Panel Input Research Articles

Designing a National Veterinary Prescribing Champion Programme for Welsh Veterinary Practices: The Arwain Vet Cymru Project.

Antimicrobial use in agriculture has been identified as an area of focus for reducing overall antimicrobial use and improving stewardship. In this paper, we outline the design of a complex antimicrobial stewardship (AMS) intervention aimed at developing a national Veterinary Prescribing Champion programme for Welsh farm animal veterinary practices. We describe the process by which participants were encouraged to design and deliver bespoke individualised AMS activities at practice level by forging participant “champion” identities and communities of practice through participatory and educational online activities. We describe the key phases identified as important when designing this complex intervention, namely (i) involving key collaborators in government and industry to stimulate project engagement; (ii) grounding the design in the literature, the results of stakeholder engagement, expert panel input, and veterinary clinician feedback to promote contextual relevance and appropriateness; and (iii) taking a theoretical approach to implementing intervention design to foster critical psychological needs for participant motivation and scheme involvement. With recruitment of over 80% of all farm animal practices in Wales to the programme, we also describe demographic data of the participating Welsh Veterinary Prescribing Champions in order to inform recruitment and design of future AMS programmes.

Towards Circular Social Housing: An Exploration of Practices, Barriers, and Enablers

The concept of Circular Economy (CE) and its application in the built environment is an emerging research field. Scholars approach CE from various perspectives covering a wide range of topics from material innovation to city-scale application. However, there is little research on CE implementation in housing stock, particularly that which is managed or owned by the social housing organisations (SHOs) and which offers opportunities to generate circular flows of materials at the portfolio level. This research focuses on Dutch SHOs and uses the Delphi method to examine CE practices in their asset management, as well as the main barriers to and potential enablers of its uptake. The analysis of two iterative rounds of expert questioning indicates that Dutch SHOs are in the early experimental phase in CE implementation. From the results, it is evident that organisational, cultural, and financial barriers are the most pressing ones that hinder the wider adoption of CE in their asset management. Building on the panel input, this study suggests potential enablers to overcome these barriers, such as CE legislation, best practice case studies, commitment and support from the top management, and the creation of a clear business case.

International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update.

ObjectiveTo update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.MethodsIn October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All previous recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on the recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on the panel input. A simple majority vote (80% of panel members voting “yes”) was used to approve minor changes in grammar and syntax to improve clarity.ResultsThe previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab, and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.ConclusionThis updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for patients with MG worldwide.

Developing trustworthy recommendations as part of an urgent response (1–2 weeks): a GRADE concept paper

ObjectivesThe aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1–2 week) in the clinical, public health, and health systems fields. Study Design and SettingWe conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group. ResultsA request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan. ConclusionAn urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest.

Rancang Bangun Prototipe Pengoptimal Charging Baterai pada Mobil Listrik dari Pembangkit Tenaga Surya dengan Menggunakan Sistem Boost Converter

In this research, the lithium-ion 48 Volt battery charging system's design was carried out on the prototype electric car using the boost converter tool. Boost converter consists of several circuit systems, namely oscillator circuit, trigger circuit, switching circuit, inductor, and DC output. IC TL 494 as pulse and frequency wave generator, used to regulate the switching process on the MOSFET circuit in the boost converter. This research was conducted by presenting variations in the inductor wire's diameter to determine the result of the current output used for the filling process by varying the diameter by 0.8 mm, 4 mm, and 8 mm. The number of wire twists used remains 5:27 and produces an output voltage boost converter of 54 Volts. The results showed the inductor wire's diameter affected the output of the boost converter and the length of battery charging time on the electric car. The length of time of battery draining at the wire's diameter is 0.8 mm, which is for 680 minutes, at the wire 4 mm diameter for 290 minutes, and at the diameter of the wire, 8 mm is for 400 minutes. The boost converter has the advantage of being more efficient in terms of dimensions, resulting in 3 times the voltage and power increase compared to the input voltage. The maximum panel input power of 14.5 Watts when added boost converter maximum power increased by 47.84 Watts.

Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

BackgroundCardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancyMethodsThe study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire.ResultsThe expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach’s alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts’ test of sphericity was greater than the critical value for chi-square, and significant (p < .0001).ConclusionsFindings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

Development of a person-centered interdisciplinary plan-of-careprogram for dialysis.

