Subject Matter Expert Input Research Articles

A New Questionnaire to Assess Respiratory Symptoms (The Respiratory Symptom Experience Scale): Quantitative Psychometric Assessment and Validation Study.

Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. The Respiratory Symptom Experience Scale (RSES)was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores -0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers' RSES scores were significantly higher than former smokers' scores (P<.001). Switchers' RSES scores were significantly lower than smokers' scores (P<.001) and no different from former smokers' scores (P=.34). The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health.

Health-related quality of life in cancer immunotherapy: a systematic perspective, using causal loop diagrams

PurposeSystem science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the health-related quality of life (HRQoL) of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for HRQoL of cancer immunotherapy patients.MethodsWe first applied a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively reviewed and enhanced the CLD through interviews with subject matter experts.ResultsBased on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL.ConclusionThe CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains.

Development of Residents’ Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey

BackgroundTreating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. MethodsBased on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. ResultsResponse rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. ConclusionsWe created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.

A Staged Approach for Facilitating Joint End User, Vendor, and Multi-Disciplinary Subject Matter Expert Input to Health Information Technology Recommendations

Design of health information technology (HIT) that improves patient outcomes is an ongoing process. We propose a methodology that takes a human factors engineering approach to develop systems-engineering-style requirements and design recommendations for both HIT and aspects beyond the scope of the HIT itself (e.g., policies and procedures). Our approach includes: (1) data collection and analysis; (2) preliminary recommendations generation; (3) recommendation review by methodological and domain subject matter experts; (4) revised recommendation review by end users; (5) revised recommendation review by HIT vendors; and (6) final recommendation generation. We illustrate the methodology by presenting a case study focusing on home health care nurses using HIT during the home care admission process.

Development of composite indices and a regional assessment framework for analyzing nation-state health

In support of efforts to predict nation-states’ health, this paper develops a methodology that addresses incorporating disparate data from a variety of sources and utilizing both subject matter expertise and mathematical insights to effectively choose variables to use in a predictive model. The developed model can then capture the interrelatedness and complexities reflective of an actual operational environment. When selecting the indicators to be included in the composite indices, it is critical to evaluate the correlation that exists (or does not exist) between indices. If significant correlation is found, it could result in “double-counting” one or more variables, meaning bias exists in the analysis. Once the indicators have been selected and composite indices formed, in order to effectively evaluate a country’s health, we have developed a regional assessment framework and provided an example risk assessment based on the country of Syria. The results of this research provide a robust analysis approach to understanding and, ultimately, assessing a nation-state’s health. While the initial steps rely heavily on subject matter expert input for identification of indicators for each Political, Military, Economic, Social, Information index, once a solid list of indicators has been selected and weighted, future analysis can be readily conducted following the Region Mean Assessment Framework plan.

Adenotonsillectomy in children with syndromic craniosynostosis: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis in children with syndromic craniosynostosis, to evaluate the effect of adenotonsillectomy for the treatment of obstructive sleep apnea (OSA). A systematic review and meta-analysis. Data sources: a comprehensive search of PubMed, SCOPUS, Ovid Medline, and Web of science databases was performed through June 22nd, 2018. Manual searches and subject matter expert input were also obtained. This article includes studies assessing the effectiveness of adenotonsillectomy in syndromic craniosynostosis children, in which apnea-hypopnea index (AHI) or oxygen desaturation index (ODI) was reported. A total of 3 retrospective studies (24 patients) met the inclusion criteria. Pooled random effect analysis did not identify a statistically significant difference between preoperative and postoperative AHI. But there was an overall reduction of AHI of 5.00 events per hour [95% confidence interval (CI) (- 17.79, 7.79); P = 0.44]. However, the fixed effect model demonstrated a statistically significant difference between preoperative and postoperative ODI with an overall reduction of 8.5 per hour [95% CI (- 15.01, - 1.99); P = 0.01]. Adenotonsillectomy showed benefits for the treatment of OSA in syndromic craniosynostosis children, in terms of AHI and ODI. However, only ODI, but not AHI, reached statistical significance. Data were based on meta-analysis of retrospective reviews. Further studies that are conducted at multiple centers are needed to confirm the benefits of adenotonsillectomy for the treatment of OSA in syndromic craniosynostosis children.

Building a Rehabilitative Care Measurement Instrument to Improve the Patient Experience

ObjectiveTo develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure. DesignMixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design. SettingOutpatient rehabilitative care settings. ParticipantsSubject matter experts (n=3), health care providers (n=137), and patients and caregivers (n=5) contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients postdischarge (n=9) for cognitive interviews to optimize survey design and user interface (N=154). InterventionsNot applicable. Main Outcome MeasureThis novel survey instrument measures 6 concepts previously identified as key to outpatient rehabilitative care patients’ experience: ecosystem issues, client and informal caregiver engagement, patient and health care provider relations, pain and functional status, group and individual identity, and open-ended feedback. Results502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analyzed to create a 10-item questionnaire representing 6 key constructs that influence patient experience quality. Cognitive interviewing with 9 patients (3 rounds of 3 participants each), produced 3 progressively edited versions of the survey instrument. A final version required no further modifications. DiscussionRehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector. ConclusionThe rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere.

