Exploration of quality criteria for the detection of peak inspiratory flow under different resistance conditions

BACKGROUND

At present, robust quality criteria and methods for the assessment of Peak inspiratory flow meter performance are lacking.

OBJECTIVE

A standard flow-volume simulator for quality control analyses of an inhalation assessment device was utilized with different simulated resistance levels in order to propose a quality testing method and associated standard for this device type.

METHODS

A standard flow-volume simulator was utilized to assess the performance of an In-Check DIAL® (Device I) and an intelligent inhalation assessment device (Device P) at a fixed volume and flow rate. Indices used to evaluate these two instruments included repeatability, accuracy, linearity, and impedance.

RESULTS

Both devices exhibited good repeatability (<± 3 L/min). The difference between test results and standard simulator values for Device P was less than ± 5 L/min at resistance level R1 but higher than ± 5 L/min at resistance levels R2-5, while Device I were greater than 5 L/min at all resistance levels. The relative error for Device P was <± 10% at resistance levels R1, R2, and R4, but > 10% at resistance levels R3 and R5. The relative error values for Device I at all five resistance levels were > 10%. Device P passed the linearity test at the R2 resistance level, while Device I partially passed the linearity test at all five resistance levels.

CONCLUSION

Standard monitoring methods and standards provide a valuable approach to the more reliable clinical assessment and application of these instruments.

Is thematic analysis used well in health psychology? A critical review of published research, with recommendations for quality practice and reporting

Despite the persistent dominance of a 'scientific psychology' paradigm in health psychology, the use of qualitative research continues to grow. Qualitative approaches are often based on fundamentally different values from (post)positivistempiricism, raising important considerations for quality, and whether qualitative work adheres to, and is judged by, appropriate publication standards. Thematic analysis (TA) has become a particularly popular method in qualitative health psychology, but poor practice is widespread. To support high quality, methodologically coherent TA practice and reporting, we critically reviewed 100 systematically selected papers reporting TA, published in five prominent health psychology journals. Our review assessed reported practice, and considered this in relation to methodological and quality recommendations. We identified 10 common areas of problematic practice in the reviewed papers, the majority citing reflexive TA. Considering the role of three 'arbiters of quality' in a peer review publication system - authors, reviewers, and editors - we developed 20 recommendations for authors, to support them in conducting and reporting high quality TA research, with associated questions for reviewers and editors to consider when evaluating TA manuscripts for publication. We end with considerations for facilitating better qualitative research, and enriching the understandings and knowledge base from which health psychology is practiced.

Development of a Core Set of Quality Criteria for Virtual Reality Applications Designed for Older Adults: Multistep Qualitative Study

BACKGROUND

Virtual reality (VR) applications are gaining growing significance, particularly among older adults. These applications can provide valuable support to older adults by offering immersive VR content that positively influences various aspects of their daily lives, including activities of daily living. Furthermore, VR applications can contribute to the enhancement of cognitive and motor skills, ultimately leading to an improved quality of life for older individuals. Nevertheless, to ensure a positive impact, it is crucial to develop VR experiences that are tailored to the needs and preferences of the users.

OBJECTIVE

This study aims to develop a core set of quality criteria and guidelines for the development of user-centered VR applications specifically designed for older adults (target group).

METHODS

The multistep qualitative study design comprised several key stages, beginning with a systematic literature search. This was followed by a framework analysis aimed at identifying a core set of criteria. Subsequently, these criteria underwent validation through expert workshops. The outcomes achieved through this iterative process were organized and categorized into criteria, accompanied by explanations detailing the underlying categories or codes.

RESULTS

The quality criteria core set for older adults-friendly VR applications has been developed through an iterative process. It is divided into 2 distinct parts, each containing criteria categorized into specific areas. The first part includes the following categories: (1) quality assurance of medical/health content, (2) data protection provisions, (3) quality requirements, (4) consumer protection, and (5) interoperability. The second part includes the following categories: (1) graphic/quality, (2) 3D character/avatar, (3) providing in-game instructions and prompts, (4) interaction, (5) navigation, and (6) promotion of user motivation and loyalty to use. The results imply a differentiated scope as well as a differentiated granularity of the criteria.

