Psychometric properties of instruments used to measure the cultural competence of nurses: A systematic review.

BACKGROUND: Cultural competence is a key component of culturally congruent nursing care. In order to reduce healthcare inequalities and to identify potentials for improvement in nursing practice, researchers need to be able to assess cultural competence properly. Although many instruments for the assessment of cultural competence have been developed, their measurement properties have not yet been reviewed systematically. Such an overview of existing instruments, however, would allow researchers to identify the most valid and reliable instrument for nursing practice. OBJECTIVE: The purpose of conducting this review is to identify and critically appraise the psychometric properties of instruments used to measure the cultural competence of nurses. METHODS: A systematic literature search was performed in November 2019 in the following electronic databases: Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO and PubMed. Studies that were conducted to assess any measurement property of instruments used to measure the cultural competence of nurses were included. Two reviewers independently screened the articles and assessed the risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The quality of included instruments was assessed on the basis of the updated criteria for good measurement properties, and the quality of the summarised results was graded based on the principles of Grading of Recommendations Assessment, Development and Evaluation. RESULTS: In total, 44 studies describing 21 instruments were included in this study. We found that most instruments were tested for at least some forms of validity, but seldom for reliability. The quality of the psychometric properties was evaluated using the criteria for good measurement properties for the following: content validity, structural validity, internal consistency, reliability, measurement error and construct validity. No studies were found in which cross-cultural validity, criterion validity, or the responsiveness of the included instruments were evaluated. The Transcultural Self-Efficacy Tool, the Cultural Competence Assessment, and the Cultural Competence Health Practitioner Assessment showed sufficient levels of quality for psychometric properties and can be recommended for the assessment of cultural competence in nurses. CONCLUSION: Given the broad availability of self-administered instruments to assess cultural competence, the development of new instrument is not recommended. A particular need was identified to conduct further psychometric evaluation studies on existing instruments and to adapt them accordingly, and especially on less frequently evaluated properties, such as reliability, measurement error and responsiveness.

Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings.

PURPOSE: The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein-energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. METHODS: 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition-i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals-making use of existing datasets, evidence and expert knowledge. RESULTS: Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. CONCLUSIONS: The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population.

Dysphagia in Hospitalized Older Patients: Associated Factors and Nutritional Interventions.

OBJECTIVES: To (1) assess the association between dysphagia and malnutrition as well as other related factors and (2) investigate the nutritional interventions that are initiated in dysphagic older patients. DESIGN: Cross-sectional, multi-center point prevalence measurement. SETTING: 53 Austrian hospitals. PARTICIPANTS: 3174 hospitalized patients, 65 years or older. MEASUREMENTS: A standardized and tested questionnaire was used for the data collection, which was based on both inspections of the patients and information documented in the patient chart. Medical diagnoses were assessed by referring to the International Classification of Diseases. Dysphagia was measured by asking the patient a dichotomous question. Several other data points were collected including: gender, age, number of diseases, malnutrition, care dependency scale (CDS) score and dependency during activities of daily living (ADL). To investigate the associations between dysphagia and malnutrition and other associated factors, cross tabulation, chi-squared test, t-test and Mann-Whitney U test were used. RESULTS: The prevalence of dysphagia among these patients was 7.6%. Dysphagia and malnutrition were significantly associated (< 0.001). Patients with dysphagia had statistically significant lower BMI values (p = 0.01), more medical diagnoses (p = 0.003) and were more care dependent (p < 0.001) than patients who did not suffer from dysphagia. The frequency of underlying respiratory diseases, dementia, nervous system disorders and cerebrovascular accidents also differed significantly between dysphagic and non-dysphagic patients. The following nutritional interventions were most frequently initiated in patients with dysphagia: provision of texture-modified food/fluid (32.2%), referral to a dietitian (31.4%), provision of an energy- and/or protein-enriched diet (27.3%), monitoring of nutritional intake (21.5%), enteral nutrition (19.4%) and provision of energy-enriched snacks (15.7%). 24% of patients received no nutritional interventions. CONCLUSION: This study demonstrates that a very strong association exists between dysphagia and malnutrition as well as high levels of care dependency and dependency in activities of daily living. Nearly one-quarter of the patients did not receive any nutritional intervention. Therefore, a potential for the improvement of nutritional therapy in older dysphagic hospitalized patients still exists.

Knowledge and Attitudes of Nursing Staff Towards Malnutrition Care in Nursing Homes: A Multicentre Cross-Sectional Study.

