Survey-based Tool Research Articles

The openVA Toolkit for Verbal Autopsies.

Verbal autopsy (VA) is a survey-based tool widely used to infer cause of death (COD) in regions without complete-coverage civil registration and vital statistics systems. In such settings, many deaths happen outside of medical facilities and are not officially documented by a medical professional. VA surveys, consisting of signs and symptoms reported by a person close to the decedent, are used to infer the COD for an individual, and to estimate and monitor the COD distribution in the population. Several classification algorithms have been developed and widely used to assign causes of death using VA data. However, the incompatibility between different idiosyncratic model implementations and required data structure makes it difficult to systematically apply and compare different methods. The openVA package provides the first standardized framework for analyzing VA data that is compatible with all openly available methods and data structure. It provides an open-source, R implementation of several most widely used VA methods. It supports different data input and output formats, and customizable information about the associations between causes and symptoms. The paper discusses the relevant algorithms, their implementations in R packages under the openVA suite, and demonstrates the pipeline of model fitting, summary, comparison, and visualization in the R environment.

O39 Validating the Campus Food Aid Self-Assessment Tool (C-FAST)

Background Recent studies have brought attention to college student food insecurity (FI), which is estimated to affect over 30% of students. While research to determine FI prevalence is growing, little research is being conducted on best practices to address student FI. As more campuses seek to address FI, resources are needed to bridge the gap between measuring FI prevalence and identifying appropriate responses. Objective This study aimed to validate the Campus Food Aid Self-assessment Tool (C-FAST). C-FAST is a survey-based tool, designed to gauge college campus performance in 6 dimensions associated with student FI: student services and supports; involvement; advocacy; campus culture and awareness; education and training; and research, scholarship, and creative works. Study Design, Setting, Participants Researchers conducted expert panel review and cognitive interviewing. Five expert reviewers evaluated the tool and provided feedback. Researchers then partnered with 10 four-year colleges and universities in Alabama to facilitate completion of C-FAST by campus representatives. Measurable Outcome/Analysis Institutions completed C-FAST and provided feedback on the tool. C-FAST submissions were evaluated to identify areas of strength and opportunities for growth for each campus then aggregated to reflect the state of FI resources and culture at Alabama institutions. Results Survey and interview feedback support the validation of C-FAST. Aggregated C-FAST results and follow-up interview themes will be presented, describing the validity of C-FAST along with a comprehensive overview of campus responses to student FI in Alabama. Conclusion This study supports validation of C-FAST as a tool for campuses to assess culture and resources relating to FI and provides statewide data on Alabama campus FI responses. Next steps include piloting C-FAST with additional campuses across the United States and validating the tool for use among 2-year institutions, so it can be used to identify appropriate campus responses to FI across a variety of campus contexts. Funding ECMC Foundation.

The validation of a Japanese language version of the postoperative quality of recovery scale: a prospective observational study

BackgroundThe Postoperative Quality of Recovery Scale (PostopQRS) is a survey-based tool that measures quality of the postoperative recovery in multiple domains over multiple time periods. The purpose of this study is to validate the Japanese version of the PostopQRS.MethodsA prospective observational study using bilingual healthy volunteers was conducted in Australia to assess equivalence of the test values between the two languages. To assess the feasibility and discriminant validity of the PostopQRS in a Japanese population, an observational study was conducted on patients undergoing ear-nose-throat and orthopedic surgery in Japan, with measurements performed prior to surgery, 2 h, and 1, 3, and 7 days following surgery. The survey was conducted face-to-face while in hospital and via the telephone following discharge.ResultsSixty-eight volunteers participated in the validation study. The scores in the Japanese version were similar to the English version in all domains at all timepoints. In the cognitive domain, there were no differences between the Japanese and English versions for word recall and word generation tasks. For digits forwards and digits backwards the values were skewed to the maximal value, and although significantly different, the absolute difference was <10% at all timepoints between English and Japanese versions. Fifty-one patients, ear-nose-throat (n=22) and orthopedic (n=29), were included in the clinical study. Orthopedic patients had a significantly worse recovery profile over time in overall recovery (p<0.01), physiological (p=0.02), nociceptive (p=0.03), and activities of daily living (ADL, p<0.01) domains, but was not different for emotive (p=0.30) or cognitive domains (p=0.10).ConclusionThe Japanese version of the PostopQRS is similar to the English version and was able to discriminate recovery between different surgery disciplines.Trial registrationUMIN, UMIN000033268, Registered 6 August 2018.

