Bentler's Comparative Fit Index Research Articles

Development and validation of Daycare Anesthesia Satisfaction (DAS) questionnaire to assess patient's satisfaction with daycare anesthesia.

The patient's satisfaction can be considered as a unique indicator of the quality of healthcare provided. The advantages of patient satisfaction surveys rely heavily on using standardized, psychometrically tested data collection approaches. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's perioperative satisfaction following all types of anesthesia in daycare facility. Hence, this study aimed to develop a Daycare Anesthesia Satisfaction (DAS) questionnaire to measure the patient's satisfaction with the experience of daycare anesthesia services. A preliminary pool of questions was generated from research literature, expert consultations, and pilot tested on patients. The internal consistency and reliability of the preliminary questionnaire was evaluated by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and feasibility with the formation of a final 27-item questionnaire. In the next step, the questionnaire was distributed to a larger group of patients in the phase 2 of postanesthesia care unit (PACU). The results were subjected to confirmatory factor analysis to determine the goodness of fit of the questions under each domain. The internal consistency of the preliminary questionnaire as measured by Cronbach's alpha was 0.929. Intraclass correlation coefficient measured for test-retest reliability was 0.97 (95% confidence interval [CI]). Feasibility was confirmed, as 75% of the patients could fill the questionnaire within 15 min. In the second step of confirmatory factor analysis (CFA), questionnaire has been shown to have goodness of fit with Bentler's comparative fit index (CFI) of 0.99 that is greater than the suggested cutoff of 0.90. The root mean square error of approximation (RMSEA) of 0.09 is also close to the suggested cutoff of 0.06. This systematically developed and validated, 27-item DAS questionnaire can be tentatively recommended to be used to measure patient's satisfaction with day care anesthesia services following all types of surgical procedures, under various types of anesthesia.

Determining public’s attitude toward medical tourism development: a scale proposal

PurposeThis paper aims to explore the public’s attitude toward medical tourism activities by developing a measurement instrument in Turkey, an emerging medical tourism destination.Design/methodology/approachDuring the development phase of the scale, 24 question pools were created. After the pilot study, data from a 20-question survey were collected from a study group consisting of Turkish citizens who received services from hospitals in the city of Ankara. Data were collected through convenience sampling of 221 study participants as they were walking in the Square of Kızılay, one of the most important centers and junction points in Turkey, between November 25, 2017, and December 27, 2017.FindingsThe content validity of the scale was assessed by expert opinion. The scale reliability is high with Cronbach’s α (0.908). A factor analysis was performed to assess the factor structure of the scale. The Kaiser–Meyer–Olkin measure of sampling adequacy (0.895) and Bartlett’s test (χ2 = 2,020.967; p = 0.001) were applied to determine the conformity of the scale of factor analysis. Exploratory factor analysis with Varimax rotation was performed to determine the factor structure of the scale. The 20 questions loaded under three factors: “contribution to the country,” “anxiety in getting services” and “service justice”. These factors explained approximately 55% of the total variance. Confirmatory factor analysis was performed with goodness-of-fit index (0.877), Bentler comparative fit index (0.909) and root mean square error of approximation index (0.069) to determine the validity of the factor structure, and the results indicated that the three-factor model is an acceptable level. All the results show that this new scale is valid and reliable in measuring the public’s attitude toward the development of medical tourism in Turkey.Originality/valueThe public’s attitudes on the medical tourism scale show that, as a measurement tool, it can be used validly and reliably in determining the public’s attitudes toward medical tourism.