CONCLUSIONS

Considering the ongoing advancement of VR technology and the diverse needs within the older adult demographic, it is essential to assess the quality criteria core set results on an individual basis.

The Left Outflow Tract in Fetal Cardiac Screening Examination: Introduction of Quality Criteria Is Not Always Associated With an Improvement of Practice When Supervised by Humans

OBJECTIVES

Since 2016, the French CNEOF included the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy in addition to the four-chamber view and the parasagittal view of the right outflow tract. The objective of this study was to define quality criteria for fetal LVOT assessment and to perform a human audit of past and current practices, before and after the implementation of those quality criteria at a large scale.

METHODS

Seven quality criteria were investigated and rated from 0 to 1 during three periods of interest. Files were randomly selected from three centers, and average total and specific scores were calculated.

RESULTS

LVOT pictures were present in more than 94.3% of reports. The average quality score was 5.49/7 (95% confidence interval [CI]: 5.36-5.62), 5.91/7 (95% CI: 5.80-6.03), and 5.70/7 (95% CI: 5.58-5.82) for the three centers in the three periods of interest. There was no significant difference following the introduction of the quality criteria, 2017 versus 2020, P = .054.

CONCLUSION

Fetal LVOT images were present in most of ultrasound reports but the introduction of the proposed quality criteria under human supervision seems not associated with a significant change in practice.

[Mixed Methods Studies in Health Services Research: Requirements, Challenges and the Question of Integration - a Discussion Paper from the Perspective of Qualitative Researchers]

With this discussion paper, the subgroup Mixed Methods of the working group Qualitative Research Methods in the non-profit organization German Network Health Services Research (DNVF) is taking up the topic of three previous discussion papers on the significance and potentials of qualitative research methods in health services research. Mixed methods are being increasingly used and demanded in health services research. However, there are also areas of conflict in the planning and implementation of mixed methods studies, and these are addressed in this paper from the perspective of qualitative research. Special attention is given to the aspect of integration as the fundamental signature of mixed methods research. With this discussion paper, our aim was to stimulate critical as well as constructive exchange of ideas on what constitutes high-quality health services research characterised by a diversity of methods and the framework conditions under which this can succeed.

Uncertainties in Pollution and Risk Assessments of Heavy Metals in Lake Sediments Using Regional Background Soils in China

Background soils are frequently utilized as a surrogate to assess pollution levels and environmental risks of heavy metals in Chinese lakes. However, there remains a lack of understanding regarding the reliability and uncertainty of such assessments. Here, we determined heavy metals (As, Cd, Co, Cr, Cu, Hg, Ni, Pb, and Zn) in sediment cores from five rural lakes in North China to evaluate the reliability and uncertainty of the assessments using background soils by comparing them with assessments based on background sediments. Comparative studies reveal large uncertainties in the assessments using background soils. Among these metals, uncertainties for Hg and Cd are relatively large, whereas those for the other metals are minor. This discrepancy is due to the considerably higher natural variability of Hg and Cd in soils and sediments in comparison to the other metals. Generally, assessments utilizing background soils underestimate pollution levels and risks of Hg but overestimate those of Cd in these lakes. Despite limited human activities around the lakes, they still received a considerable influx of heavy metals via regional atmospheric transport. Assessments of the nine metals indicate moderate to considerable ecological risks in these lakes. The risks are contributed primarily (78-89%) by Hg and Cd. This study underscores the substantial uncertainties in assessing heavy metal pollution and risks using regional background soils and emphasizes the importance of controlling atmospheric emissions of Hg and Cd to mitigate pollution in rural and remote water bodies in China.

[Which Screening Instruments are used in Kindergarten for Developmental Assessment and Identification of Developmental Needs? Quality and Usefulness Criteria of the Instruments]

On the basis of the educational plans of the federal states, kindergartens have the duty to observe the development of children.There are various instruments for developmental observations and the identification of developmental needs.However, the quality and content of these instruments vary greatly. To date, there has been little systematic research on the use of screening instruments in kindergarten.Therefore, the aim of this study was to investigate the use and the satisfaction with instruments for developmental observations and the identification of support needs. Additionally, an analysis of the used instruments in regard of their psychometric quality was conducted. N = 190 kindergarten fromThuringia participated in the study. An online questionnaire was completed, which particularly addressed the question of whether and, if so, which screening instruments were used for developmental observations or for the identification of support needs. In addition, specific information on these instruments (e. g. duration, satisfaction) was collected. Nearly 94 % of participating kindergarten used screening instruments for developmental observations, and 69 % used instruments for identifying support needs. For most frequently used instruments the psychometric quality was weak and only few practice criteria were considered.