BACKGROUND: The international literature shows that there are considerable deficits in nutritional care provision in nursing homes. Limited knowledge and negative attitudes can contribute to these deficits but international studies on knowledge and attitudes among nursing staff are rare. OBJECTIVE: The study aimed to assess the knowledge and attitudes of registered nurses and nurse aides towards malnutrition care in nursing homes. DESIGN: This study followed a multicentre, cross sectional design. SETTING AND PARTICIPANTS: The study was performed in 66 Austrian nursing homes with 1152 participants. MEASUREMENTS: The validated Knowledge of Malnutrition-Geriatric (KoM-G) questionnaire and the Staff Attitudes to Nutritional Nursing Care Geriatric (SANN-G) scale were used for data collection. RESULTS: On average, 60.6% of the respondents answered the questions correctly, whereas registered nurses knew significantly more (65.6%) than nurse aides (57.3%). The question that was answered correctly by most dealt with the factors that positively affect oral nutritional intake (87.2%) while the question which was incorrectly answered by most was on the professions involved in malnutrition treatment (26.1%). 39.2% of respondents had positive attitudes towards nutritional care. Registered nurses displayed more positive attitudes (48.1%) than nurse aides (33.6%). The most positive attitudes were shown in the 'Intervention' subscale while the least positive attitudes were indicated in the 'Norms' subscale. A medium positive correlation between knowledge and attitudes was found (r=.423, p<0.000). CONCLUSION: This study identified specific knowledge deficits and areas of negative attitudes in registered nurses and nurse aides, which will enable tailored training programmes to be developed.

What is the clinical value of PET/CT in the diagnosis of pulmonary nodules?

The noninvasive diagnostic workup of solitary pulmonary nodules (SPNs) continues to be a challenge for radiologists and nuclear medicine physicians. Morphological evaluation is useful to differentiate between benign and malignant SPNs, but there is a considerable overlap between the benign and the malignant features, resulting in a large fraction of morphologically indeterminate SPNs. Integrated PET/CT with the glucose analogue 18F-fluorodeoxyglucose (FDG PET/CT) can simultaneously evaluate morphological characteristics, anatomic location and metabolic status of SPNs. FDG PET/CT has been shown to result in an overall improved accuracy for the detection of malignant SPNs. In addition, it is the most accurate technique for the staging of malignant SPNs. On the other hand, there are many causes for false positive or false negative FDG PET/CTs. Therefore, FDG PET/CT cannot replace histological evaluation of SPNs, but can be clinically helpful in specific subgroups of patients with SPNs. The goal of this review is to provide an overview of the literature on PET/CT imaging in SPNs and to describe several clinical scenarios for the use of FDG PET/CT in SPNs.

Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital.

OBJECTIVE: To explore the quality of pressure ulcer (PU) care in stroke patients in an Indonesian stroke-specialised hospital. The prevalence, prevention, wound treatment and hospital facilities related to PU structural quality indicators at the ward and institutional levels were assessed. METHOD: A multi-level cross-sectional survey was performed over three days in an Indonesian stroke-specialised hospital. All stroke patients present on the day of the measurement were included. The European Pressure Ulcer Prevalence Study Minimum Data Set and the Dutch National Prevalence Measurement of Care Problems (Landelijke Prevalentiemeting Zorgproblemen, LPZ) questionnaire were used. RESULTS: The prevalence rates of PUs, including and excluding Category I were high in this hospital (28% and 17%, respectively). More than half of the patients/families (56%) received education about PU prevention and 74% of the patients were repositioned, although irregularly, by nurses or families. No treatment was applied to Category I PUs. Category II PUs were treated by using NaCl 0.9% solution to cleanse the wound without dressings. Category III PUs were mainly treated by using anti-microbial gauze dressing. No patient suffered a Category IV PU. Only a few structural quality indicators of PU care at ward and hospital level were met. CONCLUSION: PUs were quite prevalent in these stroke patients. The quality of PU care in this hospital could be improved, especially in the areas of prevention, treatment and structural quality indicators.

Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography.

OBJECTIVE: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate diagnostic imaging modality is in existence to allow selection of the correct treatment option. The aim of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL). METHODS: Eight lower extremities in four patients with lymphocutaneous fistulas were examined by MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and the knee region; and third, the pelvic and retroperitoneal regions. A T(1) weighted three-dimensional (3D) spoiled gradient echo and a heavily T(2) weighted 3D turbo spin echo (3D-TSE) sequence were utilised to undertake MRL. RESULTS: In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse lymphangiomatosis the lymphatic vessels were consecutively enlarged up to a diameter of 6 mm. CONCLUSION: MRL is a safe and accurate imaging modality for a comprehensive evaluation of the lymphatic system in patients suffering from lymphocutaneous fistulas.