Including Distal Motor Function within the NIHSS: Correlation with Motor Arm Function and IV rt-PA Treatment Response

ObjectivesThe Distal Motor Function (DMF) sub-score of the NIH Stroke Scale (NIHSS) was measured in the NINDS rt-PA Stroke Trials but is currently not included in the NIHSS. The correlation of DMF with the NIHSS Motor Arm Function (MAF) sub-score, the effect of IV tPA treatment on DMF, and whether adding DMF changes the utility of the NIHSS have not been analyzed. Materials and methodsMAF and DMF sub-scores were retrieved from the original NINDS rt-PA Stroke Trials for both sides of the body at baseline, 2 hours, 24 hours, 7–10 days, and 3 months after IV tPA treatment. MAF and DMF scores were correlated using Spearman correlation. Clustering of DMF and MAF scores was determined using a Bentler Comparative Fit Index (CFI) to estimate variation in NIHSS when adding DMF. The effect of IV tPA on DMF and MAF was assessed using a linear model comparing changes in scores from baseline to 3 months. ResultsMAF and DMF were highly correlated (p < 0.0001) across all time points for both dichotomous and continuous data on both sides. Intravenous tPA accounted for 21% of the change in DMF (p < 0.014, R2 = 0.0157, N = 423) and 39% of the change in MAF (p < 0.093, R2 = 0.0125, N = 547) from 0 to 3 months. On adding DMF to NIHSS, CFI decreased from 0.98 to 0.80 and DMF clustered with MAF, indicating that addition of DMF is unlikely to produce any discrepancy to NIHSS. ConclusionsIncluding DMF to the NIHSS does not appear to be of additional value. After IV tPA treatment, proximal and distal motor function in upper extremity strongly correlate over time but greater improvement in MAF is noted. Further research is needed on the role of IV tPA on minor strokes with deficits of DMF.

Perfectionism, Self-Esteem, and the Will to Win Among Adolescent Athletes: The Effects of the Level of Achievements and Gender.

This study examined the relationships between perfectionism, self-esteem, and the will to win and the effects of gender and the level of achievement on these variables. A total of 318 adolescents in the age group of 12–19 years (M = 16.10 ± 1.01) completed the self-esteem questionnaire, the will-to-win questionnaire, and the perfectionism inventory. Interstate level (ISL) athletes obtained higher scores than interdistrict level (IDL) athletes on the following variables: self-esteem, the will to win, and four of the eight dimensions of perfectionism (i.e., concern over mistakes, the need for approval, organization, and planfulness). Further, male athletes obtained higher self-esteem and perfectionism (i.e., the need for approval and rumination) scores than female athletes. Self-esteem, the will to win, and the dimensions of perfectionism were positively and significantly interrelated. However, one dimension, namely, perceived parental pressure, was unrelated to any factor except striving for excellence. Further, the will to win, concern over mistakes, high standard for others, and planfulness were unrelated to striving for excellence. The results of the discriminant analysis revealed that there was no significant difference between ISL and IDL athletes (variance explained = 9.480%). Finally, using path analysis showed that Model 3 (perfectionism self-esteem will-to-win) has provided good model fit such as Bentler's comparative fit index (CFI) (0.987), Tucker-Lewis index (TLI) (0.876), normed fit index (NFI) (0.973), and the root mean square error of approximation (RMSEA) (0.097).

Psychometric properties of the St. Elizabeth Youngstown hospital wellbeing inventory and non-burnout inventory for physicians and nurses