The role of certification, risk and time preferences in promoting adoption of climate-resilient citrus varieties in Indonesia

The adoption rate of certified climate-resilient crop seedling varieties in developing countries is generally low, impacting on the ability of smallholder perennial crop farmers to adapt to climate change. Given the long-lived nature of perennial crop investments and the high level of uncertainty regarding both the quality of the seedlings and the climate to which they will be exposed as mature trees, there are clear linkages to farmers’ subjective beliefs regarding yield differentials between certified and uncertified seedlings, risk behaviours, and time preferences. We consider these aspects using a recently developed survey-based tool for measuring risk and time preferences and link those to stated preferences and observations on the adoption of certified seedlings. Results show that farmers’ beliefs regarding yield and variance of yields of certified and uncertified seedling along with the risk attitudes are significant correlates with seedling choice behaviours. Our results also indicate that information asymmetries in the certified seedling market may play a role in limiting the benefits of certification programs both due to cheating and due to lower levels of adoption.

A systematic review of scales for measuring information security culture

Purpose The concept of information security culture, which recently gained increased attention, aims to comprehensively grasp socio-cultural mechanisms that have an impact on organizational security. Different measurement instruments have been developed to measure and assess information security culture using survey-based tools. However, the content, breadth and face validity of these scales vary greatly. This study aims to identify and provide an overview of the scales that are used to measure information security culture and to evaluate the rigor of reported scale development and validation procedures. Design/methodology/approach Papers that introduce a new or adapt an existing scale of information security culture were systematically reviewed to evaluate scales of information security culture. A standard search strategy was applied to identify 19 relevant scales, which were evaluated based on the framework of 16 criteria pertaining to the rigor of reported operationalization and the reported validity and reliability of the identified scales. Findings The results show that the rigor with which scales of information security culture are validated varies greatly and that none of the scales meet all the evaluation criteria. Moreover, most of the studies provide somewhat limited evidence of the validation of scales, indicating room for further improvement. Particularly, critical issues seem to be the lack of evidence regarding discriminant and criterion validity and incomplete documentation of the operationalization process. Research limitations/implications Researchers focusing on the human factor in information security need to reach a certain level of agreement on the essential elements of the concept of information security culture. Future studies need to build on existing scales, address their limitations and gain further evidence regarding the validity of scales of information security culture. Further research should also investigate the quality of definitions and make expert assessments of the content fit between concepts and items. Practical implications Organizations that aim to assess the level of information security culture among employees can use the results of this systematic review to support the selection of an adequate measurement scale. However, caution is needed for scales that provide limited evidence of validation. Originality/value This is the first study that offers a critical evaluation of existing scales of information security culture. The results have decision-making value for researchers who intend to conduct survey-based examinations of information security culture.

Think Before You Administer: Is Routine Benzodiazepine Premedication Before Endoscopy in Adults Necessary?

Think Before You Administer: Is Routine Benzodiazepine Premedication Before Endoscopy in Adults Necessary?

Long-term Motor and Cognitive Function in the Children of Women With Inflammatory Bowel Disease.

Research on long-term outcomes of children exposed to inflammatory bowel disease [IBD] in utero is lacking. Maternal inflammation, IBD medications, or other factors may increase the risk of developmental disabilities in the offspring. We used the Danish National Birth Cohort, an ongoing prospective study that includes 100 419 pregnancies of 92 274 women, in conjunction with the Danish National Registries, to evaluate cognitive and motor development of the children of women with and without IBD. We analysed basic measures of childhood development at 6-month and 18-month interviews with the mother and with validated questionnaires filled out by the parents when the child was 7 years old. We adjusted for multiple confounders, including preterm birth. At 6 months, we included 484 children of women with IBD and 69 571 unexposed children; at 18 months, 471 exposed and 66 018 unexposed; at 7 years, 391 exposed and 54 356 unexposed. At 18 months, exposed children were significantly less likely to 'use word-like sounds' but there was no difference between use of 'sentences of 2 words'. At 6 and 18 months, there were no other obvious differences in language and motor development. At 7 years, cognitive scores [emotional, conduct, hyperactivity, peer, and social scores] and motor development [gross/fine motor skills and general coordination] were similar between the two groups. Children exposed to IBD in utero and unexposed children scored similarly on survey-based tools assessing basic measures of neurodevelopment over 7 years. These results are reassuring for current and future parents with IBD.

