Original Checklist Research Articles

Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement

ObjectivesTo describe the processes used to update the PRISMA 2009 statement for reporting systematic reviews, present results of a survey conducted to inform the update, summarize decisions made at the PRISMA update meeting, and describe and justify changes made to the guideline. MethodsWe reviewed 60 documents with reporting guidance for systematic reviews to generate suggested modifications to the PRISMA 2009 statement. We invited 220 systematic review methodologists and journal editors to complete a survey about the suggested modifications. The results of these projects were discussed at a 21-member in-person meeting. Following the meeting, we drafted the PRISMA 2020 statement and refined it based on feedback from co-authors and a convenience sample of 15 systematic reviewers. ResultsThe review of 60 documents revealed that all topics addressed by the PRISMA 2009 statement could be modified. Of the 110 survey respondents, more than 66% recommended keeping six of the original checklist items as they were and modifying 15 of them using wording suggested by us. Attendees at the in-person meeting supported the revised wording for several items but suggested rewording for most to enhance clarity, and further refinements were made over six drafts of the guideline. ConclusionsThe PRISMA 2020 statement consists of updated reporting guidance for systematic reviews. We hope that providing this detailed description of the development process will enhance the acceptance and uptake of the guideline and assist those developing and updating future reporting guidelines.

Floating PV in mountain artificial lakes: a checklist for site assessment

Floating photovoltaics is a emerging approach to deploy photovoltaics on water bodies. Thanks to its high overall global potential and the extensive experience gained (with more than 2 GWp installed and than 510 plants, up to 2020), it represents a promising venue for expanding renewable electricity production worldwide. However, a local assessment for sustainability is needed for this potential to be converted into specific projects attracting the attention of stakeholders. This paper provides an original and wide-ranging screening checklist that allows for site assessment, with a view of separating suitable from unsuitable sites and emphasising that appropriate design can solve difficulties linked to the site features. It offers an extensive list of activities that international, national and regional authorities, investors, solution providers, local communities and civic society, environmentalists and other stakeholders might undertake for a fruitful dialogue. It explores the possibility that art, architecture and industrial design may play a role in increasing the touristic value and the public acceptance of new plants. Although the checklist can be used in other conditions, a particular attention is paid to mountain artificial lakes used as reservoirs by hydro-power plants, since they have potential high synergies (and a global potential of over 3.0 TW) but also may encounter significant implementation issues.

정신건강을 위한 노인요양병원 병실 치유환경디자인 체크리스트 개발

With the increasing population of the elderly, the demand of geriatric hospitals is increasing exponentially. Health issues of the aged also demand various types of well made healing environment. This study aims at suggesting interior design criteria for geriatric hospital bedrooms which can lead the healing environment for mental health. The study explores various interior environment elements and criteria from previous reports and research studies, and tries to suggest an original checklist for geriatric hospital bedrooms. The study firstly analysed the ‘Mind’ category of WELL Building Standard, which has been published in U.S.A, in 2014 as the first standard focusing solely on the health and wellness of building occupants, and compared its index with elements examined on many previous studies in Korea. The study established the first matrix of checklist for healing environment of geriatric hospital bedrooms by analysing the big table generated in the first step. To develop more realistic and objective list, the study collected the evaluation and comments on the pilot checklist from the 40 professionals in both design and medical fields. The checklist was amended considering gathered opinions, and finalized with 48 indicators in four main categories, which were ‘Beauty and Design’, ‘Biophilia Design’, ‘Privacy’ and ‘Community and Information’.

An updated checklist of the bees (Hymenoptera, Apoidea, Anthophila) of Pennsylvania, United States of America

Checklists provide information about the species found in a defined region and serve as baselines for detecting species range expansions, contractions, or introductions. Bees are a diverse and important group of insect pollinators. Although some bee populations are declining, these patterns are difficult to document and generalize due to a lack of long-term studies for most localities. Documenting the diversity of wild bee communities is critical for assessing pollination services, community ecology, and geographical and temporal changes in distribution and density. Here, an updated checklist of the bees of the Commonwealth of Pennsylvania, USA, is presented. Since the first checklist was published (2010; 372 species), thousands of additional specimens from the state have been collected and databased, new species have been described in the region, and the taxonomic status of some species have changed. Specimen data from insect collections, databases, scientific literature, and unpublished records were compared to the original checklist. Seventy-nine new state species records – including 49 first-time reports – representing five of the six bee families in North America, were documented resulting in a total of at least 437 bee species reported from Pennsylvania. We highlight new county records and species persistence details. Our list includes a total of 23 exotic species and at least five species of conservation concern. Lists of species excluded from the state checklist and species anticipated to occur in Pennsylvania are also included. This checklist provides baseline data for researchers and the public. The benefits of insect collections, specimen databases, determination and voucher labels, and georeferencing to biodiversity studies and other aspects of biological research are also discussed.

