Eine standardisierte Übersetzung der STAndards for Reporting of Diagnostic accuracy studies (STARD Statement) in Deutsch: Methodische Aspekte

Development and validation of the 15-STARS - A novel self-report pharmacy-based questionnaire to screen for medication non-adherence

BACKGROUND

Published scales measuring medication adherence are myriad. There is a need for a tool that guides towards downstream adherence interventions.

OBJECTIVE

To develop and validate a self-report questionnaire able to detect modifiable determinants of medication non-adherence.

METHODS

Workshops, surveys and meetings were used to identify items. Validation was performed in French and German (Switzerland) between March and April 2022. Face validation, content validation, construct validation, internal consistency and test-retest reliability were assessed. The questionnaire was finalized in August 2022.

RESULTS

The first draft in English included 13 items divided into four areas. Following translation, validation was performed with 144 patients (63 German-, 81 French-speaking) who were recruited in 35 community pharmacies. Acceptability was good (<5% missing data). Psychometric properties were acceptable with good content validity and moderate construct validity. Internal consistency was acceptable for the French version (Cronbach's alpha = 0.71 [item 1-5] - 0.61 [item 6-9]) and less acceptable for the German version (Cronbach's alpha = 0.43 [item 1-5] - 0.45 [item 6-9]). Test-retest was given for all items (r = 0.52 to 1.0) except item 10 in French (r = 0.25). The final instrument is a 15-item questionnaire called the 15-STARS (Screening Tool for AdheRence to medicineS) that assesses practical difficulties with medicine use, reasons for non-adherence, doses missed, and need for further help.

CONCLUSIONS

Our findings support the validity and clinical utility of the 15-STARS questionnaire. Reliability was inconclusive due to incoherent internal consistency, but explainable by the single-item nature of the scale. This new tool will enable the detection of patients who experience difficulties that negatively influence medication adherence. Pharmacists will be able to propose specific and tailored adherence interventions to the patients. Next steps will focus on evaluating its usefulness for developing targeted interventions that optimize medication adherence in routine care and research settings.

[Quality-Assured Translation of the Wijma Delivery Expectancy Questionnaire (W-DEQ_A) into German]

INTRODUCTION

The "Delivery Expectancy Questionnaire" by Claas Wijma et al. (W-DEQ_A), which is the most frequently used internationally to determine high levels of fear of childbirth in pregnancy, was not previously available in German. In European countries, Canada, Australia and the United States, fear of childbirth is reported to have a prevalence of 6.3 to 14.8%. Particularly, women with a fear of childbirth have an increased risk for preeclampsia, intrauterine growth retardation, and caesarean sections.

METHODS

An English version of the W-DEQ_A authorized by Claas Wijma was translated and culturally adapted according to the guideline of Ohrbach et al. (INfORM). Content validity was statistically determined by means of the content validity index/average method (S-CVI/Ave).

RESULTS

The translation of all text sections of the W-DEQ_A was subjected to independent appraisal. One introductory question and three items needed to be retranslated. Moreover, three items required rewording to achieve cultural equivalence. The calculated content validity yielded an "excellent" S-CVI/Ave of 0.91.

CONCLUSION

The W-DEQ_A is now available in a German version for the self-assessment of fear of childbirth. It is entitled "Gedanken und Gefühle schwangerer Frauen im Hinblick auf die bevorstehende Geburt". In the form of a digital health app, the questionnaire could be prescribed and the result directly transferred to the electronic patient record.

Translation and validation of a tool to assess the impact of clinical pharmacists' interventions