BackgroundPhysicians and nurses have substantial problems with wellbeing and burnout. We examined the reliability and construct validity of a wellbeing inventory (WBI) administered to some physicians and nurses working in St. Elizabeth Youngstown Hospital (SEYH).MethodsThe SEYH-WBI, consisting of 4 positive affect (PA) items and 7 negative affect (NA) items developed from 5 validated surveys, was administered (n = 419). A non-burnout inventory (SEYH-NBI) consisting of 2 PA items and 3 NA items was derived from the SEYH-WBI. The Positive and Negative Affect Schedule (PANAS), a validated survey consisting of 10 PA items and 10 NA items, was conducted (n = 191). The Maslach Burnout Inventory (MBI), a validated survey consisting of 3 domains (3 items each), was completed (n = 150).ResultsFor the SEYH-WBI, Cronbach coefficients were 0.76 for PA items and 0.83 for NA items. The NA item loading on factor 1 was 0.55–0.84 and the PA item loading on factor 2 was 0.47–0.89. Confirmatory indices were as follows: root mean square residual, 0.07 and Bentler Comparative Fit Index, 0.92. For the SEYH-NBI, Cronbach coefficients were 0.76 for PA items and 0.79 for NA items. The NA item loading on factor 1 was 0.80–0.87 and the PA item loading on factor 2 was 0.89–0.90. Confirmatory indices were as follows: root mean square residual, 0.02; and Bentler Comparative Fit Index, 0.99. PANAS correlations were as follows: SEYH-WBI PA and PANAS PA scores, r = 0.9; p < 0.0001; SEYH-WBI NA and PANAS NA scores, r = 0.9; p < 0.0001; SEYH-NBI PA and PANAS PA scores, r = 0.8; p < 0.0001; and SEYH-NBI NA and PANAS NA scores, r = 0.7; p < 0.0001. Correlations for SEYH-NBI and MBI were as follows: total NBI and total MBI, r = − 0.6, p < 0.0001; NA and emotional exhaustion, r = 0.6, p < 0.0001; PA and personal accomplishment, r = 0.3, p = 0.0003; and NA and depersonalization, r = 0.3, p = 0.0008.ConclusionsValidation assessments indicate that the SEYH-WBI and SEYH-NBI have acceptable psychometric performance. Similar findings in a larger cohort would be more compelling.

Psychometric Testing of the Indonesian Version of Dietary Sodium Restriction Questionnaire Among Patients with Hypertension

PurposeThe purpose of this research was to test the validity and reliability of the Indonesian version of the Dietary Sodium Restriction Questionnaire (DSRQ-I) among patients with hypertension. MethodsThe cross-sectional study enrolled hypertensive patients from a cardiac outpatient department in Indonesia using convenience sampling. Eligible patients received a demographic questionnaire and DSRQ-I during a one-month period of data collection. Content and construct analysis examined the validity, whereas internal consistency assessment checked reliability. Participation required 10–15 minutes on average. ResultsOne hundred thirty-five patients participated: mostly females (54.1%) and married (82.9%) with mean age of 58.18 ± 10.44 years. The item of content validity index was .97, and subscale content validity index was .81 for DSRQ-I. The Kaiser–Meyer–Olkin test gave a value of .83, indicating adequate sampling, and the Bartlett's test of sphericity reached significant result (p < .001). The principal component analysis indicated three components, with 64.2% explaining variance, including perceived behavioral control (35.5%), attitude (19.3%), and subjective norm (9.4%). Confirmatory factor analysis produced a parsimonious model on the three-factor outcome by removing a single item. The indices of good fit model was achieved at χ2/df = 2.17, goodness fit index = .85, root mean square error of approximation = .09, standardized root mean square means = .07, and Bentler comparative fit index = .90 (p < .001). Cronbach's alpha coefficients for attitude, subjective norm, and perceived behavioral control were .85, .87, and .85, respectively. All interitem and item-total correlations indicated adequate outcome and acceptable result. Consequently, 15 items were determined reliable measurement and included in the final version of DSRQ-I. ConclusionThe DSRQ-I is a valid and reliable instrument to measure facilitators and barrier of sodium restriction among hypertensive patients in Indonesia.

Explaining How Cognitive Behavioral Approaches Work for Low Back Pain: Mediation Analysis of the Back Skills Training Trial.

