Development and initial validation of the career resilience instrument for CDC emergency responders in China within the context of public health emergencies: based on a survey conducted in Shanghai.

Background: China faces various public health emergencies, and emergency responders at the Centers for Disease Control and Prevention (CDC emergency responders) are a mainstay in responding to public health emergencies. Career resilience can help CDC emergency responders to effectively respond to and recover from public health emergencies, but there is no specific measurement instrument available. In this study, we aimed to develop and conduct an initial validation of the career resilience instrument for CDC emergency responders in China within the context of public health emergencies from a process perspective. Methods: Based on a survey conducted in Shanghai, interpretive phenomenological analysis (IPA), which is a qualitative research approach to describing and analyzing individual experiences, was used to analyze the interview texts to develop the initial career resilience instrument for CDC emergency responders. The initial career resilience instrument was revised through two rounds of expert consultation. Cronbach's α coefficient and exploratory factor analysis were used to test the reliability and validity of the revised career resilience instrument. Results: The initial career resilience instrument for CDC emergency responders contained three first-level measurement dimensions, 9 second-level measurement dimensions, and 52 measurement items. After expert consultation, the first-level and second-level measurement dimensions were not revised, 13 measurement items were deleted or revised, and six measurement items were added, resulting in 48 measurement items. The revised career resilience instrument was tested for good reliability and validity. Conclusion: Career resilience for CDC emergency responders can be regarded as a set of protective factors and dynamic processes that can be cultivated and intervened in cognitive, affective, and behavioral dimensions to improve their ability to respond to and recover from public health emergencies.

A blueprint for patient and public involvement in the development of a reporting guideline for systematic reviews of outcome measurement instruments: PRISMA-COSMIN for OMIs 2024.

BACKGROUND: In recent years, projects to develop reporting guidelines have attempted to integrate the perspectives of patients and public members. Best practices for patient and public involvement (PPI) in such projects have not yet been established. We recently developed an extension of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), to be used for systematic reviews of outcome measurement instruments (OMIs): PRISMA-COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) for OMIs 2024. Patients and public members formed a small but impactful stakeholder group. We critically evaluated the PPI component in this project and developed recommendations for conducting PPI when developing reporting guidelines. MAIN TEXT: A patient partner was an integral research team member at the project development and grant application stage. Once the project started, five patient and public contributors (PPCs) were recruited to participate in the Delphi study; three PPCs contributed to subsequent steps. We collected quantitative feedback through surveys; qualitative feedback was garnered through a focus group discussion after the Delphi study and through debrief meetings after subsequent project activities. Feedback was thematically combined with reflections from the research team, and was predominantly positive. The following themes emerged: importance of PPI partnership, number of PPCs involved, onboarding, design of Delphi surveys, flexibility in the process, complexity of PPI in methodological research, and power imbalances. Impacts of PPI on the content and presentation of the reporting guideline were evident, and reciprocal learning between PPCs and the research team occurred throughout the project. Lessons learned were translated into 17 recommendations for future projects. CONCLUSION: Integrating PPI in the development of PRISMA-COSMIN for OMIs 2024 was feasible and considered valuable by PPCs and the research team. Our approach can be applied by others wishing to integrate PPI in developing reporting guidelines.

Development of a Reliable and Valid Survey Instrument to Measure Nurses' Health Behaviors Towards an Infectious Disease.

Background and Purpose: The purpose of this study is to describe the process for developing a reliable and valid survey instrument guided by the protection motivation theory (PMT) to evaluate nurses' health behaviors toward an infectious disease such as Ebola. Methods: The instrument was developed and tested through a systematic process that included a literature review, focus group, validity testing, and reliability testing. Results: The outcome variable, protection motivation, contained two elements, determined by principal component analysis. The instrument's internal consistency had a Cronbach's alpha of .80 or greater. Conclusion: The development and testing of an instrument based on PMT constructs as the theoretical framework have demonstrated a relationship between the perceived threat toward the disease and the proposed coping process needed to address the disease.

Identification and Assessment of Outcome Measurement Instruments in Cauda Equina Syndrome: A Systematic Review.