Conciliation and Approval of Quality Principles for the Self-Declaration of the Quality of Health Apps

This poster describes the conciliation and approval process of the unified set of criteria for self-declaration of health app quality. The timeline underlines the necessity of transparency and open communication in regulations.

Recommendations of the Netzwerk Kindersimulation for the Implementation of Simulation-Based Pediatric Team Trainings: A Delphi Process

BACKGROUND

Serious or life-threatening pediatric emergencies are rare. Patient outcomes largely depend on excellent teamwork and require regular simulation-based team training. Recommendations for pediatric simulation-based education are scarce. We aimed to develop evidence-based guidelines to inform simulation educators and healthcare stakeholders.

METHODS

A modified three-round Delphi technique was used. The first guideline draft was formed through expert discussion and based on consensus (n = 10 Netzwerk Kindersimulation panelists). Delphi round 1 consisted of an individual and team revision of this version by the expert panelists. Delphi round 2 comprised an in-depth review by 12 external international expert reviewers and revision by the expert panel. Delphi round 3 involved a revisit of the guidelines by the external experts. Consensus was reached after three rounds.

RESULTS

The final 23-page document was translated into English and adopted as international guidelines by the Swiss Society of Pediatrics (SGP/SSP), the German Society for Neonatology and Pediatric Intensive Care (GNPI), and the Austrian Society of Pediatrics.

CONCLUSIONS

Our work constitutes comprehensive up-to-date guidelines for simulation-based team trainings and debriefings. High-quality simulation training provides standardized learning conditions for trainees. These guidelines will have a sustainable impact on standardized high-quality simulation-based education.

Standard quality criteria in retracted vs nonretracted obstetrical randomized controlled trials

BACKGROUND

The number of retracted articles in peer-reviewed journals is increasing within the field of obstetrics. The most common reason for article retraction is scientific misconduct. Unfortunately, article retraction often occurs years after publication, allowing inaccurate data to be widely distributed to readers. There exists a great need for validated screening criteria for obstetric journals to use when reviewing randomized controlled trials for scientific misconduct.

OBJECTIVE

This study aimed to compare retracted obstetric randomized controlled trials with nonretracted randomized controlled trials with regard to their inclusion of 7 quality metrics: prospective trial registration, trial registration number, ethics approval statement, name of the approving committee, statement of informed consent, adherence to the Consolidated Standards of Reporting Trials guidelines, and a data sharing statement.

STUDY DESIGN

Obstetric randomized controlled trials retracted between 1995 and 2021 identified through Retraction Watch were compared with nonretracted randomized controlled trials published between 2018 and 2020 with regard to inclusion of the 7 quality metrics. The main outcome was the difference in prospective trial registration. Secondary outcomes were the percentage of individual criteria met and the screening performance of quality criteria in predicting article retraction.

RESULTS

A total of 150 randomized controlled trials were identified, of which 14 (9.3%) were retracted and 136 (90.7%) nonretracted. Retracted randomized controlled trials were less likely than nonretracted randomized controlled trials to be prospectively registered (14.3% vs 80.1%; P<.001). The median number of quality criteria met was lower for retracted randomized controlled trials (3 vs 6; P<.01). Using a cutoff of ≤4 criteria granted 85.7% (95% confidence interval, 57.2-98.2) sensitivity and 92.0% (95% confidence interval, 86.2-96.0) specificity in distinguishing the retracted randomized controlled trials from nonretracted studies.

CONCLUSION

Retracted obstetric randomized controlled trials were less likely to include the 7 quality metrics required on submission by most top obstetrics and gynecology journals.