This is secondary research examining the longitudinal mediation effect within a structural equation model. To identify possible mechanisms that mediate the effects of a cognitive behavioral approach upon disability and pain in low back pain patients. Cognitive behavioral interventions (CBIs) can improve pain and disability in low back pain (LBP) but the mechanisms of action are unclear. We used data from a large randomized controlled trial to investigate mediators of the treatment effect of CBI. Pain self-efficacy, fear avoidance, and physical and mental functioning were selected as candidate mediators based on the theoretical rationale of the intervention. The primary treatment outcomes were the Roland Morris Questionnaire (RMDQ) and the modified Von Korff scale (MVK pain and disability) at 12 months. We used structural equation models to estimate the contribution of mediators. All models were tested for goodness-of-fit using χ , Root Mean Square Error of Approximation, Adjusted Goodness of Fit Index, and Bentler Comparative Fit Index. We included 701 adults with LBP. The average RMDQ score at baseline for those on the intervention arm was 8.8 (Standard Deviation 5.0). The intervention was effective in reducing disability and pain at 12 months. Change in mental functioning was not a significant mediator. Changes to pain self-efficacy, fear avoidance, and physical functioning were causal mediators of the treatment effect at 12 months (RMDQ b= -0.149, P < 0.001; MVK-pain b = -0.181, P < 0.001 and MVK-disability b = -0.180, P < 0.001). Overall, the SEM model exceeded the threshold for acceptable goodness-of-fit. Fear avoidance and self-efficacy were important causal mediators of the cognitive behavioral treatment effect. Self-assessed change in physical function was a causal mediator but mental functioning was not. This suggests people need to experience meaningful change in physical function and beliefs but not in mental functioning associated with LBP, to achieve a treatment benefit. 2.

Validation of overactive bladder questionnaire (1-week recall version) in medically complex elderly patients with overactive bladder.

The 33-item Overactive Bladder questionnaire (OAB-q; 1-week recall version) has been psychometrically validated in middle-aged, generally healthy patients with overactive bladder. The present analysis was conducted to determine the psychometric validity of the OAB-q in medically complex elderly patients. OAB-q structure was evaluated using a second-order confirmatory factor analysis (CFA) model with five domains and one aggregated domain, using pooled data from two clinical trials (786 observations) for urgency urinary incontinence (UUI). Psychometric validity was evaluated with CFA, Cronbach coefficient α (CCA) for reliability, Spearman correlations for convergent validity, differences in OAB-q scores in relation to UUI severity and Patient Perception of Bladder Condition (PPBC) scores for known-groups validity, and effect size (ES) of differences in mean scores of OAB-q domains over time for treatment responsiveness. Participants were predominantly female (82.2%) and white (85.9%); mean age was 75.0years. The second-order CFA was confirmed with a Bentler's comparative fit index of 0.90, t values for path coefficients of >1.96, and standardized path coefficients of >0.40. OAB-q domains demonstrated good internal consistency (CCA >0.7). Convergent validity was supported by moderate correlations (0.4-0.7) between OAB-q domain and PPBC scores. Significant differences in OAB-q domain scores between groups with different symptom severity established known-groups validity. Significant changes in mean OAB-q scores from baseline to week 12 with moderate-to-large ES (0.50-0.80) demonstrated treatment responsiveness. The OAB-q demonstrates reliability, concurrent and discriminant validity, and responsiveness to treatment. The evidence shows that the OAB-q is psychometrically sound for use in medically complex elderly patients with overactive bladder.

Does the EPIC-26 measure five domains in English and Spanish speakers?

e557 Background: Despite being widely used in many countries to assess health-related quality of life for patients undergoing treatment for localized prostate cancer(PC), seldom research has been done to investigate the five domain scores generated by 26 question short form of the Expanded Prostate Cancer Index Composite Short (EPIC-26). We conducted exploratory and confirmatory factor analyses searching for evidence of five unique domains of dysfunction in men being treated for PC in the US and Spain.Methods: Using two-year post treatment information, data from 400 men who were part of the original EPIC (OE) validation cohort [T1 or T2, 87% Radical Prostatectomy (RP), 10% External Beam Radiation (EBR), 3% Brachytherapy (BR)] and 450 men who were treated for prostate cancer at Institut Hospital del Mar d'Investigacions Mèdiques in Spain [33% RP, 33% EBR, 33% BR], were subjected to exploratory (EFA) and confirmatory factor analysis (CFA).Results: EFA analyses on both the OE and Spanish cohorts provides support for three, four or five factor models (accounting for approximately 83, 91 or 97% of variance in either cohort) to describe the EPIC-26 variables and weak evidence for the hormonal domain. There is evidence of separate urinary, sexual and bowel factors, but limited evidence of a separate hormonal domain. With the exception of the questions which could be described as assessing depression (lack of energy and depression and in some models weight gain), items within the hormonal domain frequently failed to consistently load onto a single factor (orthogonal communalities ranging from .22 to .27 in the OE cohort and .10 to .21 in the Spanish for hot flashes, breast tenderness and weight gain). CFA looking for the published five domain solution in the Spanish data provides mediocre support for a five factor solution (Standardized RMR = .0624, RMSEA Estimate = .07, Bentler Comparative Fit Index = .91). Conclusions: While all questions asked on the EPIC-26 are of clinical value, there is limited evidence to continue to treat the hormonal domain as a single entity. Urologists should consider looking at the questions linked to depression separately from the other hormonal questions