Dialysis care often focuses on outcomes that are of lesser importance to patients than to clinicians. There is growing international interest in individualizing care based on patient priorities, but evidence-based approaches are lacking. The objective of this study was to develop a person-centered dialysis care planning program. To achieve this objective we performed qualitative interviews, responsively developed a novel care planning program and then assessed program content and burden. We conducted 25 concept elicitation interviews with US hemodialysis patients, care partners and care providers, using thematic analysis to analyze transcripts. Interview findings and interdisciplinary stakeholder panel input informed the development of a new care planning program, My Dialysis Plan. We then conducted 19 cognitive debriefing interviews with patients, care partners and care providers to assess the program's content and face validities, comprehensibility and burden. We identified five themes in concept elicitation interviews: feeling boxed in by the system, navigating dual lives, acknowledging an evolving identity, respecting the individual as a whole person and increasing individualization to enhance care. We then developed a person-centered care planning program and supporting materials that underwent 32 stakeholder-informed iterations. Data from subsequent cognitive interviews led to program revisions intended to improve contextualization and understanding, decrease burden and facilitate implementation. My Dialysis Plan is a content-valid, person-centered dialysis care planning program that aims to promote care individualization. Investigation of the program's capacity to improve patient experiences and outcomes is needed.

Disease State Adaptation Experienced By Patients with Hemophilia: Literature Review and Expert Consensus

Introduction Hemophilia is an inherited disorder that causes a deficiency of a blood clotting factor resulting in a lifelong bleeding diathesis. People with hemophilia (PWH) may experience significant morbidity including potentially life-threatening hemorrhages and accumulation of joint damage and require burdensome and costly chronic treatment with factor replacement therapies. Gene therapies aimed at providing endogenous production of the missing clotting factor have the potential to yield significant health benefits for PWH. Economic evaluation is an important component for the commissioning and funding of new treatments like gene therapies. In economic evaluation, quality-of-life (QoL) is measured using health state utility valuations (HSUV). However, people with inherited and long-term health conditions may adapt to their given health state and adjust their expectations, therefore biasing the estimates of QoL/HSUV (i.e., disease state adaptation (DSA) or "disability paradox"; Albrecht and Devlieger, 1999). Here, we describe the first stages of research to evaluate DSA experienced by PWH. Methods To facilitate the selection of research methodology, a systematic litearure review (SLR) was performed to examine existing studies on QoL/HSUVs for PWH. A SLR was conducted to identify full-text studies by searching electronic databases (e.g. MEDLINE, Web of Science, Cochrane Library). Studies were included in the review using predefined inclusion/exclusion criteria for population, study type, language (English). Additionally, a manual search (last three years) for conferences abstracts was performed to capture the most up-to-date research. Findings from the SLR informed the conceptualisation of a study framework. The proposed research approach was then discussed with an expert panel consisting of clinicians, patient advocacy representatives, and Health Technology Assessment (HTA) specialists. Results The SLR identified 32 studies reporting HSUVs in hemophilia. The studies identified applied a mix of direct and indirect HSUV elicitation techniques. Two studies applied direct time trade-off methodology and the remaining 30 studies adopted indirect valuation methodologies. Utility values were found to vary by disease severity, musculoskeletal damage, bleed frequency, inhibitors, hemophilia subtype, treatment regimen, and adherence. Interestingly, HSUVs derived from valuations from the general public were found to be valued lower than those derived from PWH for the same health states. For example, in Carlsson et al. (2017), general public participants consistently rated significantly lower HSUVs for hemophilia disease states compared to PWH (range: 0.54-0.60 vs. 0.67-0.73), suggesting DSA might exist for PWH. Based on SLR findings, an expert panel discussed the feasibility and acceptability of an approach for conducting a preference elicitation study to directly evaluate DSA in PWH. Preference elicitation is an established research framework that is widely used in health economics. A comparative preference elicitation study was proposed to describe and quantify DSA by comparing responses from PWH, caregivers of PWH, and the general public. Conclusion Based on the SLR and expert panel inputs from clinicians, patients and HTA experts, an agreement was achieved about the research methodology for a new study directly assessing DSA experienced by PWH. Experts agreed that a comparative preference elicitation approach among PWH, caregivers of PWH, and the general public was fit-for-purpose for this research. The impact of DSA on QoL/HSUV should be characterized within economic evaluations of novel treatments with transformative impact on patients' lives, such as gene therapies. Disclosures Martin: HCD Economics: Employment. Mulhern:HCD Economics: Consultancy. Shaikh:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Pedra:HCD Economics: Employment. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.