Defining Quality Criteria for Nanoplastic Hazard Evaluation: The Case of Polystyrene Nanoplastics and Aquatic Invertebrate Daphnia spp

Polystyrene nanoparticles are the most investigated type of nanoplastics in environmental hazard studies. It remains unclear whether nanoplastic particles pose a hazard towards aquatic organisms. Thus, it was our aim to investigate whether the existing studies and data provided therein are reliable in terms of data completeness. We used the example of Daphnia spp. studies for the purpose of polystyrene nanoplastic (nanoPS) hazard evaluation. First, a set of quality criteria recently proposed for nanoplastic ecotoxicity studies was applied. These rather general criteria for all types of nanoplastics and different test organisms were then, in the second step, tailored and refined specifically for Daphnia spp. and nanoPS. Finally, a scoring system was established by setting mandatory (high importance) as well as desirable (medium importance) criteria and defining a threshold to pass the evaluation. Among the existing studies on nanoPS ecotoxicity for Daphnia spp. (n = 38), only 18% passed the evaluation for usability in hazard evaluation. The few studies that passed the evaluation did not allow for conclusions on the hazard potential of nanoPS because there was no consensus among the studies. The greatest challenge we identified is in data reporting, as only a few studies presented complete data for hazard evaluation.

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

BACKGROUND AND PURPOSE

The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC).

METHODS

A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript.

RESULTS

A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement.

CONCLUSIONS

This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine.

CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy - a multicentric validation study

BACKGROUND

Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule.

AIM

The aim of this study is to validate the association between CC-CLEAR's classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment.

METHODS

Multicentric cohort of consecutive CCs. An expert's panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades.

RESULTS

From 168 CC's included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC's lesion detection (OR 1.25 95% IC [1.07-1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04-1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07-1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12-0.36], p-value < .001) and the recommendation for CC in 3-5 years' time (OR 1.47 95% IC [1.50-1.86], p-value < .002). The Leighton-Rex scale was not correlated with major CC outcomes.

CONCLUSION

CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.

How Structured Metadata Acquisition Contributes to the Reproducibility of Nanosafety Studies: Evaluation by a Round-Robin Test

It has been widely recognized that nanosafety studies are limited in reproducibility, caused by missing or inadequate information and data gaps. Reliable and comprehensive studies should be performed supported by standards or guidelines, which need to be harmonized and usable for the multidisciplinary field of nanosafety research. The previously described minimal information table (MIT), based on existing standards or guidelines, represents one approach towards harmonization. Here, we demonstrate the applicability and advantages of the MIT by a round-robin test. Its modular structure enables describing individual studies comprehensively by a combination of various relevant aspects. Three laboratories conducted a WST-1 cell viability assay using A549 cells to analyze the effects of the reference nanomaterials NM101 and NM110 according to predefined (S)OPs. The MIT contains relevant and defined descriptive information and quality criteria and thus supported the implementation of the round-robin test from planning, investigation to analysis and data interpretation. As a result, we could identify sources of variability and justify deviating results attributed to differences in specific procedures. Consequently, the use of the MIT contributes to the acquisition of reliable and comprehensive datasets and therefore improves the significance and reusability of nanosafety studies.

Use of ohmic heating as an alternative method for cooking pasta

BACKGROUND

In this study, the alternative method of ohmic heating (OH) was applied to investigate its potential usage in the cooking process for pasta and its comparison with the conventional method. For this purpose, OH was operated at four different voltage gradients (10, 20, 30, 40 V cm^-1 ). The electrical conductivity of pasta σ (S m^-1 ) was calculated for the temperature range 22-95 °C and a three-phase linear relation between σ and temperature was determined.

RESULTS

According to the results, the energy consumption of the OH system and cooking time were lower than the conventional method. Energy conservation was about 73.7% at 40 V cm^-1 and increased up to 90.4% (at 10 V cm^-1 ) with lower voltage gradients. Total cooking time, cooking loss, water absorption, degree of gelatinization, volume uptake, energy consumption and sensorial properties were investigated. No significant differences between the results of samples cooked with the conventional method and OH at 30-40 V cm^-1 were found in terms of starch gelatinization degree, volume change, water absorption, and sensorial analysis (P > 0.05).

CONCLUSION

These results revealed that OH did not cause any negative effects on the quality parameters of pasta samples, and positive effects were observed on energy and time saving. © 2021 Society of Chemical Industry.

