Using measures of agreement to develop a taxonomy of passivity in dementia

Development of a method to investigate medical students' perceptions of their personal and professional development

Personal and Professional Development (PPD) is now key to the undergraduate medical curriculum and requires provision of appropriate learning experiences. In order to achieve this, it is essential that we ascertain students' perceptions of what is important in their PPD. We required a methodological approach suitable for a large medical school, which defines constructs used by the students to describe their PPD, and is not constrained by a researcher's predetermined line of questioning. It should also quantify the saliencies of these constructs in the student population and indicate how they gauge their own PPD. The instrument should also be suitable for administration at key stages of the students' learning experience. Here we describe the first stages in developing a novel method, which fulfils these requirements. It is based on a modified self repertory grid, the "Ideal Self" Inventory. All first year students (N = 379), provided five descriptors of a "good medical student" and of a not very good medical student, which generated 1,531 'ideal' qualities. To define underlying themed constructs, 49 randomly selected descriptors, were grouped together by self selected students (n = 55), using commonly held assumptions. Frequency of item co-occurrence was tabulated by multidimensional scaling. Themed clusters of 'ideal' qualities, defined by hierarchical cluster analysis, were overlaid onto the multidimensional scaling to generate a concept map. This revealed seven themed constructs; Personal Welfare, Time and Self Management Committed Work Ethic, Learning Skills, Personal Development/Reflection, Personal and Professional Conduct and Teamwork. We then analysed the 1,531 'ideal' qualities, by determining the frequency with which students used each construct and the proportion of students who used a construct at least once. Personal and Professional Conduct, Committed Work Ethic and Time and Self Management were the most frequently used, implying that they were the most salient for the first year students.

Social interaction, premorbid personality, and agitation in nursing home residents with dementia

Agitation is exhibited by most nursing home residents with dementia and is a risk factor for poor health outcomes. Identifying the antecedents of agitation is essential for appropriate treatment because interventions require well-defined targets. This study explored relationships between level of social interaction (high vs. low), the premorbid personality trait of extraversion, and agitation using baseline data from a clinical trial that tested the efficacy of activity interventions for agitation. Most residents exhibited at least one agitated behavior over the 332 observation days. Agitation was significantly greater under high social interaction as compared with low social interaction (P < .0001) regardless of the extraversion score.

A Chinese Translation of the EdFED-Q and Assessment of Equivalence

The purpose of this study was to translate the Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) from the original English into a Chinese language version and to assess the equivalence of the English and Chinese EdFED-Q versions. To use a directly translated instrument without minimal explanation of the procedures for determining the equivalence between the original and secondary language instrument is questionable. Ensuring equivalence of a translated Chinese version of the EdFED-Q for patients with dementia is an essential prerequisite for identifying culturally specific expressions of feeding difficulty under investigation. Phase 1 consisted of experts doing the initial translation into Chinese and then English back-translations of the questionnaire. Six experts determined the equality of the Chinese and English versions, and five monolingual nurses provided information for the C-EdFED-Q. In phase 2, two bilingual gerontological nurses rated 33 residents with dementia to determine equivalence across time. In phase 3, three groups of bilingual nurses used the Chinese, English, and finally both versions simultaneously to judge a model case's feeding behavior on the videotape. In phase 1, the rating on the equality of the items on the Chinese and English versions was 0.969. In phase 2, kappa coefficients for all items on the C-EdFED-Q and E-EdFED-Q ranged from 0.44 to 1.00. In determining the consistency of the scores for the C-EdFED-Q and E-EdFED-Q between the two raters across time, the intraclass correlation coefficient for the absolute agreement was found to range from 0.85 to 0.90. In phase 3, except for items 6 and 9, all items showed no significant difference among the three groups. Further studies to assess the relationship between constructs and to compare it with known and predicted relationships are recommended.

Two quantitative approaches for estimating content validity

Instrument content validity is often established through qualitative expert reviews, yet quantitative analysis of reviewer agreements is also advocated in the literature. Two quantitative approaches to content validity estimations were compared and contrasted using a newly developed instrument called the Osteoporosis Risk Assessment Tool (ORAT). Data obtained from a panel of eight expert judges were analyzed. A Content Validity Index (CVI) initially determined that only one item lacked interrater proportion agreement about its relevance to the instrument as a whole (CVI = 0.57). Concern that higher proportion agreement ratings might be due to random chance stimulated further analysis using a multirater kappa coefficient of agreement. An additional seven items had low kappas, ranging from 0.29 to 0.48 and indicating poor agreement among the experts. The findings supported the elimination or revision of eight items. Pros and cons to using both proportion agreement and kappa coefficient analysis are examined.

Therapeutic recreation interventions for need-driven dementia-compromised behaviors in community-dwelling elders

This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized recreational therapy interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.