STUDY DESIGN: This was a systematic review of surgically managed Cauda Equina Syndrome (CES) Outcome Measurement Instruments (OMI). OBJECTIVE: A core outcome set (COS) defines agreed outcomes which should be reported as a minimum in any research study for a specific condition. This study identified OMIs used in the wider CES literature and compare these to the established CESCOS. METHODS: To identify measurement methods and instruments in the CES surgical outcome evidence base, a systematic review was performed. Medline, Embase and CINAHL plus databases were queried. In addition, a secondary search for validation studies of measurement instruments in CES was undertaken. Identified studies from this search were subject to the COSMIN risk of bias assessment. RESULTS: In total, 112 studies were identified investigating surgical outcomes for CES. The majority (80%, n = 90) of these OMI studies were retrospective in nature and only 55% (n = 62) utilised a measurement method or instrument. The remaining 50 studies used study specific definitions for surgical outcomes defined within their methods. Of the 59 measurement instruments identified, 60% (n = 38 instruments) were patient reported outcome measures. Only one validated instrument was identified, which was a patient reported outcome measure. The validated instrument was not used in any study identified in the initial search (to identify measurement instruments). CONCLUSIONS: This review highlights the wide heterogeneity of measurement instruments used in surgically managed CES research. Subsequently, there is need for consensus agreement on which instrument or instruments should be used to measure each core outcome for CES surgical outcomes.

Systematic calibration reduces sources of variability for the preliminary OMERACT juvenile idiopathic arthritis MRI- sacroiliac joint score (OMERACT JAMRIS-SIJ).

OBJECTIVE: To determine whether systematic calibration enhances scoring proficiency of the OMERACT juvenile idiopathic arthritis MRI-Sacroiliac Joint score (JAMRIS-SIJ) and whether contrast-enhancement enhances its performance. METHODS: MRI SIJ scans of 50 cases with juvenile spondyloarthritis were scored by 7 raters after calibration with 3 different knowledge transfer tools. RESULTS: Calibrated readers achieved greater reliability for scoring certain inflammatory and structural lesions. Sensitivity and reliability for scoring inflammatory lesions was greater on fluid-sensitive compared to contrast-enhanced sequences. CONCLUSION: Systematic calibration should be implemented prior to the use of JAMRIS-SIJ for clinical trials. It is unlikely that contrast-enhanced MRI will improve the performance of this method.

Assessing uptake of the core outcome set in randomized controlled trials for Parkinson's disease: A systematic review.

BACKGROUND: Parkinson's Disease (PD) affects more than 10 million individuals, with increasing incidence worldwide. As PD's incidence rises, research funding is increasing substantially. PD's core outcome set (COS) provides standardization for PD clinical trial outcomes, improves research quality, and study comparability. Our study aimed to analyze COS uptake rate before and after the PD COS publication. METHODS: We searched ClinicalTrials.gov to retrieve phase III/IV adult PD trials published between 2013 and 2023. Screening for inclusion and data extraction occurred in a masked, duplicate fashion. Trial characteristics and COS uptake rate were extracted from this sample. RESULTS: In our 111 included trials, the COS uptake rate was highest for the 'Walking and Balance' outcome and lowest for the 'Hospital Admissions' outcome. Overall, there was a non-significant monthly increase of 0.26 % (P = 0.266, CI = [-0.20, 0.72]) in "COS-defined outcome" measurement when comparing pre- and post-COS publication. CONCLUSION: Our study found no significant increase in COS uptake in PD clinical trials. We found multiple outcomes to be vastly unmeasured and heterogeneity among the measurement instruments used. These findings complicate standardizing and comparing RCT outcomes. Overcoming these barriers is vital to improving the usefulness of PD research.

Psychometric properties of the research competencies assessment instrument for nurses (RCAIN) in Greece.

Background and Purpose: Evidence-based practice can improve quality of care and patient and system outcomes. Healthcare professionals need certain research competencies to achieve evidence-based practice. We aimed to evaluate the psychometric properties of the self-reported 19-item Research Competencies Assessment Instrument for Nurses (RCAIN) with Greek. Methods: This cross-sectional study included in total, 520 respondents (within 33 health organizations) who completed the 5-point Likert-type RCAIN as well as the 8-item "Research Utilization by Nurses" that was used to assess construct validity. Expert scholars translated both survey questionnaires into the Greek language. A baseline one-factor model was compared against three-factor model (i.e., knowledge, skills, and application of knowledge and skills) that were developed based on the hypothetical design of the instrument. Results: Participants were females (86.4%) 50 years old or younger (91%). The RCAIN had a Cronbach's alpha coefficient of 0.937 and intraclass correlation coefficient of 0.440 (95% CI 0.403 to 0.480, p < .001). Confirmatory factor analysis revealed a 3-factor solution (i.e., knowledge, skills, application of knowledge & skills). Fit indices for the three-factor model were statistically superior when compared with the baseline model. Reliability and validity of each subscale were acceptable. Further assessment of construct validity using hypothesis testing indicated that there is a statistically significant difference in research utilization by knowledgeable or not participants. Specifically, the effect size between knowledge synthesis and instrumental research use was eta squared = 0.020, meaning that approximately 2.0% of the variance in instrumental research use scores can be explained by knowledge in methods of knowledge synthesis. The predictive validity, based on correlations between the two instruments, showed that increasing levels of instrumental research use were associated with an increasingly positive and statistically significant pattern of correlations. Conclusions: The RCAIN survey is a psychometrically sound tool for nurses. Providers, educators, and health administrators may use it for professional development and improvement of individual research competencies.