Integration of Entrustable Professional Activities with the Milestones for Emergency Medicine Residents.

IntroductionMedical education is moving toward a competency-based framework with a focus on assessment using the Accreditation Council for Graduate Medical Education Milestones. Assessment of individual competencies through milestones can be challenging. While competencies describe characteristics of the person, the entrustable professional activities (EPAs) concept refers to work-related activities. EPAs would not replace the milestones but would be linked to them, integrating these frameworks. Many core specialties have already defined EPAs for resident trainees, but EPAs have not yet been created for emergency medicine (EM). This paper describes the development of milestone-linked EPAs for EM.MethodsTen EM educators from across North America formed a consensus working group to draft EM EPAs, using a modified Glaser state-of-the-art approach. A reactor panel with EPA experts from the United States, Canada and the Netherlands was created, and an iterative process with multiple revisions was performed based on reactor panel input. Following this, the EPAs were sent to the Council of Residency Directors for EM (CORD-EM) listserv for additional feedback.ResultsThe product was 11 core EPAs that every trainee from every EM program should be able to perform independently by the time of graduation. Each EPA has associated knowledge, skills, attitudes and behaviors (KSAB), which are either milestones themselves or KSABs linked to individual milestones. We recognize that individual programs may have additional focus areas or work-based activities they want their trainees to achieve by graduation; therefore, programs are also encouraged to create additional program-specific EPAs.ConclusionThis set of 11 core, EM-resident EPAs can be used as an assessment tool by EM residency programs, allowing supervising physicians to document the multiple entrustment decisions they are already making during clinical shifts with trainees. The KSAB list within each EPA could assist supervisors in giving specific, actionable feedback to trainees and allow trainees to use this list as an assessment-for-learning tool. Linking each KSAB to individual EM milestones allows EPAs to directly inform milestone assessment for clinical competency committees. These EPAs serve as another option for workplace-based assessment, and are linked to the milestones to create an integrated framework.

Systematic development of CHEMO-SUPPORT, a nursing intervention to support adult patients with cancer in dealing with chemotherapy-related symptoms at home

BackgroundGiven the great symptom burden associated with chemotherapy on the one hand and generally poor self-management of symptoms by cancer patients on the other hand, our aim was to develop a nursing intervention to reduce symptom burden in adult cancer patients treated with chemotherapy and to support them in dealing with their various symptoms at home.MethodsDevelopment of the intervention was guided by the Intervention Mapping Approach and included following steps: needs assessment, formulation of proximal programme objectives, selection of methods and strategies, production of programme components, and planning for implementation and evaluation of the intervention. A panel of multidisciplinary healthcare professionals (n = 12) and a panel of patients and family caregivers (n = 7) were actively involved developing the intervention at each stage.ResultsFor the intervention, four patient performance objectives relating to self-management were advanced. Self-efficacy and outcome expectations were selected as key determinants of dealing with chemotherapy-related symptoms. As methods for supporting patients, motivational interviewing and tailoring were found to fit best with the change objectives and determinants. Existing patient information materials were re-designed after panel input to reinforce the new intervention approach.ConclusionThe intervention mapping approach, including active involvement of the intervention providers and receivers, informed the design of this nursing intervention with two or more contacts. Further evaluation is needed to gain insight into the potential effects, feasibility and mechanisms of this complex intervention.

Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis.

BackgroundFor consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health.ObjectiveThe aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems.MethodsA panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort.ResultsApproximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer’s household, number of visits to providers outside the consumer’s insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis.ConclusionsThis study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care.