How Do We Define and Measure Optimal Care for Cancer Survivors? An Online Modified Reactive Delphi Study

This research sought to answer the question 'what quality criteria do survivorship experts consider to be important in achieving optimal cancer survivorship care?'. An online modified reactive Delphi survey consisting of two rounds was completed with experts including consumers, clinicians, researchers, policymakers and quality and accreditation professionals. Survey items were based on international literature and considered three domains: Policy, process and outcome. In round 1 (R1), experts ranked the importance of 68 criteria on a five-point Likert scale. Criteria were retained if scored 4 (important) or 5 (very important) by >75% participants. In round 2 (R2), experts ranked top 10 criteria per domain. Response rates were 79% (70/89) and 84% (76/91), respectively. After R1, six criteria were removed and six were added. From R2, ten items for each domain were retained. These 30 items formed the Quality Framework. A consensus meeting considered priority items from the Quality Framework and feasibility of data collection. Prioritized items included having a policy on survivorship care; the existence of a multidisciplinary survivorship program (policy); appropriate processes to assess survivors' emotional, psychological and physical needs following treatment and stratification to appropriate models of care (process); and collecting patient-reported outcomes, quality of life and survival rates (outcome).

Diet and Inflammatory Bowel Disease: What Quality Standards Should Be Applied in Clinical and Laboratory Studies?

Many patients suffering from inflammatory bowel disease (IBD) follow restrictive diets, as many respective recommendations circulate. Efforts are made to evaluate and summarize the published information, for example, in a recent consensus manuscript by the International Organization for the Study of IBD (IOIBD). However, the standards that should be applied to make claims about dietary effects are poorly defined. In this manuscript, the scientific basis of recommendations for nutritional interventions in IBD is analyzed. Epidemiological evidence on diet in IBD is always biased by numerous factors, and the number of robust dietary intervention studies is limited due to methodological difficulties. Therefore, animal models are used to test hypotheses with respect to dietary factors and intestinal inflammation. Naturally, animal models have limitations, and knowledge of key characteristics of colitis animal models is crucial to understand their advantages and disadvantages. In recent years the important role of the microbiota for IBD and dietary factors has been discovered. Microbiota data are added to many publications on IBD and nutrition. The quality of those data varies largely. Subsequently, quality standards for microbiota analyses also are discussed. Finally, quality requirements to be applied on recommendations for dietary changes in patients with IBD are suggested.

Quality criteria for randomized controlled studies: obstetrical journal guidelines

BACKGROUND

Most retractions of obstetrics and gynecology manuscripts are because of scientific misconduct. It would be preferable to prevent randomized controlled trials with scientific misconduct from ever appearing in the peer-reviewed scientific literature, rather than to have to retract them later.

OBJECTIVE

This study aimed to evaluate the policies of obstetrics and gynecology and top medical journals in their author guidelines and electronic submission systems regarding prospective randomized controlled trial registration, ethics committee approval, research protocols, Consolidated Standards of Reporting Trial guidelines, and data sharing and to detect the most common quality criteria requested for randomized controlled trials in these journals.

STUDY DESIGN

Author guidelines were identified via online Google searches from the websites of selected peer-reviewed medical journals. Journals in obstetrics and gynecology were selected from the list of journals with impact factors based on the Journal Citation Report released by Clarivate Analytics on June 29, 2020, focusing on those publishing original clinical research in obstetrics, in particular randomized controlled trials. In addition, 4 of the top impact factor peer-reviewed general medical journals publishing randomized controlled trials were included. The requirements for selected quality criteria for randomized controlled trials analyzed in the author guidelines for each journal were details of 5 general issues: prospective randomized controlled trial registration (4 subcategories), ethics committee approval (4 subcategories), research protocol (3 subcategories), Consolidated Standards of Reporting Trials guidelines (3 subcategories), and data sharing (3 subcategories). To evaluate the requirements within the electronic submission system, a mock submission of a randomized controlled trial was also done for each journal, and the same criteria were assessed on the online software for submission. The primary outcome was the overall percentage for each of the quality criteria that were listed as required within the author guidelines or required in the submission system among all journals. Planned subgroup analyses were top general medicine vs obstetrics and gynecology journals and top 4 obstetrics and gynecology vs other obstetrics and gynecology journals.