Background The tool CLEO in French language is designed for estimating the potential relevance of pharmacists' interventions (PIs) in three independent dimensions with regard to process-related, clinical, economic, and humanistic impact. Objective We aimed to translate CLEO into German (CLEO_de), to demonstrate its feasibility in daily practice, and to validate the German version. Setting Convenience sample of three Swiss hospitals with established clinical pharmacy services. Method We translated CLEO according to the ISPOR Principles of Good Practice. The potential relevance of PIs performed within a 13-day period of routine clinical pharmacy services was then estimated with CLEO_de. Ten clinical pharmacists experienced with CLEO_de subsequently completed a 19-item questionnaire to assess user's agreement on appropriateness, acceptability, feasibility, and precision of the tool. Additionally, each pharmacist evaluated 10 model cases with CLEO_de. Main outcome measure User satisfaction; interrater reliability and test-retest reliability. Results CLEO_de was used to estimate the potential relevance of 324 PIs. The reported time needed to complete a single estimation was less than 1 min. The use of CLEO_de was seen as appropriate, acceptable, feasible, and precise. Interrater reliability was good for the clinical and economic dimensions and was poor for the organisational dimension; test-retest correlation was strong for all three dimensions with excellent to fair reliability. Conclusion We present CLEO_de as a validated tool in German language suitable to estimate the potential relevance of PIs. After further refinement of the organisational dimension, CLEO_de could provide a qualitative value to quantitative information on PIs.

Lessons learned in applying the International Society for Pharmacoeconomics and Outcomes Research methodology to translating Canadian Emergency Department Information System Presenting Complaints List into German

OBJECTIVES

The patient's presenting complaint guides diagnosis and treatment in the emergency department, but there is no classification system available in German. The Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (PCL) is available only in English and French. As translation risks the altering of meaning, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) has set guidelines to ensure translational accuracy. The aim of this paper is to describe our experiences of using the ISPOR guidelines to translate the CEDIS PCL into German.

MATERIALS AND METHODS

The CEDIS PCL (version 3.0) was forward-translated and back-translated in accordance with the ISPOR guidelines using bilingual clinicians/translators and an occupationally mixed evaluation group that completed a self-developed questionnaire.

RESULTS

The CEDIS PCL was forward-translated (four emergency physicians) and back-translated (three mixed translators). Back-translation uncovered eight PCL items requiring amendment. In total, 156 comments were received from 32 evaluators, six of which resulted in amendments.

CONCLUSION

The ISPOR guidelines facilitated adaptation of a PCL into German, but the process required time, language skills and clinical knowledge. The current methodology may be applicable to translating the CEDIS PCL into other languages, with the aim of developing a harmonized, multilingual PCL.

The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporomandibular joint: a meta-analysis employing the HSROC statistical model

The study aimed to assess the diagnostic value of high-resolution ultrasonography (HR-US) in the detection of anterior disc displacement (ADD) of the temporomandibular joint. Relevant trials reported in MEDLINE, the Chinese National Knowledge Infrastructure Database, the Chinese Biomedical Literature Database, and Embase were identified. A manual search was also performed. The quality of retrieved data was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Data were extracted and cross-checked, and a statistically rigorous meta-analysis was performed using a hierarchical summary receiver operating characteristic model (HSROC). The clinical utility of results was assessed using Fagan nomograms (Bayes theory). All data were evaluated using Stata software. A total 11 studies including 1096 subjects were included in the analysis; all reported the utility of HR-US for the diagnosis of ADD with reduction (ADDWR) and without reduction (ADDWoR). For ADDWR, the weighted sensitivity and specificity were 0.83 (95% confidence interval (CI) 0.78-0.88) and 0.85 (95% CI 0.76-0.92) respectively. The lambda value was 3.41 (95% CI 2.37-4.46) and the Fagan nomogram pre-test probability 58%, with a positive likelihood ratio (LR) of 6.01. The positive post-test probability was 89%, with a negative LR of 0.20. The negative post-test probability was 21%. The positive increase in diagnostic utility was 31% and the negative decrement in that value 37%. For ADDWoR, the weighted sensitivity and specificity values were 0.72 (95% CI 0.59-0.81) and 0.90 (95% CI 0.86-0.93), respectively. The lambda value was 3.69 (95% CI 2.39-4.99) and the Fagan nomogram pre-test probability 38%, with a positive LR of 7.00. The positive post-test probability was 82%, with a negative LR of 0.32. The negative post-test probability was 16%. The increase in diagnostic utility was 44% and the negative decrement in that value 22%. HR-US delivers acceptable performance when used to diagnose ADD, being superior for the detection of ADDWoR than ADDWR, and exhibiting a lower negative diagnostic value in the detection of ADDWoR than ADDWR. HR-US may serve as a new method for the rapid diagnosis of ADD. The method has the advantages of simplicity and low cost. Given the uncertainty in some of the estimated values, more high-quality studies are needed to assess that diagnostic efficacy.