The Short Form Vaping Consequences Questionnaire: Psychometric Properties of a Measure of Vaping Expectancies for Use With Adult E-cigarette Users.

E-cigarettes are popular in the United States, but psychometrically sound measures of vaping beliefs and behaviors are lacking. We evaluated the psychometrics of the Short Form Vaping Consequences Questionnaire (S-VCQ), a modified version of the Short Form Smoking Consequences Questionnaire that assesses expectancies for negative consequences, positive reinforcement, negative reinforcement, and appetite/weight control associated with vaping. Adult, past-month e-cigarette users completed an anonymous survey in Fall 2015 (N = 522, 50.4% female; 71.5% white; 34.10 [SD = 9.66] years). Psychometric analyses included confirmatory factor analysis, internal consistency, measurement invariance, t tests, correlations, and test-criterion relationships with vaping outcomes. The S-VCQ evidenced a four-factor latent structure (Bentler's Comparative Fit Index = .95, Root Mean Square Error of Approximation = .05, Standardized Root Mean Square Residual = .06), and subscales evidenced internal consistency (mean α = 0.89). S-VCQ scores were scalar invariant for sex and smoking status; women reported stronger appetite/weight control than men and dual cigarette/e-cigarette users (n = 309) reported stronger negative vaping consequences and negative reinforcement than nonsmokers. Among dual users, vaping and smoking expectancies also were scalar invariant; dual users reported stronger positive reinforcement associated with vaping than smoking but stronger negative consequences, negative reinforcement, and appetite/weight control associated with smoking than vaping. Correlations indicated that vaping and smoking expectancies were related, yet distinct constructs. Univariate general linear models indicated that vaping frequency and dependence were associated with positive reinforcement (ηp2 = .02/.02), negative reinforcement (ηp2 = .02/.08), and appetite/weight control (ηp2 = .02/.02) from vaping. The S-VCQ evidences solid psychometrics as a measure of adult e-cigarette users' vaping expectancies. The current study provides evidence for the reliability and validity of the S-VCQ, the first measure of vaping expectancies that has been validated for use with adult e-cigarette users. Results indicated that the S-VCQ comprises four subscales that evidence internal consistency, scalar measurement invariance for important groups of interest, and test-criterion relationships with vaping outcomes. Researchers are encouraged to consider using this measure for assessing vaping expectancies in adult e-cigarette users.

Development and assessment of a shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55).