RESULTS

Most studied peer-reviewed journals listed in their author guidelines 7 specific criteria for submission of randomized controlled trials: prospective registration and registration number, statement of ethical approval with name of approving committee and statement of informed consent, statement of adherence to Consolidated Standards of Reporting Trials guidelines, and data sharing statement. For most journals, the submission software did not require these or any other criteria for submission. There were minimal differences in criteria listed for top medical journals vs other obstetrics and gynecology journals and among top vs other obstetrics and gynecology journals.

CONCLUSION

Prospective registration and registration number, statement of ethical approval with name of approving committee and statement of informed consent, statement of adherence to Consolidated Standards of Reporting Trials guidelines, and data sharing statement are the randomized controlled trial quality criteria requested by leading medical and obstetrics and gynecology journals. These obstetrics and gynecology journals agree to make, as much as possible, these criteria uniform and mandatory in author guidelines and also through improved submission software.

The Development of High-Quality Multispecies Probiotic Formulations: From Bench to Market

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. To date, there is an increasing number of commercially available products containing probiotics on the market. Probiotics have been recommended by health care professionals for reasons ranging from their long-term immunomodulatory effects to proven benefits in the management of different health conditions. For probiotic products, there are several important aspects that determine the success rate of the development from bench to market. The aim of this review is to explore how the current knowledge on microbe–microbe and host–microbe interactions can be used to develop high-quality, evidence-based probiotic formulations, specifically probiotic dietary supplements, with a focus on the selection of safe strains with relevant functional properties. In addition, we will highlight aspects of the probiotic manufacturing process that need to be considered during the product development and the subsequent manufacturing process to guarantee consistent efficacy of a probiotic product. For each high-quality probiotic formulation, it is important to screen multiple strains, and select only those strains that show relevant functional properties and that can be considered safe for human consumption. In addition, it is imperative that attention is paid to the product development and manufacturing process, and that safety and quality properties are monitored. Importantly, the beneficial effects of probiotics should be evaluated in product efficacy studies and post-marketing surveys in order to demonstrate their clinical efficacy. All these aspects need to be evaluated and validated during the development of a successful high-quality and ready-to-market probiotic.

Quality Criteria for Serious Games: Serious Part, Game Part, and Balance

Serious games are digital games that have an additional goal beyond entertainment. Recently, many studies have explored different quality criteria for serious games, including effectiveness and attractiveness. Unfortunately, the double mission of serious games, that is, simultaneous achievement of intended effects (serious part) and entertainment (game part), is not adequately considered in these studies. This paper aims to identify essential quality criteria for serious games. The fundamental goal of our research is to identify important factors of serious games and to adapt the existing principles and requirements from game-related literature to effective and attractive serious games. In addition to the review of the relevant literature, we also include workshop results. Furthermore, we analyzed and summarized 22 state-of-the-art serious games for education and health. The selected best-practice serious games either prove their effectiveness through scientific studies or by winning game awards. For the analysis of these games, we refer to "DIN SPEC 91380 Serious Games Metadata Format." A summarized text states quality criteria for both the serious and the game part, and especially the balance between them. We provide guidelines for high-quality serious games drawn from literature analysis and in close cooperation with domain experts.

Quality Criteria to Evaluate Performance and Scope of 2030 Agenda in Metropolitan Areas: Case Study on Strategic Planning of Environmental Municipality Management

The United Nations’ (UN) 2030 Agenda brings new governance challenges to municipal environmental planning, both in large urban centres and in metropolitan peripheries. The opportunities of the new framework of action proposed by the United Nations (UN) and its integrative, global, and transversal nature constitute advances from the previous models of municipal management based on the Local Agenda 21. This text provides evidence to apply quality criteria and validated instruments of participatory evaluation. These instruments have been built on the foundation of evaluative research, a scientific discipline that provides rigour and validity to those decisions adopted at a municipal level. A case study focused on a metropolitan area serves as a field of experimentation for this model of the modernization of environmental management structures at a local level. Details of the instruments, agents, priority decision areas, methodologies, participation processes, and quality criteria are provided, as well as an empirically validated model for participatory municipal management based on action research processes and strategic planning that favours a shared responsibility across all social groups in the decision-making process and in the development of continuous improvement activities that are committed to sustainability. Finally, a critical comparison of weaknesses and strengths is included in light of the evidence collected.

