant items for deletion. Cronbach's alpha was .78. Construct validity was supported by confirmatory and exploratory factor analysis. Positive relationships between thirst distress and, respectively, thirst intensity and interdialytic weight gain provided additional evidence of construct validity. Overall, these preliminary data indicate that the thirst distress scale has sufficient reliability and validity for use in clinical studies.