Measuring Adherence to Pulmonary Rehabilitation: A Prospective Validation Study of the Dutch Version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL).

Purpose: Measuring exercise adherence is important in patients with chronic obstructive pulmonary disease (COPD). For this, the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems to be a promising instrument, and a Dutch version (RAdMAT-NL) is available. The aim of this study was to explore the dimensionality and construct validity of the RAdMAT-NL in patients with COPD. Secondly, we examined whether the items of the RAdMAT-NL could be summed to a single score. Patients and Methods: This prospective study included 193 patients with COPD from 53 primary physiotherapy practices in The Netherlands and Belgium. Patients and their physiotherapist provided data including the RAdMAT-NL, at one, two, and three months after inclusion. Horn's parallel analysis and exploratory factor analysis (EFA) were used to assess the dimensionality of the RAdMAT-NL. Fit to the dichotomous Rasch model for measurement was used to confirm the unidimensionality of the extracted RAdMAT-NL subscales and total scale. To evaluate construct validity, Spearman correlations with other indicators of adherence were calculated, including SIRAS score, percentage attendance and change in exercise skills. Results: EFA identified two dimensions of the RAdMAT-NL, "Participation" (13 items) and "Communication" (3 items), explaining 50.8% of the total variance. Rasch analysis confirmed the unidimensionality of the two dimensions. The unidimensional Rasch model was rejected for a summed score of all 16 RAdMAT-NL items. Medium to large significant positive correlations between the RAdMAT-NL subscale participation and different measures of adherence supported its convergent validity. Conclusion: The RAdMAT-NL exhibited two subscales that fitted the unidimensional Rasch model for objective measurement. Construct validity was supported by convergence with other established measures of adherence.

Breastfeeding Self-Efficacy: A Systematic Review of Psychometric Properties Using COSMIN.

BACKGROUND: Breastfeeding self-efficacy has been proven to play a predictive role in enhancing breastfeeding initiation and continuation. Breastfeeding self-efficacy measurement tools have facilitated healthcare professionals' early identification and support of women at higher risk of early discontinuation of breastfeeding. RESEARCH AIM: The aim of this study was to assess the psychometric properties of breastfeeding self-efficacy measurement tools. METHOD: A systematic review was carried out in three phases. Phase One comprised a systematic literature review performed in PubMed, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews from February 2021 to January 2023, including 36 studies for final analysis. Phase Two provided a quality appraisal of the psychometric properties of each of the seven breastfeeding self-efficacy measurement tools, according to COnsensus-based Standards for the selection of health Measurement Instrument checklist (COSMIN) guidelines. Phase Three summarized and graded the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) modified approach. RESULT: The included articles comprised 9,225 participants and seven breastfeeding self-efficacy measurement tools. The Breastfeeding Self-Efficacy Scale, Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), and Prenatal Breastfeeding Self-Efficacy Scale were supported by Grade A evidence sustaining their validity and reliability to assess breastfeeding self-efficacy in the continuum of maternity care. The BSES-SF is the most feasible tool in clinical practice and the most utilized internationally, available in 15 languages. CONCLUSION: This systematic review provided a Grade A recommendation on breastfeeding measurement tools that will be helpful both for clinical and research purposes.Registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021238450).

Lumbar joint position sense measurement of patients with low back pain.