An exploration of factors influencing the decision-making process and selection of academic help sources

This study identifies factors that influence undergraduate students’ selection of a source of help. Learners engage in intentional decisions to seek help from human and non-human sources to resolve gaps in knowledge. Previous research in academic help-seeking assumed learners sought only human sources of assistance, resulting in a narrow understanding of how learners resolve knowledge gaps. Methodological trends in help-seeking research consistently favor quantitative, survey-based tools with pre-defined options. As a result, the factors that influence the selection of a source in a real-world setting with both human and online sources remain unexplored. The findings support including online sources in help-seeking models. Furthermore, the findings demonstrate the importance of relationships and underscore the need for an integrated framework of help-seeking. A new theory of source selection emerged which integrates academic help-seeking and information-searching behavior.

Survey-based Work System Assessment to Facilitate Large-scale Dissemination of Healthcare Quality Improvement Programs.

The dissemination of quality improvement (QI) interventions to a broader range of healthcare settings requires a proactive assessment of local work systems and processes. The objective of this study was to examine the feasibility of using a survey-based work system assessment (WSA) tool to facilitate the dissemination of a program for optimizing blood culture (BC) use. Informed by findings from an onsite, interview-based WSA at 2 hospitals, a 50-item WSA survey was devised and administrated to 15 hospitals participating in a QI collaborative. WSA survey data were summarized, shared, and discussed with individual hospitals to inform the adaptation and implementation of the BC program. Physician champions leading the local QI team assessed the use of the WSA survey by completing an 8-item survey. A total of 347 clinicians completed the WSA survey, and physician champions at 12 hospitals evaluated the use of the WSA survey. Both the WSA survey data and the evaluation of the WSA survey showed that the survey-based WSA tool could help participating hospitals understand their current BC ordering practices and identify potential barriers to implementing the program from the perspectives of different clinicians. We demonstrated how a survey-based tool could be used to facilitate WSA in the dissemination of a program for improving BC use to a multisite collaborative. A survey-based WSA tool can be used to facilitate future large-scale intervention dissemination efforts.

Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

Excessive opioid prescribing creates risk for abuse and adverse effects, but must be balanced against individualized pain control. Minimal literature exists to guide providers in the postoperative bariatric surgical setting. We compare opioid prescribing practice for minimally invasive bariatric surgery in a university hospital with self-reported patient use and satisfaction. This data is used to create practice guidelines for postoperative prescriptions. A 10-question survey was administered at the first postoperative office visit. All patients at this visit were eligible. None declined or excluded. We analyzed 115 patients for 3 procedures: laparoscopic sleeve gastrectomy (LSG; n = 53), laparoscopic roux-en-Y gastric bypass (LRYGB; n = 50), and laparoscopic adjustable gastric band removal (LAGBR; n = 12). Outcomes included number of pills prescribed (verified), proportion used, duration of use, satisfaction with pain control, and non-narcotic analgesic use. An average of 27 ± 10 pills were dispensed for LSG, average 4.1days of use; 28 ± 7 pills for LRYGB, 4.6days; and16 ± 9 pills for LAGBR, 2.6days. Fifty to 74% retained more than half or all of their opioids at 2weeks. Fifty-four percent utilized non-narcotic analgesics. Overall, 91.3% reported adequate pain control. For each procedure, average number of pills used was calculated with representative values for "less than half left" (75% of average number of pills prescribed) and "more than half left" (25% of average number of pills prescribed). For LSG, an average of 9 pills were used; LRYGB 14 pills, and LAGBR 7 pills. Opioids are overprescribed following most common surgical procedures, but only one study has evaluated patterns after bariatric surgery. Our survey-based tool examines prescribing, utilization and satisfaction following common minimally invasive bariatric procedures. Opioid prescriptions were variable, and excessive for most patients. We now recommend prescribing no more than 15 pills after these operations.