Identification of physical and psychosocial problems based on symptoms in patients with Beh\xe7et\u2019s disease

The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet’s disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the “ICF Checklist”, and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.

Toward guidelines for reporting assistive technology device outcomes

Purpose The aim of this study was to develop and pilot-test reporting guidelines for manuscripts describing studies of assistive technology device outcomes, with the hopes of improving the overall quality of research in this field. Methods The research is presented in two stages. In Stage 1, a literature review was completed to identify the essential components of a conceptual framework for reporting guidelines and to create a checklist. In Stage 2, two independent reviewers evaluated twenty articles using the checklist to identify any short-comings of the tool and produce an estimate of interrater reliability. Two items of the original checklist were revised after reconciling disagreements between the two raters. Results The Cohen’s Kappa value of the checklist was 0.887 (p < .000), reflecting excellent interrater agreement. The overall percent agreement was 94.6%. Conclusions Reporting guidelines for studies of assistive technology device outcomes appear to be reliable. Although the checklist may require periodic updating, it has potential for advancing outcomes research. Researchers are invited to share comments and criticisms to aid in the efforts of enhancing the quality of reporting in this field. Implications for rehabilitation Reporting checklists and guidelines are effective tools for achieving a minimum standard of reporting quality in all areas of rehabilitation research. This study presents a preliminary reporting checklist for the field of assistive technology device outcomes that has potential for advancing outcomes research. Authors and journal editors are encouraged to adopt and adhere to reporting guidelines in order to enhance the clarity and completeness of prospective studies.

The quality of quality criteria: Replicating the development of the Consolidated Criteria for Reporting Qualitative Research (COREQ)

BackgroundUsing checklists to critically evaluate and report qualitative research is a common practice in the health sciences and there is currently a plethora of checklists available. One strategy for developing such checklists is to identify and amalgamate items from previous checklists into more comprehensive, consolidated ones. ObjectiveThis paper aims to critically review the credibility of a widely endorsed checklist of this type, the Consolidated Criteria for Reporting Qualitative Research (COREQ), by replicating the procedures that led to the consolidation of its 32 items. The original development of COREQ consisted of four phases: 1. A literature search and identification of a sample (n = 22) of references, 2. Data extraction through coding the references, 3. A simplification of an intermediate list of items, and 4. Addition of two items. Design and methodsA replication of the four-phased development of COREQ. We used the reported account of the development of COREQ to replicate the procedures and rationale applied in the four phases. However, we were rarely able to replicate them completely because of uncertainty about the actual procedures. The problems with the replication indicated that COREQ's items were not credible because the coding processes were not trustworthy and because they decontextualized original checklist items and significantly distorted their meaning in COREQ's final list of items. We discuss the use of checklists by means of Haraway's figure of the “modest witness”, which emphasizes that checklists can de-politicize research and create an illusion of rationality and objectivity. ConclusionsConsidering that COREQ is widely endorsed by scholarly journals, it is alarming that the checklist's particular technical and a-political approach to achieve more complete reporting of qualitative research and its particular perspective on what constitutes quality in qualitative research remains unchallenged.

Early Miscarriage: Morphological Data Useful to Clinical and Nosographic Classification

The most frequent complication of the pregnancy is miscarriage. One in five pregnancies ends in miscarriage and the risk of recurrence increases with the increase of previous spontaneous abortions. In the present article an original checklist is shown to classify the causes of abortion based on morphological criteria that can be highlighted on abortive tissue. These histopathological elements are useful in distinguishing fetal from maternal causes of spontaneous abortions and those are used for a nosographic classification.