Magnetic resonance lymphangiography in Klippel-Trénaunay syndrome.

To date, lymphoscintigraphy and conventional, direct lymphography have been the favoured imaging modalities in assessing the lymphatic system in patients with Klippel-Trénaunay syndrome. We report on the first patient suffering from Klippel-Trénaunay syndrome whose lymphatic vasculature of the lower limbs was evaluated with MR lymphangiography.

Disseminated lymphangiomatosis with skeletal involvement: detection with magnetic resonance lymphangiography.

Disseminated lymphangiomatosis is an uncommon disorder characterized by diffuse or multifocal proliferation of complex, irregular lymphatic channels involving soft tissue, viscera, retroperitoneum, eyes and the skeletal system. Currently, magnetic resonance imaging, computed tomography, ultrasonography, and conventional radiography are the favored radiologic imaging modalities in assessing the extent of pathologic changes in patients suffering from disseminated lymphangiomatosis. Historically, imaging evaluation was performed with conventional lymphography. We report on the first patient suffering from disseminated lymphangiomatosis with skeletal involvement, whose lymphatic vasculature of the lower limbs and pelvic region was evaluated with magnetic resonance lymphangiography.

Gadoteridol for MR imaging of lymphatic vessels in lymphoedematous patients: initial experience after intracutaneous injection.

The aim of this study was to evaluate the feasibility of gadoteridol in visualizing lymphatic vessels of lymphoedematous patients after intracutaneous injection. 20 lower extremities in 10 lymphoedematous patients were examined. Gadoteridol (9 ml) was subdivided into five portions and injected intracutaneously into the dorsal aspect of each foot. For MRI, a three-dimensional spoiled gradient echo sequence was performed. No complications were observed during or after intracutaneous injection of gadoteridol. The lymphoedema was bilateral in seven and unilateral in three of the examined patients. Contrast enhancement of gadoteridol was detected in lymphatic vessels at the level of the lower leg in 17 lower extremities (85%). Enhancing lymphatic vessels of the upper leg were observed in 11 lower extremities (55%). Furthermore, gadoteridol enhanced 10 out of 20 inguinal lymph node groups (50%). No external iliac lymph nodes were observed in any of the patients. Regions of dermal backflow, indicating proximal lymphatic obstruction, were seen in 13 lower extremities (65%). As soon as 15 min after gadoteridol injection, accompanying venous enhancement was detected in all lower extremities (100%). MRI of lymphatic vessels in lymphoedematous patients is safe and feasible after intracutaneous injection of gadoteridol if the diagnosis of lymphoedema necessitates a better definition for optimal therapeutic planning or an objective, diagnostic baseline is required. The proposed technique represents a minimally invasive imaging method of identifying anatomical and physiological derangements in lymphatic vessels.

Outpatient chemotherapy with gemcitabine and oxaliplatin in patients with biliary tract cancer.

This phase II study was conducted to determine the efficacy and toxicity of a gemcitabine (GEM) and oxaliplatin (OX) chemotherapy protocol in patients with unresectable biliary tract cancer (BTC). Patients were treated with GEM 1000 mg m-2 (30 min infusion) on days 1, 8, 15, and OX 100 mg m-2 (2 h infusion) on days 1 and 15 (gemcitabine and oxaliplatin (GEMOX-3 protocol), repeated every 28 days. The data were collected according to the Simon 2-stage design for a single centre phase II study (alpha=0.05; beta=0.2). Primary end point was response rate; secondary end points were time-to-progression (TTP), median survival, and safety profile. Thirty-one patients were enrolled in the study between July 2002 and April 2005. Therapeutic responses were as follows: partial response in eight patients (26%, 95% confidence interval (CI) 14-44), stable disease in 14 patients (45%, 95%CI 29-62), resulting in a disease control rate of 71%. Nine patients (29%, 95%CI 16-47) had progressive disease. Median TTP was 6.5 months. Median overall survival was 11 months. Common Toxicity Criteria (CTC) Grade 3-4 toxicities were transient thrombocytopenia (23%), peripheral sensory neuropathy (19%), leucopenia (16%), and anaemia (10%). In conclusion the GEMOX-3 protocol is active and well tolerated in patients with advanced BTC. It can be applied in an outpatient setting with three visits per month only.

Whole-body MRI in comparison to skeletal scintigraphy in detection of skeletal metastases in patients with solid tumors.