Abatement Efforts, Technological Progress, and Pollution Control in China’s Industrial Sector

ABSTRACTThis article examines the roles of abatement efforts and the technological progress in the pollution control of China’s industrial sector. Based on StoNED model, as a measurement of the technological progress, the total factor productivity (TFP) of China’s industry is estimated by using panel input−output data of the industrial sector at provincial level, and then, the impact of abatement efforts and TFP on the emissions of SO2 and COD in China’s industry is investigated. The results show that (i) there is too much statistical noise in input−output data of China’s industry, and it could lead to an underestimate of TFP if all deviations from the production frontier are attributed to inefficiency; (ii) improving TFP has greater impact on the reduction of the industrial SO2 and COD than increasing abatement efforts does, although improving TFP does not exert statistically significant effect on COD emission.

P1.03-059 Organized High Risk Lung Cancer Screening in Ontario, Canada: A Multi-Centre Prospective Evaluation

Guidelines published in Ontario Canada in 2013, recommend screening individuals at high risk of lung cancer with low-dose computed tomography through an organized program. Cancer Care Ontario, Ontario’s provincial cancer agency, is implementing a prospective evaluation of organized high risk lung cancer screening (HRLCS) in a 2-year, multi-center pilot. The pilot evaluation aims to inform: Recommendations to Ontario’s Ministry of Health and Long Term Care regarding the potential for a provincial program; Optimal program design and requirements for effective implementation. The process to establish a robust evaluation plan for the HRLCS pilot included the development of a logic model, evaluation objectives and evaluation questions. Input from a multidisciplinary panel of experts, including clinicians, epidemiologists, and administrators guided the development of the evaluation plan. A modified Delphi technique facilitated panel input on the proposed evaluation questions, which were drafted based on the logic model and evaluation objectives, and aligned to the steps in the screening pathway. Panel members rated the importance of each evaluation question through an online survey using a 5-point Likert scale, and proposed changes or additional questions. A question was retained if >75% of panel members rated it as important or very important. A facilitated discussion post survey enabled a review of survey results to confirm consensus on the final set of evaluation questions. The survey was completed by all panel members. Of 32 evaluation questions proposed, 31 were rated as important or very important by more than 75% of respondents. Endorsed questions addressed both screening processes and key outcomes, and included, for example: Did recruitment strategies engage individuals representative of the eligible population? Did the follow-up processes occur as intended? Did screening identify early stage lung cancers? Panel discussion led to retention of the single question that did not meet the threshold, and the addition of one new question to the evaluation plan. Given consensus was achieved, a second round modified Delphi survey was not required. Using an expert panel and modified Delphi technique was an effective method to obtain consensus on the pilot evaluation questions. Endorsed evaluation questions will frame the development of measures and indicators to be assessed throughout the pilot. This comprehensive evaluation strategy will inform the design and implementation of a high quality organized HRLCS screening program.

Associations between patients’ perceptions of care integration and organizational features of medical groups in the United States

