The psychometric properties of the Varieties of Inner Speech Questionnaire-Revised in Hebrew.

Introduction: The Varieties of Inner Speech Questionnaire-Revised (VISQ-R) is a self-report questionnaire designed to measure characteristics of inner speech. In the current study, we adapted and validated a Hebrew version of VISQ-R. Our first hypothesis was that Confirmatory Factor Analysis (CFA) of the Hebrew VISQ-R would confirm the five subscales replicating the factor structure of the original questionnaire. In addition, building on previous findings that inner speech is involved in tasks that require the executive functions we examined the relationship between VISQ-R and self-reported executive functions questionnaire (BRIEF-A). We hypothesized that correlations between subscales of the Hebrew VISQ-R would reveal covariance between BRIEF-A and some but not all inner speech subscales. Methods: 406 participants completed the Hebrew VISQ-R and 280 of them also completed the BRIEF-A. Results: As hypothesized, CFA confirmed the factor structure revealing the same 5 subscales reported in the original English version, with acceptable internal reliability. Partial support was found for the hypothesized correlations between VISQ-R and BRIEF-A, with covariance of executive functions with some subscales of inner speech (Evaluative, Other-People and Dialogic), and distinct variance with others (Condensed and Positive). Discussion: These results indicate that the Hebrew version of the VISQ-R has good psychometric properties and that it can be used in future research. The implications concerning the contribution of inner speech for people with difficulties in executive functions are discussed.

Comparative Validation of Abdominal CT Models that Predict Need for Surgery in Adhesion-Related Small-Bowel Obstruction.

INTRODUCTION: Adhesion-related small-bowel obstruction (ASBO) can be managed without surgery in selected patients. The aim of this study was to validate three previously published computed tomography (CT) models that predict need for surgery. METHODS: A retrospective study of patients with ASBO admitted to a tertiary referral hospital between November 2009 and April 2015 was conducted. Data on clinical variables were extracted from medical records. CT signs were assessed by a radiologist who was blinded to whether or not the patients required surgery. Three previously published models were validated by testing their ability to predict need for surgery. RESULTS: The cohort comprised 233 patients with ASBO (mean age 69.7 years, 47.6% male), of whom 73 (31.3%) required surgery. A predictive model using a combination of mesenteric oedema, free intraperitoneal fluid and absence of small-bowel faecalisation had a sensitivity of 38% [95% CI 27-50%], specificity of 88% [81-92%], positive likelihood ratio (LR+) of 3.1 [1.6-5.1] and negative likelihood ratio (LR-) of 0.7 [0.6-0.8]. Only the results of one previously published model (which used a combination of obstipation, free intraperitoneal fluid and high-grade or complete obstruction) could be reproduced. This model had a potentially clinically useful LR+ of 2.9 [1.1-7.4] and LR- of 0.9 [0.8-1.0]. The poor performances of the other two models may be partially explained by measurement bias. CONCLUSION: The performances of the previously published predictive models in this validation study were varied. Future attempts to develop models should use clearly defined, standardised and reproducible predictors wherever possible.

Pulmonary embolism: are we there yet?

INTRODUCTION: Clinical prediction rules (such as Wells model) are a reliable assessment tool for diagnostic work-up of suspected pulmonary embolism (PE). When used as part of a clinical algorithm and in combination with a D-Dimer, the model can safely exclude PE in low-risk groups and indicate when further investigations are unnecessary. The purpose of this study was to investigate the level of adherence to local diagnostic imaging guidelines for suspected PE and to ascertain the impact of interventions. METHODS: Retrospective search of all patients referred from the Emergency Department (ED) of Royal Perth Hospital for computed tomography pulmonary angiography (CTPA) or V/Q scan between 11 September 2005 to 10 March 2006 (pre-intervention) and 1 January 2008 to 31 March 2008 (post-intervention) was conducted. The guidelines on 'Diagnostic Imaging Pathways' were considered as gold standard. Interventions included orienting ED doctors to guidelines and modified request forms for mandatory completion of Wells score. A prevalence- and bias-adjusted kappa (PABAK) score analysed the level of agreement between documentation on notes (R-score) and stamp (S-score). RESULTS: Thirty-five per cent (n = 187) and 22% (n = 109) deviated from the pathway pre-intervention and post-intervention, respectively (13% absolute reduction; P = 0.017). Stamp compliance was only 55% despite mandatory filling requirement. PABAK for 'PE as most likely diagnosis' was 0.25 for V/Q group and - 0.26 for CTPA. In addition, 44/60 (73%) had an intermediate or high S-score, yet only 11 of those 44 had a matched intermediate to high R-Score. CONCLUSIONS: Interventions reduced inappropriate practice but did not eliminate it completely. Compliance issues may be managed in the future via the introduction of electronic request linked to decision support.