[Comparative clinical evaluation of the prosthetic treatment quality of molars restored by chairside manufactured CAD/CAM crowns]

AIM

A comparative clinical evaluation of the results of prosthetic treatment with chairside CAD/CAM crowns for molars made from hybrid ceramics VITA Enamic, blocks of feldspatic ceramics VITABlocs Mark II, blocks of leucite glass IPS Empress CAD.

MATERIAL AND METHODS

The study involved 30 patients aged from 19 to 60 years old with defects in hard tissues of molars. For clinical evaluation we used 'Clinical criteria for evaluation of direct and indirect restorations' developed by FDI in 2007, which included the assessment of several aesthetic, functional and biological parameters. We also included 2 additional criteria indicators: the condition of the antagonist tooth and the hygienic condition of the prosthesis in comparison with the hygiene of natural teeth. All patients were randomized into 3 groups of 10 people. After the treatment the clinical quality assessment was carried out in the following time intervals: 30 minutes, 1, 6, 12, 18, 24 months after the fixation of the crown.

RESULTS

Clinical evaluation of the results of prosthetic treatment of 30 patients with chairside CAD/CAM crowns made from three different materials did not reveal any significant difference in the clinical criteria for evaluation of direct and indirect restorations within 24 months.

Prioritizing research challenges and funding for allergy and asthma and the need for translational research-The European Strategic Forum on Allergic Diseases

The European Academy of Allergy and Clinical Immunology (EAACI) organized the first European Strategic Forum on Allergic Diseases and Asthma. The main aim was to bring together all relevant stakeholders and decision-makers in the field of allergy, asthma and clinical Immunology around an open debate on contemporary challenges and potential solutions for the next decade. The Strategic Forum was an upscaling of the EAACI White Paper aiming to integrate the Academy's output with the perspective offered by EAACI's partners. This collaboration is fundamental for adapting and integrating allergy and asthma care into the context of real-world problems. The Strategic Forum on Allergic Diseases brought together all partners who have the drive and the influence to make positive change: national and international societies, patients' organizations, regulatory bodies and industry representatives. An open debate with a special focus on drug development and biomedical engineering, big data and information technology and allergic diseases and asthma in the context of environmental health concluded that connecting science with the transformation of care and a joint agreement between all partners on priorities and needs are essential to ensure a better management of allergic diseases and asthma in the advent of precision medicine together with global access to innovative and affordable diagnostics and therapeutics.

Demands for multidimensional information on the work environment: A methodological framework for regular studies

BACKGROUND

Development of methodologies for making economic decisions on designing work environment studies is a theoretical challenge for researchers in occupational health sciences. There are well-defined tools available in the relevant literature for analysis of cost-efficiency associated with the assessment of an occupational exposure of interest. However, these analytical tools are not appropriate for holistic studies of the work environment as a multidimensional reality.

OBJECTIVE

This article introduces an appropriate methodology for designing cross-sectional comprehensive studies of the work environment, in order to optimize the production of information on the psychosocial, ergonomic, and physical dimensions of the work environment in regular studies.

METHODS

The employment of a translog cost-utility function is suggested as a suitable way to provide cost-minimized designs for regular studies which are aimed at providing or developing multidimensional information systems of the work environment.

RESULTS

The translog cost-utility function is not subject to predetermined restrictions, but has a flexibility property allowing it to be transformed to any specification that is adaptable to the specific work environmental characteristics and research requirements.

CONCLUSION

The translog cost-utility function is an appropriate econometric model for optimizing the production of multidimensional information on occupational exposures in regular cross-sectional workplace studies.

Quality Principles of App Description Texts and Their Significance in Deciding to Use Health Apps as Assessed by Medical Students: Survey Study

Background

Currently, there are no binding requirements for manufacturers prescribing which information must be included in the app descriptions of health apps.

Objective

The aim of this study was to investigate how medical students perceive a selection of quality principles, intended for usage decisions in the app context, and establish whether the information presented in a sample of app descriptions is perceived as sufficient for facilitating an informed usage decision.