A133 - Postoperative opioid prescribing practices and evidence-based guidelines in bariatric surgery

Excessive opioid prescribing creates risk for abuse and adverse effects, but must be balanced against individualized pain control. Minimal literature exists to guide providers in the postoperative bariatric surgical setting. We compare opioid prescribing practice for minimally invasive bariatric surgery in a university hospital with self-reported patient use and satisfaction. This data is used to create practice guidelines for postoperative prescriptions. A 10-question survey was administered at the first postoperative office visit. All patients at this visit were eligible. None declined or excluded. We analyzed 115 patients for 3 procedures: laparoscopic sleeve gastrectomy (LSG; n = 53), laparoscopic roux-en-Y gastric bypass (LRYGB; n = 50), and laparoscopic adjustable gastric band removal (LAGBR; n = 12). Outcomes included number of pills prescribed (verified), proportion used, duration of use, satisfaction with pain control, and non-narcotic analgesic use. An average of 27 ± 10 pills were dispensed for LSG, average 4.1 days of use; 28 ± 7 pills for LRYGB, 4.6 days; and16 ± 9 pills for LAGBR, 2.6 days. Fifty to 74% retained more than half or all of their opioids at 2 weeks. Fifty-four percent utilized non-narcotic analgesics. Overall, 91.3% reported adequate pain control. For each procedure, average number of pills used was calculated with representative values for “less than half left” (75% of average number of pills prescribed) and “more than half left” (25% of average number of pills prescribed). For LSG, an average of 9 pills were used; LRYGB 14 pills, and LAGBR 7 pills. Opioids are overprescribed following most common surgical procedures, but only one study has evaluated patterns after bariatric surgery. Our survey-based tool examines prescribing, utilization and satisfaction following common minimally invasive bariatric procedures. Opioid prescriptions were variable, and excessive for most patients. We now recommend prescribing no more than 15 pills after these operations.

Kikuyu or Kenyan? Government Service Provision and the Salience of Ethnic Identities

Ethnicity has dominated recent political science research on Africa. Ethnic divisions, ethnic politics and salient ethnic identities have been blamed for a whole host of political and economic dysfunctions, in particular countries and continent-wide. But why do some ethnic identities become salient? And why do we observe such significant variation in identity salience within countries where ethnicity is thought to be uniformly important? Drawing on social-psychological theories of identity formation, I argue that ethnic identification is rooted, in part, in weak service provision by central governments. State action is a visible reminder of one's national identity. In the absence of state service provision, African citizens have few links to an imagined community at the national level. Instead, parochial sub-national identities remain. I develop a new survey-based tool to measure ethnic identification in the presence of social stigma and use it to test the effect of government service provision on ethnic identification in Kenya. In a survey experiment, I find that respondents who are primed to recall a set of services provided by the Kenyan government exhibit significantly lower levels of ethnic identification. The results have implications for studies that take ethnic diversity as a fixed characteristic of societies, and the study of ethnic politics more broadly.

An evaluation of overall effectiveness and treatment satisfaction with intravenous immunoglobulin among patients with immune thrombocytopenia.

A global assessment of patient satisfaction that considers therapeutic effect, toxicities, and convenience is needed to evaluate the acceptability of intravenous immunoglobulin (IVIG) as a treatment for patients with immune thrombocytopenia (ITP). We performed a cross-sectional pilot study to assess the feasibility and usefulness of a treatment satisfaction questionnaire for adult patients with ITP receiving IVIG in an academic hematology clinic. Treatment satisfaction was evaluated by administration of a validated survey-based tool 7 days after IVIG administration. The tool assessed treatment satisfaction across four domains (effectiveness, toxicity, convenience, and global satisfaction); results were summarized with mean scores. Twelve patients were enrolled (nine females; median age, 44 years; interquartile range, 35-69 years). Mean platelet increment after infusion was 54.2 × 10(9) /L (SD, 47.6 × 10(9) /L). Treatment satisfaction scores were highest in the side effect burden domain (88.2/100; SD, 19.3; higher scores indicate a lower burden of side effects). Six participants reported IVIG-associated toxicities; most were "slightly" or "not at all" dissatisfied by the impact of side effects. The domain with the lowest score was convenience (62.0/100; SD, 24.7). The assessment of treatment satisfaction using a survey-based assessment tool was feasible for patients receiving IVIG and provided meaningful results that discriminated between domains. Patients found IVIG treatment to be inconvenient, but were satisfied with its tolerability as an ITP treatment. Larger studies are needed to determine the precise impact on each domain and the reproducibility of study results. Patient satisfaction scores can be used to compare different ITP treatments.