To develop and validate a shortened version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). A secondary aim was to compare baseline risk factors predicting health-related quality of life (HRQoL) in children newly diagnosed with epilepsy, as identified using the original and shortened version. Data came from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES, N = 373), a multicenter prospective cohort study. Principal component analysis reduced the number of items from the original QOLCE, and factor analysis was used to assess the factor structure of the shortened version. Convergent and divergent validity was assessed by correlating the Child Health Questionnaire (CHQ) with the shortened QOLCE. Multiple regression identified risk factors at diagnosis for HRQoL at 24 months. A four-factor, higher-order, 55-item solution was obtained. A total of 21 items were removed. The final model represents functioning in four dimensions of HRQoL: Cognitive, Emotional, Social, and Physical. The shortened QOLCE demonstrated acceptable fit: Bentler's Comparative Fit Index = 0.944; Tucker-Lewis Index = 0.942; root mean square approximation = 0.058 (90% CI: 0.056-0.061); weighted root mean square residuals (WRMR) = 1.582, and excellent internal consistency (α = 0.96, subscales α > 0.80). Factor loadings were good (first-order: λ = 0.66-0.93; higher-order λ = 0.66-0.85; p < 0.001 for all). The shortened QOLCE scores correlated strongly with similar subscales of the Child Health Questionnaire (ρ = 0.38-0.70) while correlating weakly with dissimilar subscales (ρ = 0.30-0.31). While controlling for HRQoL at diagnosis, predictors for better HRQoL at 24 months were the following: no cognitive problems reported (p = 0.001), better family functioning (p = 0.014), fewer family demands (p = 0.008), with an interaction between baseline HRQoL and cognitive problems (p = 0.011). Results offer initial evidence regarding reliability and validity of the proposed 55-item shortened version of the QOLCE (QOLCE-55). The QOLCE-55 produced results on risk factors consistent with those found using the original measure. Given the fewer items, QOLCE-55 may be a viable option reducing respondent burden when assessing HRQoL in children with epilepsy.

Contributions of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) for the diagnosis of MCI in Brazil.

ABSTRACT Background: The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) is a computer-based cognitive screening instrument that involves automated administration and scoring and immediate analyses of test sessions. The objective of this study was to translate and culturally adapt the Brazilian Portuguese version of the CANS-MCI (CANS-MCI-BR) and to evaluate its reliability and validity for the diagnostic screening of MCI and dementia due to Alzheimer's disease. Methods: The test was administered to 97 older adults (mean age 73.41 ± 5.27 years) with at least four years of formal education (mean education 12.23 ± 4.48 years). Participants were classified into three diagnostic groups according to global cognitive status (normal controls, n = 41; MCI, n = 35; AD, n = 21) based on clinical data and formal neuropsychological assessments. Results: The results indicated high internal consistency (Cronbach's α = 0.77) in the total sample. Three-month test-retest reliability correlations were significant and robust (0.875; p < 0.001). A moderate level of concurrent validity was attained relative to the screening test for MCI (MoCA test, r = 0.76, p < 0.001). Confirmatory factor analysis supported the three-factor model of the original test, i.e., memory, language/spatial fluency, and executive function/mental control. Goodness of fit indicators were strong (Bentler Comparative Fit Index = 0.96, Root Mean Square Error of Approximation = 0.09). Receiver operating characteristic curve analyses suggested high sensitivity and specificity (81% and 73% respectively) to screen for possible MCI cases. Conclusions: The CANS-MCI-BR maintains adequate psychometric characteristics that render it suitable to identify elderly adults with probable cognitive impairment to whom a more extensive evaluation by formal neuropsychological tests may be required.

Further Understanding of the International Index of Erectile Function at 15+ Years: Confirmatory Factor Analysis and Multidimensional Scaling.

The objective of this study was to describe confirmatory factor analysis (CFA) and multidimensional scaling (MDS) on the International Index of Erectile Function (IIEF) to confirm the structure and to enrich understanding of the IIEF, thereby heightening appreciation of the factors and responses underlying sexual functioning for men with erectile dysfunction. Baseline, end of double-blind, and end of open-label data sets were derived from all data from 2 previously published sildenafil trials. For the CFA model, an acceptable fit of the data was shown for each data set, as indicated by a Bentler comparative fit index >0.9, statistically significant path coefficients ( t values >1.96), and (except for IIEF item 6at baseline) statistically significant standardized path coefficients ≥0.4. For MDS modeling, the distance matrix created for each data set, based on polychoric correlations, interpreted relationships between the IIEF items in 2-dimensional space across the "sexual intercourse interference" dimension (horizontal axis) and the "sexual satisfaction" dimension (vertical axis). The 5-factor structure of the IIEF was confirmed by CFA and enriched with visual interpretation by MDS.