AIM: To evaluate the diagnostic value of whole-body magnetic resonance imaging (MRI) and skeletal scintigraphy in the detection of skeletal metastases in patients with solid tumors. MATERIALS AND METHODS: One hundred and twenty-nine tumor patients were examined with whole-body MRI using coronal TIRM sequences for the different anatomical regions. Skeletal scintigraphy was performed with 99mTc-DPD. RESULTS: In 105/129 (81%) patients, the whole-body MRI and skeletal scintigraphy findings were concordant. In 56/129 (43%) patients, both imaging modalities excluded skeletal metastases. In 49/129 (38%) patients, whole-body MRI and skeletal scintigraphy revealed metastases, however whole-body MRI demonstrated more extensive disease in 22/49 (45%) cases. In 6/49 (12%) cases, skeletal scintigraphy was superior to whole-body MRI in detecting more skeletal metastases. In 24/129 (19%) cases, the imaging findings were discordant. In 15 cases, skeletal scintigraphy was negative, whereas whole-body MRI revealed skeletal metastases. In 9 cases, skeletal scintigraphy was positive, whereas whole-body MRI failed to detect these metastases. In 77/129 (60%) patients, whole-body MRI revealed additional tumor-related findings. CONCLUSION: Whole-body MRI, as a new staging method, is superior to skeletal scintigraphy with respect to the detection of skeletal metastases and the extent of metastastic disease. Furthermore, whole-body MRI yields additional tumor-related findings. Therefore, whole-body MRI should be performed as an alternative to skeletal scintigraphy for the assessment of skeletal metastases.

MR imaging of the lymphatic system: distribution and contrast enhancement of gadodiamide after intradermal injection.

We examined 24 lower extremities in 12 patients with lymphedema to evaluate the distribution and enhancement of gadodiamide after intradermal injection for MR imaging of lymphatic pathways in lymphedematous patients. The lymphedema was bilateral in 8, unilateral in 4, and 3 patients suffered from lymphedema in the genital region. 9 mL of gadodiamide and 1 mL of mepivacainhydrochloride 1% were divided into 5 portions and injected intradermally into the dorsal aspect of each foot. For MR imaging, a 3D spoiled gradient-echo sequence (Volumetric Interpolated Breathold Examination, VIBE) was performed. We detected the beaded appearance of lymphatic vessels extending from the injection site in 22 lower extremities (92%). In 13 lower extremities (54%), lymphatic vessels of the upper leg could be visualized. A contrast enhancement was observed in 16 out of 24 inguinal lymph node groups (67%). After 15 minutes of contrast material application, concomitant venous enhancement was detected in all lower extremities (100%). In 15 lower extremities (63%), collateral vessels with dermal backflow areas between lymphatic vessels were seen. Thus, intradermal injection of gadodiamide allows the visualization of lymphatic pathways in patients with lymphedema. In comparison to the venous system, lymphatic vessels show a tendency to have the highest contrast material uptake in the later acquisitions of 35, 45, and 55 minutes after intradermal injection of gadodiamide. Furthermore, 3D MIP reconstructions supported the identification of the lymphatic vessels and differentiation from veins due to the different angles of view.

Serial high-resolution computed tomography imaging in patients with Wegener granulomatosis: differentiation between active inflammatory and chronic fibrotic lesions.

PURPOSE: To evaluate pulmonary pathologies in Wegener granulomatosis with sequential computed tomography (CT) in order to differentiate active inflammatory lesions from chronic fibrotic lesions. MATERIAL AND METHODS: Serial CT findings in 38 patients with Wegener granulomatosis were retrospectively analyzed (mean follow-up period, 21 months). The presence, extension, and distribution of the following findings were evaluated with CT: parenchymal nodules, masses, ground-glass attenuation, airspace consolidation, bronchial wall-thickening, bronchiectasis, linear areas of attenuation, pleural irregularities, pleural effusions, hilar and mediastinal lymphadenopathy. RESULTS: Observed in 92% of patients, nodules were the most common CT pathology. Areas of ground-glass attenuation, consolidation, masses of linear attenuation, and tracheal/bronchial wall-thickening were detected in 24%, 26%, 32%, 39%, and 68% of patients. At follow-up, the clearance of lesions was most consistent for areas of ground-glass attenuation (89%), masses (87%), and cavitated nodules (85%). In the follow-up scan, 58% of all nodules, 47% of pulmonary consolidations, and 66% of bronchial wall-thickening were completely resolved. Areas of bronchiectasis and septal/non-septal lines remained stable in 70% and 71% of patients. CONCLUSION: The majority of the lesions decreased or resolved completely with or without areas of linear attenuation. Ground-glass attenuation, cavitated nodules and masses appear to represent active inflammatory lesions. In most probability, areas of bronchiectasis and septal/non-septal lines more often represent chronic fibrotic changes rather than active inflammatory changes. In combination with clinical evaluation and bronchoscopy, CT assists in the assessment of disease activity.