Lingual tonsillectomy with palatal surgery for the treatment of obstructive sleep apnea in adults: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis to evaluate effects of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of obstructive sleep apnea (OSA) in adults. Data source: a comprehensive search of MEDLINE, Scopus, Ovid, Web of Science, and the Cochrane Library was performed through November 2017. Manual searches and subject matter expert input were also obtained. This review includes studies assessing efficacy of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of OSA in adults, who had multilevel obstruction including lingual tonsil hypertrophy, in which apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) were reported. A total of four studies (107 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant improvement of polysomnographic respiratory events postoperatively, with average AHI reduction of 18.51 events per hour, [95% confidence interval (CI) (- 31.72, - 5.31); P = 0.006] and increase in minimal arterial oxygen saturation of 5.26 [95% CI (0.10, 10.42); P = 0.05]. The result also showed that the procedures significantly improved sleepiness resulting in an average Epworth Sleepiness Scale (ESS) reduction of 5.44 [95% CI (- 8.69, - 2.18); P = 0.001]. A combination of lingual tonsillectomy with palatal surgery may offer benefits in a selected group of OSA adults, in terms of apnea/hypopnea index, minimal arterial oxygen saturation and Epworth Sleepiness Scale. Data were based on meta-analysis of all case series with 2-6months' follow-up.

The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis.

The purpose of the study was to conduct a systematic review and meta-analysis in patients with obstructive sleep apnea (OSA), evaluating effects of topical nasal steroids on continuous positive airway pressure (CPAP) machine use and nasal symptoms. Data source: A comprehensive search of Pubmed, Scopus, Web of Science, and the Cochrane Library was performed through April 2016. Manual searches and subject matter expert input were also obtained. Studies assessing effects of nasal steroids on CPAP machine use in adults, which reported quantitative outcome data of CPAP compliance, were included. Two studies (144 patients) met inclusion criteria. Both were randomized, placebo-controlled clinical trials (RCT). Pooled fixed effects analysis did not identify a statistically significant difference between both the groups for average duration of CPAP machine use per night. But there was an overall increase in the usage of 0.4h (95% confidence interval (CI) (-0.20, 1.00); P = 0.19) in favor of nasal steroids. Difference of percentage of nights with CPAP use was not demonstrated (mean difference 0.06, 95% CI (-0.27, 0.39); P = 0.71). There was also no significant difference in nasal symptoms (mean difference 0.63, 95% CI (-0.11, 1.36), P = 0.1). Nasal steroids showed benefits on CPAP use, but did not reach statistical significance. Data was based on meta-analysis of RCTs of 4-week follow-up in unselected OSA patients. Future controlled studies with selected group and longer follow-up duration are needed to confirm the benefits of nasal steroid on CPAP compliance in OSA patients.

Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis.

To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patients with obstructive sleep apnea and nasal airway obstruction improves obstructive sleep apnea. Computerized searches were performed in PubMed, EMBASE, and the Cochrane Library through October 2014. Manual searches and subject matter expert input was also solicited. A search protocol was defined a priori, and 2 independent investigators performed the data extraction, focusing on relevant data, including quality data polysomnography data, and taking note of methodological quality and risk for bias. The 10 studies meeting criteria included a total of 320 patients. There were 2 randomized controlled trials, 7 prospective studies, and 1 retrospective study. There was a significant improvement in the pooled results of both Epworth Sleepiness Scale (ESS; difference 3.53, 95% confidence interval [CI] [0.64, 6.23]) and Respiratory Disturbance Index (RDI; 11.06, 95% CI [5.92, 16.19]) scores with isolated nasal surgery. There was no significant improvement in the Apnea Hypopnea Index (AHI) in the random effects model (4.83, 95% CI [-1.6, 11.62]). The pooled results showed that isolated nasal surgery for patients with nasal obstruction and obstructive sleep apnea improved some sleep parameters, as shown by significant improvements in ESS and RDI, but had no significant improvements on AHI. Future controlled studies with larger groups are needed to confirm the benefits of isolated nasal surgery in this patient population.

Workload from Nuclear Power Plant Task Types Across Repeated Sessions

Nuclear Power Plant (NPP) operators complete multiple types of tasks within Emergency Operating Procedures (EOPs). Due to the potential serious consequences of committing an error, it is important to determine if the workload (WL) demands operators encounter are at acceptable levels. This study investigates whether there are workload differences are distinct between task types and if there is a difference between each task type over multiple sessions in a simulated environment. Previous research supports that EEG, ECG, and the NASA-TLX are sensitive to changes in WL. The present preliminary experiment sought to investigate WL changes for experienced participants over a number of sessions and task types. During each session, participants completed tasks derived from a combination of EOPs and subject matter expert input that consisted of checking, detection, and response implementation task types. WL changes were measured through EEG, ECG, and NASA-TLX responses. The results indicate that WL differences were found among the different task types, but not sessions. The implications for these findings are discussed in detail.