Using a checklist to facilitate management of long-term care needs after stroke: insights from focus groups and a feasibility study

BackgroundLong-term needs of stroke survivors are often not adequately addressed and many patients are dissatisfied with care post-discharge from hospital. Primary care could play an important role in identifying need in people with stroke.AimWe aimed to explore, refine and test the feasibility and acceptability of a post-stroke checklist for stroke reviews in primary care.Design and settingFocus groups (using a generic qualitative approach) and a single-centre feasibility study.MethodFive focus groups were conducted; three with healthcare providers and two with stroke survivors/carers. The focus groups discussed acceptability of a checklist approach and the content of an existing checklist. The checklist was then modified and piloted in one general practice surgery in the East of England.ResultsThe qualitative data found the concept of a checklist was considered valuable to standardise stroke reviews and prevent post-stroke problems being missed. Items were identified that were missing from the original checklist: return to work, fatigue, intimate relationships and social activities. Time constraints was the main concern from healthcare professionals and pre-completion of the checklist was suggested to address this.Thirteen stroke survivors were recruited to the feasibility study. The modified checklist was found to be feasible and acceptable to patients and primary care clinicians and resulted in agreed action plans.ConclusionThe modified post-stroke checklist is a pragmatic and feasible approach to identify problems post-stroke and facilitate referral to appropriate support services. The checklist is a potentially valuable tool to structure stroke reviews using a patient-centred approach.

Pain Assessment and Management by Nurses in a Geriatric Setting: Discrepancies between Guidelines and Documented Practice

Background: Pain is a common subjective symptom among older adults in general and among older adult residents in long-term geriatric facilities in particular. Pain diminishes older adults’ quality of life and may impair their ability to recover from various illnesses. Therefore, the Israeli Ministry of Health has issued guidelines on effectively assessing and treating pain in this population. Aims: To examine discrepancies between the Ministry of Health's pain assessment guidelines and documented practice by nursing staff at a long-term geriatric care facility and whether these discrepancies correlate to characteristics of the nurses, the wards, and the patients' characteristics. Design and Settings: A descriptive cross-sectional design study conducted at a large geriatric facility in central Israel. Participants: A random sample of 200 computerized patient records of pain assessment and management performed by 69 individual nurses. Methods: The study used an original checklist based on Israeli Ministry of Health guidelines to assess nursing documentation regarding 19 aspects of pain assessment and management. Results and Conclusions: There were discrepancies found between the Ministry of Health's pain assessment guidelines and documented practice by the nursing staff. An average of 13.8 out of 19 aspects of pain assessment and management were documented. As nurses' knowledge about pain assessment and management increased and as staffing ratios improved, the greater was the adherence to Ministry of Health guidelines, resulting in fewer discrepancies between the guidelines and documented practice. There was less pain assessment and management documentation for mechanically ventilated patients and for male patients.

Female fertility in the cancer setting: availability and quality of online health information

As cancer survival rates continue to increase, so does the relevance of starting or expanding a family after cancer, impacting quality of life. However, the option of fertility preservation is not always addressed by physicians before treatment. In the meanwhile, many patients look for health information online. Although potentially helpful in the decision-making process, the Internet could also have adverse effects for this vulnerable patient group when information is incorrect. We aimed to assess the availability and quality of information on female oncofertility on websites of (inter)national oncology, fertility and oncofertility organizations. Availability was identified using an original checklist. Quality was measured by reliability (DISCERN and LIDA instruments), usability (LIDA instrument), and readability (Flesch Kincaid Grade Level test). Of all investigated websites, 52% contained information on oncofertility, with 32% containing a stand-alone page. Of those sites, the amount of treatment options covered were equivalent between specialty sites and general fertility and oncology sites (p = 0.07). The quality of information on treatment choices was the highest for oncofertility websites. Reliability and usability did not differ significantly between websites. No websites evaluated were at the recommended 7th–8th grade reading level. Availability and quality should be improved, and high-quality resources are recommended by physicians.

Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status. Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule (DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between groups. The clients' home environments were categorized using an original checklist, the Home Observation Data Form (HOD). Moderate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses. Guardians agreed with their client's perceptions of difficulty in year 2. Major areas of concern were taking care of household responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day. Community reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client's rehabilitation phase and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered care, and the relationship between motor and cognitive function and reintegration status.

The Revised Role Checklist: Improved Utility, Feasibility, and Reliability.

The Role Checklist is used by occupational therapists across the globe. Developed in 1981 and consistent with the Model of Human Occupation (MOHO), until recently, the Role Checklist was not updated. This is of concern as the Role Checklist originally was established to measure role performance. In 2008, Kielhofner, in the fourth edition of A Model of Human Occupation, differentiated occupational performance in 10 roles which clearly fall into occupational participation in the Role Checklist Version 3. The objective of the study was to describe changes and establish utility, feasibility, and reliability of the Role Checklist Version 3. The Role Checklist Version 3 was administered electronically to N = 114 occupational therapists and students. A short time span was used due to sensitivity to history bias. Test-retest reliability using Cohen's Kappa and Cronbach's alpha mirrored analysis done on the original version. Qualitatively, nine themes emerged regarding utility and feasibility. Test-retest reliability is acceptable to excellent for present role incumbency (κ = 0.74-1.00), desired future role engagement (κ = 0.44-1.00), and satisfaction with performance (α = 0.77-0.98). Participants (91%) found it useful for treatment planning and 75% would recommend Version 3 over the original Role Checklist. Data support the Role Checklist Version 3 as a reliable, electronic instrument feasible for occupational therapists to measure participation.