Rare cause of abdominal pain in childhood: computed tomography findings in a 14-year-old boy with a colonic carcinoma.

Carcinoma of the colon during infancy and childhood is a rare disease, and the diagnosis is usually not taken into consideration in a child complaining of abdominal pain. Owing to the lack of awareness of its occurrence and the histological cell type, it generally presents as advanced disease. We report on the case of a 14-year-old patient admitted to hospital with an acute abdomen and a 2-month history of night sweats and weight loss of 10 kg. Ultrasound and computed tomography revealed an unclear mass of the lower abdomen, and colonoscopic histopathologic examination disclosed an obstructing tubular-papillary adenocarcinoma of the sigmoid colon. Colonic carcinoma should be included as a differential diagnosis in young patients with abdominal pain of unknown etiology.

Endovascular treatment of superficial femoral artery occlusive disease with stents coated with diamond-like carbon.

A major consideration in the reduction of early stent thrombosis and in-stent restenosis is the improvement of biocompatibility of the devices. Diamond-like carbon is a novel material for coating stent surfaces in order to increase biocompatibility. The authors report on the endovascular treatment of two individuals with superficial femoral artery occlusions, using stents coated with diamond-like carbon. Technical and clinical success was achieved in both cases, with primary patency rates of 100% 12 months after intervention.

[Care dependency in nursing homes--a psychometric study]. / Pflegeabhängigkeit im Pflegeheim--eine psychometrische Studie.

The Dutch Care Dependency Scale, an instrument for the assessment of a patient's care dependency, has been translated into German. The purpose of this study was to examine the reliability and validity of the German version of the scale. The 15-item scale has been developed for the use in nursing homes. Data were collected from 81 people living in nursing homes in Berlin, Germany. The sample was measured three times. Cronbach's alpha was 0.94. Interrater and intrarater reliability revealed moderate to substantial Kappa statistics. As the results of this study were satisfying, positive recommendations regarding the suitability of the German version of the Care Dependency Scale for use in nursing homes could be made. However, further psychometric testing of the scale is recommended.

CT-guided radiofrequency ablation of a bronchogenic carcinoma.

We report on the successful use of percutaneous CT-guided radiofrequency ablation (RFA) of a peripheral bronchogenic carcinoma in a 73-year-old patient. RFA was the favoured treatment option in this patient, who owing to comorbid factors was not a candidate for surgery. A 15 G LeVeen Needle Electrode (RadioTherapeutics, Sunnyvale, USA) with an array diameter of 3.0 cm was connected to a 200 Watt Generator (RF 3000, RadioTherapeutics, Sunnyvale, USA) and inserted into a 3.5 cm squamous cell carcinoma of the axillary subsegment of the right upper lobe. RFA resulted in complete tumour necrosis confirmed by histopathological examination. No complications such as a pneumothorax or bleeding occurred. Further clinical experience and prospective studies are necessary to determine the long-term efficacy of RFA in the treatment of lung tumours.

Background suppression using magnetization preparation for contrast-enhanced 3D MR angiography of the pelvic and lower leg arteries.

PURPOSE: To develop and evaluate non-slab-selective magnetization preparation in contrast-enhanced 3D-MR angiography. METHODS: An ultrafast spoiled mr angiography sequence (FLASH) with non-selective inversion prepulses for background suppression was implemented on a 1.5 T MR system. In 11 patients gadobenate dimeglumine-enhanced mr-angiography of the pelvic and lower leg arteries was performed using the AngioSURF device. Source data was evaluated for contrast-to-noise-ratio, image quality and the extent of background suppression. RESULTS: Background suppression and selective vessel contrast was excellent in all vascular levels. The mr protocol was comfortable and easy-to-handle. Abandonment of precontrast-series acquisition simplified the examination procedure markedly. CONCLUSIONS: Magnetization preparation provides efficient suppression of the background signal in contrast-enhanced 3D mr angiography of the pelvic and lower leg arteries. Since no subtraction technique is needed, moving-bed and whole body MRA-protocols can be simplified significantly.

Different striatal dopamine D2 receptor occupancy in alcohol dependent patients with or without physical withdrawal symptoms --a study using IBZM-SPECT.

Ten male patients with type I alcohol dependency fulfilling DSM-IV criteria for alcohol dependency were investigated twice using IBZM-SPECT after alcohol withdrawal (day 2 and day 28 after withdrawal). Five patients had a history of physical withdrawal symptoms, 5 patients had no such history. The group with physical withdrawal symptoms showed higher IBZM binding in both scans indicating differences of dopaminergic neurotransmission in different subtypes of alcohol dependency.