Development and validation of PRISM: A survey tool to identify diabetes self-management barriers

AimsAlthough most children with type 1 diabetes do not achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. This study develops and validates PRISM (Problem Recognition in Illness Self-Management), a survey-based tool for efficiently identifying self-management barriers experienced by children/adolescents with diabetes and their parents. MethodsAdolescents 13 years and older and parents of children 8 years and older visiting for routine diabetes management (n=425) were surveyed about self-management barriers. HbA1c was abstracted from the electronic health record. To develop PRISM, exploratory and confirmatory factor analyses were used. To assess validity, the association of PRISM scores with HbA1c was examined using linear regression. ResultsFactor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: (1) Understanding and Organizing Care, (2) Regimen Pain and Bother, (3) Denial of Disease and Consequences, and (4) Healthcare Team, (5) Family, or (6) Peer Interactions. All models exhibited good fit, with χ2 ratios<2.21, root mean square errors of approximation<0.09, Confirmatory Fit Indices and Tucker–Lewis Indices both >0.92, and weighted root mean square residuals<1.71. Greater PRISM barrier scores were significantly associated with higher HbA1cs. ConclusionsOur findings suggest at least six different domains exist within self-management barriers, nearly all of which are significantly related to HbA1c. PRISM could be used in clinical practice to identify each child and family's unique self-management barriers, allowing existing self-management resources to be tailored to the family's barriers, ultimately improving effectiveness of such services.

A systematic review of the literature on the evaluation of handoff tools: implications for research and practice

Given the complexities of the healthcare environment, efforts to develop standardized handoff practices have led to widely varying manifestations of handoff tools. A systematic review of the literature on handoff evaluation studies was performed to investigate the nature, methodological, and theoretical foundations underlying the evaluation of handoff tools and their adequacy and appropriateness in achieving standardization goals. We searched multiple databases for articles evaluating handoff tools published between 1 February 1983 and 15 June 2012. The selected articles were categorized along the following dimensions: handoff tool characteristics, standardization initiatives, methodological framework, and theoretical perspectives underlying the evaluation. Thirty-six articles met our inclusion criteria. Handoff evaluations were conducted primarily on electronic tools (64%), with a more recent focus on electronic medical record-integrated tools (36% since 2008). Most evaluations centered on intra-departmental tools (95%). Evaluation studies were quasi-experimental (42%) or observational (50%), with a major focus on handoff-related outcome measures (94%) using predominantly survey-based tools (70%) with user satisfaction metrics (53%). Most of the studies (81%) based their evaluation on aspects of standardization that included continuity of care and patient safety. The nature, methodological, and theoretical foundations of handoff tool evaluations varied significantly in terms of their quality and rigor, thereby limiting their ability to inform strategic standardization initiatives. Future research should utilize rigorous, multi-method qualitative and quantitative approaches that capture the contextual nuances of handoffs, and evaluate their effect on patient-related outcomes.

Characterizing explanatory models of illness in healthcare: Development and validation of the CONNECT instrument

A growing body of qualitative and quantitative research suggests that individual patients and physicians often have differing perspectives, or 'explanatory models,' regarding the patient's health condition or illness. Discordance between explanatory models may lead to difficulties in communication and poor disease outcomes. However, due to a lack of tools to systematically measure concordance in patient and physician explanatory models, a large-scale study of explanatory models of illness has not been previously possible. The objective of this project was to develop and pilot-test a survey-based tool (the CONNECT Instrument) that measures salient aspects of explanatory models of illness. We conducted a multi-method survey development project that included qualitative and quantitative item development, refinement, pilot testing, and psychometric evaluation. We evaluated the instrument in two unique, consecutive cohorts of primary care patients in a variety of private and public settings in Houston, TX. We also used the instrument to examine concordance between patient and physician explanatory models in the second cohort. The final version of the CONNECT Instrument contains nineteen items that focus on six dimensions of explanatory models. Cronbach alphas ranged from 0.65 to 0.89 for the six CONNECT dimensions. The instrument demonstrated evidence of criterion-related validity when individual CONNECT dimension scores were compared with scores from previously published instruments, and demonstrated expected differences between patients 'and physicians' explanatory models of illness. The CONNECT instrument is a tool with good psychometric properties that enables researchers to measure important aspects of patients 'and physicians' explanatory models of illness. Our continuing work will focus on gathering additional validity evidence and evaluating associations between explanatory model concordance and health outcomes. The CONNECT instrument can be used to improve quality in clinical practice and medical education by measuring an important intermediate outcome in the chain of factors leading to patient trust, satisfaction, and adherence.

Do children with gastroesophageal reflux become adults with gastroesophageal reflux? What is the role of Acid suppression in children?

Do children with gastroesophageal reflux become adults with gastroesophageal reflux? What is the role of Acid suppression in children?