The STROBE extensions: protocol for a qualitative assessment of content and a survey of endorsement

IntroductionThe STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was developed in response to inadequate reporting of observational studies. In recent years, several extensions to STROBE have been...

Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight questionnaire versus the Modified Kihon Checklist for Frailty Screening in Community-Dwelling Older Adults: The Aging Study of PyeongChang Rural Area.

To compare the five-item Korean version of the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (K-FRAIL) questionnaire versus the 28-item Kihon + 3 index (the 25-item original Kihon checklist plus multimorbidity, sensory impairment, and Timed Up and Go test) in identifying prefrail or frail older adults. We carried out a cross-sectional analysis of 212 community-dwelling older adults (mean age 76 years; 41% male) in PyeongChang County, Korea. We compared the C statistic, sensitivity and specificity of the K-FRAIL questionnaire (range 0-5; cut-point ≥1) versus the Kihon + 3 index (range 0-31; cut-point ≥4) and the original Kihon checklist (range 0-25; cut-point ≥4) in identifying prefrail or frail individuals according to the Cardiovascular Health Study criteria. According to the Cardiovascular Health Study criteria, 150 individuals (70.8%) were prefrail or frail. The C statistic of the K-FRAIL questionnaire in identifying prefrail or frail individuals was lower than that of the Kihon + 3 index (0.77 vs 0.85; P = 0.022) or that of the original Kihon checklist (0.77 vs 0.84; P = 0.046). However, at the a priori cut-points, the K-FRAIL questionnaire had sensitivity (0.79 vs 0.85; P = 0.095) and specificity (0.69 vs 0.69; P = 1.000) that were not significantly different from those of the Kihon + 3 index. However, the K-FRAIL questionnaire was more sensitive (0.79 vs 0.69; P = 0.016), but less specific (0.69 vs 0.86, p = 0.018) than the original Kihon checklist. For frailty screening in community-dwelling older adults, the simple K-FRAIL questionnaire might not be inferior to the current standard of the Kihon + 3 index, and it might be more sensitive and less specific than the original Kihon checklist. Geriatr Gerontol Int 2017; 17: 2046-2052.

Nineteenth Century New Zealand Novels and Novellas Published as Serials in New Zealand, Australian and British Newspapers and Periodicals and Never Published as Monographs: A Checklist. Addendum.

The original checklist of 114 titles was published in the Journal of New Zealand Studies 20 (2015): 10-23. This addendum lists a further 10 titles, all published in New Zealand newspapers and periodicals.

Education Considerations: Communication Curricula, Simulated Resuscitation, and Duty Hour Restrictions.

In routine practice, an intensivist must convey intricate and often devastating information to patients and surrogates, guiding them through complex decisions with life-and-death implications. Although the Accreditation Council for Graduate Medical Education (ACGME) and the American Thoracic Society have called for pulmonary and critical care medicine (PCCM) trainees to receive formal communication skills training, few curricula have been developed, implemented, and published. Focusing on the family meeting as a prototypical intensive care unit (ICU) encounter, McCallister and colleagues (1) developed a year-long communication skills educational program. Beginning with a 3-hour didactic workshop incorporating role plays, the program was interwoven into the first year of PCCM fellowship. The authors created a checklist-based assessment derived from available literature on ICU communication, the Family Meeting Behavioral Skills Checklist, to facilitate feedback and monitor evolution of fellows’ skills. This tool was used for self-evaluation, to provide structured feedback from palliative medicine faculty observing fellows conducting family meetings, and by two blinded psychologists who scored digital recordings of simulated family meetings performed before and after the intervention. In a pre–post analysis, trainees demonstrated a significant increase in total observed Family Meeting Behavioral Skills Checklist skills from 51 to 65% (P, 0.01; Cohen’s D effect size, 1.13) and improved self-confidence (from 77 to 89%, P, 0.01; effect size, 0.87). In the same issue of AnnalsATS, Hope and colleagues (2) describe a communication skills program implemented in their medical ICU. This 1-month curriculum incorporated didactic sessions focused on palliative care, ethics, and end-of-life care, as well as several family conference simulations. Key communication concepts were emphasized through repetition and reinforcement. In unblinded pre–post faculty evaluations fellows demonstrated a statistically significant improvement in three skills: setting an agenda (64% vs. 41%; chi-square, 5.27; P = 0.02); summarizing the care the patient would receive (64% vs. 39%; chi-square, 6.21; P = 0.01); and outlining the follow-up plan (60% vs. 37%; chi-square, 5.2; P = 0.02). Both fellowships created a didactic series, an original checklist evaluation, and used both self-assessments and simulations to judge trainees’ progress. Whereas one was interwoven throughout the year, the other occurred in a single medical ICU rotation. These studies demonstrate the feasibility of embedding communication training in PCCM fellowship, thereby improving trainees’ observable skills and self-confidence. Further study is required to validate these novel assessment tools and measure impact of the educational interventions on patient-centered outcomes, including attention to emotion and to assess optimal structure and duration of curriculum. n