Lumbar position sense can be assessed by measurement instruments including the goniometer, isokinetic dynamometry, and electronic motion monitoring equipment, which have demonstrated relatively high reliability. This literature provides a comprehensive overview of influencing factors of lumbar position sense measurement, including repositioning method, fatigue degree, and posture during the reposition. It highlights the significant role of muscle proprioception, which contributes to greater accuracy in active reposition compared to passive reposition. The differences in lumbar position sense with different measurement positions may be explained by the presence of mechanoreceptors in the load-bearing structures of the lumbar spine, especially in the facet joint capsules. These mechanoreceptors play a crucial role in providing sensory feedback and proprioceptive information pertaining to the position and movement of the lumbar spine. Individuals with low back pain (LBP) demonstrate alterations in lumbar position sense compared to those without LBP. The auto motor sensory feedback transmission mechanism of patients with non-specific LBP was more unstable than that of healthy people. These findings suggest that lumbar position sense may play a potential role in the development and perpetuation of LBP. At present, the commonly used clinical assessment methods for determining position sense include both active and passive repositioning. However, neither method exhibits high sensitivity and specificity, leading to the poor comparability of relevant studies and posing challenges for clinical application.

Measuring and Manipulating the Rhine River Branches: Interactions of Theory and Embodied Understanding in Eighteenth Century River Hydraulics.

Eighteenth century river hydraulics used both theory and measurement to address problems of flood safety, navigation and defense related to the rivers. In the late eighteenth century the Dutch overseer of the rivers, Christiaan Brunings, integrated hydraulic theory and meteorological practices, which enabled him to design a unique instrument for measuring river flow. The question is whether the unprecedented detail of measurements fits the putative empirical stance in the eighteenth century. The interactions between theory, instrument, measurement, and other knowledge practices are here assessed using experiences in similar measurement practices. I argue that Brunings had theoretical and embodied understanding of hydrodynamics, as he knew how to design an instrument for flow measurement of sufficient accuracy for his purpose in the sociopolitical context of river management.

Quality of life patient/cancer survivor version in Chinese cancer survivors: A validation study.

Objective: To validate the Chinese version of the Quality of Life (QoL) Patient/Cancer Survivor Version (QOLCSV-C) for measuring QoL in Chinese cancer survivors. Methods: The study followed a seven-step research practice guideline for cross-cultural research instrument validation study including translation, adaptation, and psychometric assessment. A forward- and backward-translation procedure was approached, followed by cultural adaptation and acceptability assessment. For its psychometric properties, its concurrent validity with the Functional Assessment of Cancer Therapy-General (FACT-G) was examined with correlation analysis. The internal consistency (Cronbach's alpha) and item-total and item-subtotal correlations of the QOLCSV-C were obtained. Factor analyses were conducted. Floor and ceiling effects and the discriminant performance of the selected variables on QOLCSV-C score were also examined. Results: The QOLCSV-C was translated from the 41-item QOLCSV with four domains: psychological, physical, spiritual and social well-being. The content validity was excellent (CVI â€‹= â€‹1.00). Time spent to complete the QOLCSV-C was about 10 â€‹min. The QOLCSV-C was found easy to use, appropriate in length, and reflective of their QoL. The strong correlation between QOLCSV-C and FACT-G indicates a satisfactory concurrent validity (Spearman's rho â€‹= â€‹0.765, P â€‹< â€‹0.001, n â€‹= â€‹205). The overall internal consistency of the QOLCSV-C (Cronbach's alpha â€‹= â€‹0.888) and the split-half reliability (Spearman-Brown r â€‹= â€‹0.918) were excellent. Most of the items show moderate to strong item-total correlation. The exploratory factor analysis revealed a four-factor solution, and confirmatory factor analysis has a satisfactory model fit with indicative items. None of the total scores of QOLCSV-C reveal the floor or ceiling effect. For discriminant performance, variables demonstrating significant between-group differences include sleep quality, pain, fatigue, nausea, physical health, and financial burden. Conclusions: The QOLCSV-C is a reliable and valid instrument for measuring the QoL in Chinese cancer survivors. Future studies can explore the factor structure, gender universal or specific items, and significant predictors of QoL of cancer survivors in different cultures.

Measurement instruments to evaluate diaper dermatitis in children: Systematic review of measurement properties.

AIM: The aim of this study was to summarize and evaluate the empirical evidence on the measurement properties of diaper dermatitis (DD) measurement instruments in children. DESIGN: Systematic review. METHODS: MEDLINE, CINAHL and EMBASE were systematically searched until 14 June 2021. Citation searching was conducted in Scopus. The risk of bias, the reported measurement properties and the quality of evidence were evaluated using the COSMIN framework. The reporting follows the PRISMA 2020 statement. RESULTS: We identified 1200 records in the databases and 108 records during citation searching and included four studies describing three measurement instruments for DD in children and their measurement properties. We considered the content validity inconsistent for all three instruments. The study authors reported internal consistency, reliability and construct validity for one instrument. We rated the quality of evidence from very low to moderate.

Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments.

OBJECTIVE: Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. METHODS: A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. RESULTS: We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. CONCLUSION: No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.

A clinimetric assessment of the validity and reliability of 3D technology for scar surface area measurement.

INTRODUCTION: The quality of scars has become an important outcome of burn care. Objective scar assessment through scar surface area measurement enables quantification of scar formation and evaluation of treatment efficacy. 3D technology has proven valid and reliable but often remains cumbersome, expensive, and time-consuming. 3D technology with depth sensors on mobile devices has become available and might surpass these limitations. This study provides a clinimetric assessment of the validity and reliability of a 3D system with a depth sensor for scar surface area measurement. METHODS: A technology involving a depth sensor mounted on a mobile device was used. Images and analyses were made with a custom-made software application. A standardized one-keyframe image capturing procedure was followed. To assess validity, stickers with predefined dimensions (8.01 cm2 - 77.70 cm2) were imaged in a single observer setting on various body parts of healthy volunteers. To assess reliability, hypertrophic scars, keloids, and normotrophic scars were imaged and rated by two observers independently. Data are expressed as mean (+/-SD), Coefficient of Variation (CV), Intraclass Correlation Coefficients (ICC), and Limits of Agreements (LoA). RESULTS: Eighty stickers placed on 20 healthy volunteers showed validity with CV between 0.62%- 1.67% for observer A and 0.75%- 1.19% for observer B. For the reliability study, 69 scars on 36 patients were included. Mean scar surface area ranged from 0.83 cm2 to 155.59 cm2. Mean scar surface area measurement was 13.83 cm2 (SD 23.06) for observer A and 13.59 cm2 (SD 23.31) for observer B. Adjusted interobserver CV for trained observers is estimated as 5.59%, with corresponding LoA = 0 ± 0.15 x mean surface area. Interobserver ICCs were 0.99-1.00. CONCLUSION: This 3D technology with a depth sensor for measuring scar surface area provides valid and reliable data and thereby surpasses expensive and time-consuming 3D cameras.

Predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) in critically ill, mechanically ventilated adults: a prospective clinimetric study.

PURPOSE: To investigate the predictive validity of the Chelsea Critical Care Physical Assessment tool (CPAx) at intensive care unit (ICU) discharge in critically ill adults for their 90-day outcomes. MATERIALS AND METHODS: This prospective clinimetric study investigated four theory-driven, a-priori hypotheses in critically ill adults recruited within 72-144 h of mechanical ventilation. The primary hypothesis was a moderate accuracy (AUROC = 0.750) in predicting residence at home within 90 days. Secondary hypotheses included discrimination between hospital discharge destinations, correlation with subsequent health-related quality of life and length of ICU stay. RESULTS: We observed a good accuracy (AUROC = 0.778) of the CPAx at ICU discharge in predicting a return to home within 90 days. The CPAx score significantly increased between the discharge groups "undesirable" ≤ "rehabilitation" ≤ "home" (p < 0.001), but was not associated with 90-day health-related quality of life (physical: r = 0.261, mental: r = 0.193). Measured at baseline, CPAx scores correlated as expected with length of ICU stay (r = -0.443). CONCLUSIONS: The CPAx at ICU discharge had a good predictive validity in projecting residence at home within 90 days and general discharge destinations. The CPAx might therefore have clinical value in prediction, though it does not seem useful to predict subsequent health-related quality of life. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) identification number: DRKS00012983, registered on September 20, 2017IMPLICATIONS FOR REHABILITATIONThe CPAx is a valid and reliable measurement instrument to evaluate critically ill adults' physical function and activity, in addition the CPAx might be useful to predict rehabilitation needs.The CPAx had a moderate to good predictive validity with three out of four a-priori hypotheses accepted.A CPAx score of ≥18 at critical care discharge has a sensitivity of 80% and a specificity of 70% in predicting a return to home within 90 days.The CPAx might consequently be valuable to identify critically ill adults' rehabilitation needs, to advise on their potential trajectory of recovery or to screen patients for follow-up after hospital discharge.