Validation of an Instrument to Measure High School Students' Attitudes Toward Fitness Testing

Purpose The purpose of this investigation was to develop an instrument that has scores that are valid and reliable for measuring students' attitudes toward fitness testing. Method The method involved the following steps: (a) an elicitation study, (b) item development, (c) a pilot study, and (d) a validation study. The pilot study included 427 student-completed instruments from 3 schools. Pilot study data analyses were conducted resulting in a proposed model for the final study. Participants for the final study were 1,199 students (524 boys and 675 girls) from 13 schools. Thirty-six experts in physical education pedagogy were the participants of the content validity study. Results The data fit a model with 4 factors: cognitive, affective-enjoyment, affective-feelings, and affective-teacher. Fit statistics from the confirmatory factor analysis indicated an overall good fit of the data to this model. Goodness of Fit Index (GFI), GFI Adjusted for Degree of Freedom, root mean square error of approximation, Bentler's Comparative Fit Index, and Bentler & Bonett's Normed Fit Index scores were .892, .862, .080, .920, and .910, respectively. The Guttman-Cronbach alpha reliability coefficients for the 4 factors and overall model were: cognitive (α = .919), affective-enjoyment (α = .887), affective-feelings (α = .865), affective-teacher (α = .801), and overall (α = .902). Conclusion Scores from this instrument indicate that we can measure students' attitudes toward fitness testing well and can therefore permit further examination into the role these attitudes play in future physical activity.

Examining the ability to detect change using the TRIM-Diabetes and TRIM-Diabetes Device measures

PurposeResponsiveness is defined as the ability of an instrument to accurately detect change when it has occurred and is an essential psychometric property of a patient-reported outcomes (PRO) measure to understand and interpret study findings. This study examined the responsiveness of 2 Treatment Related Impact Measures (TRIMs): The TRIM-Diabetes (TRIM-D) and TRIM-Diabetes Device (TRIM-DD) as well as confirmed their measurement models in a randomized controlled trial (RCT) design.MethodsThe data were collected in a multi-center, randomized, open-label (2 × 12 week), cross-over study of two prefilled pens in subjects with type 1 or type 2 diabetes, age 18 or older. Internal and external responsiveness were examined. To confirm the measurement model identified in the previous study, the Bentler comparative fit index (CFI) and internal consistency for the RCT sample scores were examined and compared.ResultsBased on a priori criteria, tests of responsiveness were confirmed with patients having significant improvements over time ranging from 2.7 (Psychological Health) to 11.1 (Treatment Burden) (P < 0.01) (effect sizes ranging from 0.2 to 0.8). The previous measurement model factor structure was confirmed (CFI ranging from 0.8 to 1.0), and internal consistency of the TRIMs was similar to the developmental findings.ConclusionsThe total score as well as all domain scores of the TRIMs was significantly responsive over time, thus acceptable internal and external responsiveness of TRIM-D and TRIM-DD are concluded. To date, all validation evidence supports the use of these two measures in future clinical trials.

Factors affecting job and career satisfaction among community pharmacists: A structural equation modeling approach

To investigate the effects of continuing pharmacy education (CPE), preceptorship, and the relationship between intrinsic and extrinsic factors affecting job and career satisfaction. Cross-sectional study. Two grocery store pharmacy chains located in Indiana between May 2002 and February 2004. 108 community pharmacists. Self-administered survey. Structural equation modeling was used to determine the effects of intrinsic and extrinsic factors, perceived benefits of CPE, advanced training, and being a preceptor on community pharmacists' job and career satisfaction. Job satisfaction predicted career satisfaction (regression weight 0.49, P = 0.007). The final model comprised extrinsic factors only (regression coefficient = 0.897, P = 0.013) with reasonable-fit indices (X2 ratio = 1.38, root mean square error of approximation = 0.07 [90% CI 0.05-0.09], Bentler comparative fit index 0.915). Intrinsic factors were omitted because of insignificant regression weight (B) in the initial model (B = 0.24, P = 0.278). CPE and preceptorship provided significantly positive effects on extrinsic factors, with coefficients of 0.30 (P = 0.029) and 0.27 (P = 0.027), respectively. While perceived value of being a preceptor contributed significantly to extrinsic factors related to job satisfaction, it was associated with a negative impact on career satisfaction (B = -0.41, P = 0.005). Advanced training had a negative impact on career satisfaction (B = -0.21, P = 0.114). Job and career satisfaction are significantly influenced by extrinsic factors and may increase when pharmacists enroll in CPE programs and/or precept students. Pharmacists may engage in precepting in an attempt to increase job satisfaction. Further research in this area is needed.