Background: Prior studies suggest structurally integrating healthcare organizations may not yield care that is integrated for patients. This research has been limited by lack of comprehensive measures of integrated patient care. Our study establishes an evidence base of care integration from the patient’s perspective among a national sample in the United States using a reliable and valid survey. We explore the relationship between patient-perceived integration and elements of organizational integration among medical groups.Methods: We refined and administered the Patient Perceptions of Integrated Care (PPIC) survey. It was theoretically derived, refined through pilot-testing, cognitive testing, and advisory panel input, and tested for reliability and validity. Psychometric analysis supported six dimensions of patient-perceived integration: (1) Provider Knowledge of the Patient, (2) Staff Knowledge about the Patient’s Medical History, (3) Specialist Knowledge about the Patient’s Medical History, (4) Support for Self-directed Care, (5) Support for Medication and Home Health Management, and (6) Test Result Communication. We also created an index of Integration following Hospitalization. This structure achieved good model fit and internal, discriminant, and construct validity. We administered the survey across a stratified random sample of 12,364 Medicare beneficiaries with at least two chronic conditions who had received care from a sample of 150 medical groups from the National Study of Physician Organizations (NSPO3). The final sample included 3,067 Medicare beneficiaries (26% response after 412 exclusions). We extracted data on the medical groups from the NSPO3 for five dichotomized dimensions: large/small size, physician/hospital ownership, primary care/multi-specialty, an information technology sophistication index related to electronic medical record and e-prescribing use (high/low), and an index regarding key care management process intensity (high/low). We conducted analyses using ordered logistic regression models with robust standard errors and weighting by response probability, adjusting for patient demographic, health and psychological characteristics.Results: Among the seven dimensions of integration, Test Result Communication exhibited the most consistently positive responses; each of its three items had over 70% of respondents reporting the most favorable option. Support for Self-directed Care and Support for Medication and Home Health Management exhibited consistently the least favorable responses. For Support for Self-directed Care, none of its five items had more than half of responses in the most favorable option, and four of the five items had over 20% of responses in the least favorable option. For Support for Medication and Home Health Management, only one of its four items revealed a majority in the most favorable option (at 55%).We did not find evidence of strong, consistent relationships between medical group characteristics and integrated care from the patient's perspective. Being a patient in a multispecialty group was associated with higher patient-perceived integration in all domains except for test result communication, but only the relationship with staff knowledge was statistically significant (odds ratio = 1.70; p&lt;.05). There were no strong relationships between perceived integration and either hospital ownership or technological capabilities (odds ratios ranging from 0.99 to 1.01). As compared to patients of large medical groups, patients of both solo practices and small groups had greater odds of being in a higher quartile for provider knowledge, staff knowledge, and support for medication and home health management (the latter was statistically significant; odds ratio = 1.35; p&lt;.01). There was a negative relationship between care management and test result communication for large groups, but a positive relationship for small and solo groups (chow test p =.002).Discussion: According to respondents in this national survey, many opportunities exist to better integrate care for patients with multiple chronic conditions. Notably, the two dimensions exhibiting the lowest levels of integration both related to how well providers support patients in participating in their own care. Particularly for patients with complex illnesses, who require care at home and often face barriers to receiving it, this gap signals an important opportunity for investment and improvement.Our results indicate that opportunities to better integrate care exist for all organizations. No single organizational feature was associated with stronger integration across all dimensions.Conclusion: This research suggests that producing truly integrated care may be more complex than can be captured by simple measures of organizational structure, function and process. Considering patient-perceived assessments of care integration is critical to understanding delivery system transformation.

Managing Heart Failure in Long-Term Care: Recommendations from an Interprofessional Stakeholder Consultation.

Heart failure (HF) affects up to 20 per cent of residents in long-term care (LTC) and is associated with substantial morbidity, mortality, and health service utilization. Our study objective was to formulate recommendations on implementing HF care processes in LTC. A three-phase and iterative stakeholder consultation process, guided by expert panel input, was employed to develop recommendations on implementing care processes for HF in LTC. This article presents the results of the third phase, which consisted of a series of interdisciplinary workshops. We developed 17 recommendations. Key elements of these recommendations focus on improving interprofessional communication and improving HF-related knowledge among all LTC stakeholders. Engaging frontline staff, including personal support workers, was stated as an essential component of all recommendations. System-level recommendations include improving communication between LTC homes and acute care and other external health service providers, and developing facility-wide interventions to reduce dietary sodium intake and increase physical activity.

Development and psychometric evaluation of a health-related quality of life instrument for individuals with adult-onset hearing loss

Objective: Self-reports of ‘hearing handicap’ are available, but a comprehensive measure of health-related quality of life (HRQOL) for individuals with adult-onset hearing loss (AOHL) does not exist. Our objective was to develop and evaluate a multidimensional HRQOL instrument for individuals with AOHL. Design: The Impact of Hearing Loss Inventory Tool (IHEAR-IT) was developed using results of focus groups, a literature review, advisory expert panel input, and cognitive interviews. Study sample: The 73-item field-test instrument was completed by 409 adults (22–91 years old) with varying degrees of AOHL and from different areas of the USA. Results: Multitrait scaling analysis supported four multi-item scales and five individual items. Internal consistency reliabilities ranged from 0.93 to 0.96 for the scales. Construct validity was supported by correlations between the IHEAR-IT scales and scores on the 36-item Short Form Health Survey, version 2.0 (SF-36v2) mental composite summary (r = 0.32–0.64) and the Hearing Handicap Inventory for the Elderly/Adults (HHIE/HHIA) (r ≥ −0.70). Conclusions: The field test provides initial support for the reliability and construct validity of the IHEAR-IT for evaluating HRQOL of individuals with AOHL. Further research is needed to evaluate the responsiveness to change of the IHEAR-IT scales and identify items for a short-form.

Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): a tool for critical appraisal of quality improvement intervention publications

ObjectiveValid, reliable critical appraisal tools advance quality improvement (QI) intervention impacts by helping stakeholders identify higher quality studies. QI approaches are diverse and differ from clinical interventions. Widely used critical...

The F3A-App: Interactive Software for Children with Food Allergies

U E S D A Y 828 The F3A-App: Interactive Software for Children with Food Allergies Elizabeth L. McQuaid, PhD, ABPP, Michael L. Farrow, MA, Cynthia Esteban, MSN, MPH, Barbara N. Jandasek, PhD, Susan A. Rudders, MD, Dawn McDaniel, PhD, Josh Spitalnick, PhD, ABPP; Bradley/Hasbro Children’s Research Center, Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, University of Rhode Island, Kingston, RI, Division of Asthma and Allergy, Department of Pediatrics, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI, Virtually Better, Inc, Decatur, GA, Citrine Tchnologies, LLC, Atlanta, GA. RATIONALE: Pediatric food allergy (FA) is increasingly common, yet few interventions exist to promote effective management in school-aged children. METHODS: We utilized focus groups and expert panel input to design a prototype of the Friends, Family, and Food App (FA-App) a computerized intervention for school-aged children with FA. The FA-App consists of: a school cafeteria scene where the child interacts with virtual peers and adults; two fast-paced, multi-tiered games to build skills in food avoidance and symptom awareness; and a reward system where the child earns points to decorate an animated aquarium. Skills of food avoidance, symptom recognition/management, and responding to bullying/teasing are emphasized. We evaluated feasibility and preliminary efficacy in an open trial of families (n 5 32) with children (ages 8-12, 44% female) with documented FA to peanut/tree nut. RESULTS: The FA-App was well-received by families (84% would probably/definitely recommend to others). Most children (76%) reported feeling ‘‘less nervous’’ about ‘‘what it might be like getting a shot during an allergic reaction’’; analyses revealed increased self-efficacy using epinephrine (t 5 2.24, p < .05), and trends toward increased knowledge of ‘‘what would happen’’ during a reaction (t 5 1.98, p 5 .06) and confidence to stay calm during reactions (t 5 1.98, p 5 .06). Many parents (62%) reported that the FA-App prompted family discussions regarding the social pressures of FA, including bullying. CONCLUSIONS: Computerized interventions may be a useful channel to enhance children’s confidence regardingFAmanagement and facilitate family communication regarding the stresses of FA management around peers.

Cost effectiveness of caspofungin vs. voriconazole for empiric therapy in Turkey

Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated patient and patient survival, respectively (approx. USD1414, 16328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting.

Development of a Self-Report Physical Function Instrument for Disability Assessment: Item Pool Construction and Factor Analysis

ObjectivesTo build a comprehensive item pool representing work-relevant physical functioning and to test the factor structure of the item pool. These developmental steps represent initial outcomes of a broader project to develop instruments for the assessment of function within the context of Social Security Administration (SSA) disability programs. DesignComprehensive literature review; gap analysis; item generation with expert panel input; stakeholder interviews; cognitive interviews; cross-sectional survey administration; and exploratory and confirmatory factor analyses to assess item pool structure. SettingIn-person and semistructured interviews and Internet and telephone surveys. ParticipantsSample of SSA claimants (n=1017) and a normative sample of adults from the U.S. general population (n=999). InterventionsNot applicable. Main Outcome MeasureModel fit statistics. ResultsThe final item pool consisted of 139 items. Within the claimant sample, 58.7% were white; 31.8% were black; 46.6% were women; and the mean age was 49.7 years. Initial factor analyses revealed a 4-factor solution, which included more items and allowed separate characterization of: (1) changing and maintaining body position, (2) whole body mobility, (3) upper body function, and (4) upper extremity fine motor. The final 4-factor model included 91 items. Confirmatory factor analyses for the 4-factor models for the claimant and the normative samples demonstrated very good fit. Fit statistics for claimant and normative samples, respectively, were: Comparative Fit Index=.93 and .98; Tucker-Lewis Index=.92 and .98; and root mean square error approximation=.05 and .04. ConclusionsThe factor structure of the physical function item pool closely resembled the hypothesized content model. The 4 scales relevant to work activities offer promise for providing reliable information about claimant physical functioning relevant to work disability.