Reporting guidelines for population health and policy interventions: TIDieR-PHP

BackgroundInadequate descriptions of interventions in reports of research studies impede evidence synthesis, and result in unnecessary research duplication and suboptimum real-world implementation. The Template for Intervention Description and Replication (TIDieR) provides guidance for reporting interventions, and is primarily focussed on interventions delivered to individuals or small groups. We aimed to assess the need for additional reporting guidance for population health and policy (PHP) interventions and, if appropriate, develop an extension to TIDieR. MethodsThis study was the preliminary stage of an expert consensus consultation. We drew on our collective experience of evaluating and synthesising evidence of PHP interventions that fall within the scope of Cochrane Public Health to purposively select a diverse range of interventions and compare these with the original TIDieR checklist and to assess whether additional reporting items were needed. Interventions studied included tobacco and alcohol regulation, health service reorganisation, welfare system changes, conditional incentives for behaviour change, and environmental or infrastructural improvement programmes. Intervention descriptions from published evaluations were abstracted independently by four authors. Items that could be fitted into TIDieR were identified, and new categories were developed for those items that did not fit the existing template. A revised TIDieR-PHP reporting template was created through an iterative process of incorporating items into the draft template and testing them against additional interventions. FindingsSix example intervention studies were selected for analysis, covering categories including incentive-based, regulatory, infrastructural, material benefits, systems and policy, and taxation and pricing interventions. Many population-level interventions have characteristics that do not fit well within the existing TIDieR framework, but affect intervention implementation and success. Attributes of PHP interventions not adequately captured include the policy and organisational setting of the intervention; political acceptability and relevant co-interventions; and key features of the dose involved (eg, for interventions offering transfer payments or imposing sanctions). InterpretationThis preliminary stage of the development of TIDieR-PHP found that important features of population-level interventions might not be easily captured by existing guidelines. TIDieR-PHP aims to provide guidance for reporting population health and policy interventions so that learning from population health research is maximised. It will be further developed via a modified Delphi survey. FundingNone.

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

Does the introduction of newborn hearing screening improve vocabulary development in hearing-impaired children? A population-based study in Japan

ObjectivePermanent hearing impairment has a life-long impact on children and its early identification is important for language development. A newborn hearing screening (NHS) program has started in Okayama Prefecture, Japan, in 1999 to detect hearing impairment immediately after birth. We aim to examine the effect of this screening program on vocabulary development in pre-school children in a before and after comparative study design. MethodsA total of 107 5-year-old children who graduated from Okayama Kanariya Gakuen (an auditory center for hearing-impaired children) between 1998 and 2011 were enrolled in this study. The pre-NHS group (n=40) was defined as those who graduated between 1998 and 2003, while the post-NHS group (n=67) was defined as those who graduated between 2004 and 2011. The primary outcome was receptive vocabulary, which was assessed by the Picture Vocabulary Test [score <18 (low) vs. score ≥18 (high)]. The secondary outcome was productive vocabulary, or the number of productive words, which was assessed by an original checklist [<1773 words (low) vs. ≥1773 (high)]. We calculated odds ratios and 95% confidence intervals for vocabulary development and compared both groups. ResultsThe adjusted Picture Vocabulary Test score and number of productive words were significantly higher (p<0.01) in the post-NHS group than the pre-NHS group. Odds ratios were 2.63 (95% confidence interval: 1.17–5.89) for receptive vocabulary and 4.17 (95% confidence interval: 1.69–10.29) for productive vocabulary. ConclusionsThe introduction of NHS in Okayama Prefecture significantly improved both receptive and productive vocabulary development in hearing-impaired children.