A standardized measurement instrument was recommended for evaluating operator experience in complex healthcare interventions.

OBJECTIVE: During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators' experiences (how professionals feel undertaking the innovation) drive this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators' experience of surgical innovation. STUDY DESIGN AND SETTING: There were three phases: (1) Literature reviews identified measures of operators' experience and concepts measured were extracted and grouped into domains. (2) Quality appraisal was conducted to assess content validity of identified instruments and was supported by COnsensus-based Standards for the selection of health Measurement Instruments methodology. Self-reported measurement instruments that had underdone formal development were eligible. Content validity was assessed using COnsensus-based Standards for the selection of health Measurement Instruments criteria for good content validity (rated sufficient/insufficient/indeterminate/inconsistent), informed by standards for measurement development and domains identified in phase 1. (3) Instruments determined suitable and of sufficient quality underwent supplemental appraisal in interviews with international multidisciplinary professionals and a focus group. RESULTS: Literature reviews identified 16 measurement instruments from 243 studies. Most assessed 'psychological' experiences and 'usability'. No instrument was specifically validated for innovative surgery. Three instruments were rated 'sufficient' (Surgery Task Load Index [SURG-TLX]) or 'indeterminate' (Spielberger State-Trait Anxiety Inventory, Imperial Stress Assessment Tool). Twenty professionals were interviewed (seven female; 15 specialties; six countries) and the focus group included 10 participants (four professionals, six researchers). The SURG-TLX was considered the most relevant, comprehensive, and comprehensible instrument. CONCLUSION: The SURG-TLX is preliminarily recommended to measure operators' experiences of innovation. Further work exploring its role and impact on surgical innovation is required.

Seeing Is Believing: Using Eye-Tracking Devices in Environmental Research.

OBJECTIVES: This article aims to provide methodological guidance for research that uses eye-tracking devices (ETDs) to study environment and behavior relationships. BACKGROUND: Vision is an important human sense through which people acquire a large amount of environmental information. ETDs are tools for detecting eye/gaze behaviors, facilitating better understanding about how people collect visual information and how such information is related to emotions and psychological states. However, there is a lack of guidance for the application of ETDs to environment and behavior studies. METHODS: A literature review was conducted on articles reporting empirical studies that used ETDs. The data were extracted and compiled, including information such as research questions, research design, types of ETDs, variables measured, types of physical environment (or visual stimuli), stimuli durations, data analysis methods, and so on. RESULTS: Fifty articles were identified. The main research topics were related to urban and landscape environments, and architecture and interior spaces. Most of the research designs were experimental or quasi-experimental designs, with a few cross-sectional studies. The majority types of ETDs were screen-based ETDs, followed by mobile ETDs (glasses). Main variables were gaze fixations, fixation durations, and scan paths. Typical types of stimuli included images, videos, virtual reality, and real environments and/or objects. CONCLUSIONS: Guidance for eye-tracking research on environment and behavior was developed based on the literature review results, to provide direction for determining research questions, selecting appropriate research designs, establishing participant inclusion and/or excluding criteria, collecting and analyzing data, and interpreting research results.

Resilience in Stroke Patients: A Concept Analysis.

(1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures.

Cross-Cultural Adaptation and Validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL-SR) for Diabetic Patients in Serbia.

Thoroughly validated instruments can provide a more accurate and reliable picture of how the instrument works and of the level of health literacy in people with type 2 diabetes mellitus (T2DM). The present work aimed at cross-cultural adaptation and validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL) in patients with T2DM in Serbia. After translation and back-translation, views from an expert group, one cognitive interview study (n = 10) and one survey study (n = 130) were conducted among samples of diabetic patients. Item analysis, internal consistency, content validity, confirmatory factor analysis (CFA) and reliability testing were performed. When all 14 items were analyzed, loading factors were above 0.55, but without adequate model fit. After removing two items with the lowest loadings FHL1 and IHL2 the fit indexes indicated a reasonable normed χ2 (SB scaled χ2/df = 1.90). CFI was 0.916 with SRMR = 0.0676 and RMSEA = 0.0831. To determine internal consistency, Cronbach's alpha coefficient was 0.796 for the whole FCCHL-SR12. With only minor modifications compared to the English version, the 12-item FCCHL instrument is valid and reliable and can be used to measure health literacy among Serbian diabetic patients. However, future research on a larger population in Serbia is necessary for measuring the levels of HL and their relationship with other determinants in this country.