Medical Students?? Clinical Reasoning Skills as a Function of Basic Science Achievement and Clinical Competency Measures: A Structural Equation Model

The purpose of this study was to investigate the fit of a hypothesized model of medical students' diagnostic or clinical reasoning skills based on their aptitude for medical school, basic science achievement, and clinical competency measures. A total of 589 medical students who received their MD from 1994 to 2002 participated in this study. Confirmatory factor analysis was used to evaluate the fit of theoretical models of clinical reasoning using measures of basic science and clinical knowledge. The results provided support for a three-factor model of medical student performance (Bentler's Comparative Fit Index = .905, standardized root mean squared residual = .054, root mean squared error of approximation = .105). The clinical reasoning skills of medical students were influenced by an independent relationship between latent variables of basic science achievement and clinical competency. The findings support a theoretical model of diagnostic or clinical reasoning that treats the basic science and clinical knowledge of medical students as distinct domains.

Self-Administered Screening for Mild Cognitive Impairment: Initial Validation of a Computerized Test Battery

The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI), a computer administered, scored, and interpreted touch screen battery was evaluated for its ability to detect mild cognitive impairment. Subjects were three hundred ten community-dwelling elders who enrolled in an National Institute on Aging (NIA)-funded study. One-month test-retest reliability correlations were all significant (p<0.05-p<0.001). Concurrent validity correlations were all significant (p<0.001). A high level of diagnostic validity was attained relative to the Weschler Memory Scale-Revised (WMS-R) LMS-II test (p<0.001). Confirmatory factor analysis supported a three-factor model indicating the tests measure the intended cognitive dimensions of memory, language/spatial fluency, and executive function/mental control. Goodness-of-fit indicators were strong (Bentler Comparative Fit Index=0.99; Root Mean Square Error of Approximation=0.055). Initial validation analyses indicate that the CANS-MCI shows promise of being a reliable, valid screening tool in determining whether more intensive testing for early cognitive impairment is warranted.

A Framework for Studying the Nutritional Health of Community-Dwelling Elders

Ensuring nutritional health for elders has been shown to reduce healthcare costs and enhance quality of life. Studies, however, have shown that malnutrition is present in 2% to 51% of community-dwelling elders, depending on the definition used and the population studied. An empirically tested framework for studying nutritional health in community-dwelling elders is not yet available. To test the goodness-of-fit exhibited by the framework of nutritional health among community-dwelling elders based on the Roy Adaptation Model using structural equation modeling (SEM). A population-based study investigated 243 elders dwelling in public housing. Demographics, polypharmacy, chronic illness, oral health, depressive symptoms, functional status, and satisfaction with social support were assessed to test their relation with nutritional health according to the propositions of the Roy Adaptation Model and scientific evidence. The SEM analysis indicated that functional status, oral health, depressive symptoms, and satisfaction with social support affect nutritional health directly. Oral health, depressive symptoms, functional status, and satisfaction with support mediated the effects of age, ethnicity, education, and number of medications and chronic illnesses on nutritional health. The model accounted for 35% of the variance in nutritional health and demonstrated a good fit with the data and with the values for Bentler's Comparative Fit Index (0.94) and chi (1.76). The propositions of the Roy Adaptation Model were supported, and the findings showed that this framework of nutritional health among community-dwelling elders could serve as a theoretical and empirical base for future inquiry.