Methods

A total of 123 students (mean age 24.2 years, SD 3.4) participating in a 6-week teaching module covering cardiology and pulmonology at the University of Göttingen (original enrollment 152 students, response rate 80.9%) were included. Students were asked to read 3 store description texts of cardiological or pneumological apps and initially assess whether the descriptions sufficed for a usage decision. Subsequently, they were queried on their perception of the relevance of 9 predefined quality principles, formulated for usage decisions. An appraisal of whether the app description texts contained sufficient information to satisfy these quality principles followed. By means of 20 guiding questions, participants were then asked to identify relevant information (or a lack thereof) within the descriptions. A reassessment of whether the description texts sufficed for making a usage decision ensued. A total of 343 complete datasets were obtained.

Results

A majority of the quality principles were described as “very important” and “important” for making a usage decision. When accessed via the predefined principles, students felt unable to identify sufficient information within the app descriptions in 68.81% (2124/3087) of cases. Notably, information regarding undesired effects (91.8%, 315/343), ethical soundness (90.1%, 309/343), measures taken to avert risks (89.2%, 306/343), conflicts of interest (88.3%, 303/343), and the location of data storage (87.8%, 301/343) was lacking. Following participants’ engagement with the quality principles, statistically significant changes in their assessment of whether the app descriptions sufficed for a usage decision can be seen—McNemar-Bowker test (3)=45.803919, P<.001, Cohen g=.295. In 34.1% (117/343) cases, the assessment was revised. About 3 quarters of changed assessments were seen more critically (76.9%, 90/117). Although, initially, 70% (240/343) had been considered “sufficient,” this rate was reduced to 54.2% (186/343) in the second assessment.

Conclusions

In a considerable number of app descriptions, participants were unable to locate the information necessary for making an informed usage decision. Participants’ sensitization to the quality principles led to changes in their assessment of app descriptions as a tool for usage decisions. Better transparency in app descriptions released by manufacturers and the exposure of users to quality principles could collectively form the basis for well-founded usage decisions.

[Quality criteria of internet-based cognitive-behavioral interventions for children and adolescents and their parents - A systematic review]

Quality criteria of internet-based cognitive-behavioral interventions for children and adolescents and their parents - A systematic review Abstract. Introduction: This study provides an overview of existing internet-based evidence-based cognitive behavioral interventions (iCBT) for children/adolescents and their parents. The studies were evaluated based on preliminary defined quality criteria regarding their usability in the healthcare system. Methods: The review was performed according to PRISMA guidelines and evaluated the scientific literature concerning to iCBT. We conducted a comprehensive literature search of PubMed, PsychINFO, PsychARTICLES, PsychNDEX and Science Direct using relevant keywords. Studies were rated according to 10 previously predefined quality measures. Results: A total of 4,479 articles were screened, 62 of which were selected for further analysis. Thereof, 24 international iCBT programs with 50 randomized controlled trials (RCTs) were evaluated and met the quality criteria (M = 7.25, SD = 1.07). Further 13 publications showed preliminary efficacy for another 11 international iCBT programs and met the quality criteria (M = 7.45, SD = .82). There was no significant difference between programs evaluated within and without RCTs t(33) = -.56, p = .58. Conclusions: Our results indicate that multiple international iCBT programs exist. Because in Germany the waiting time for psychotherapeutic or psychiatric treatment is still about five months, iCBT programs have the potential to reduce this gap.

Impact of donor characteristics on the quality of bone marrow as a source of mesenchymal stromal cells

In recent years, the therapeutic use of mesenchymal stromal cells (MSC) has generated a valuable number of scientific studies that delve into their biological characteristics and their potential in regenerative medicine; however, the impact of the clinical characteristics of tissue donors, from which these cells are isolated, on their potential in applied clinical research is not yet clear. The objective of this study was to evaluate the impact of the clinical characteristics of bone marrow donors on the quality of this tissue as a source of MSC for therapeutic use. Human MSC were isolated, characterized and cultured (according to ISCT criteria) from bone marrow samples from volunteer donors (n = 70) attending the Department of Orthopedics and Traumatology of the Hospital Universitario San Ignacio (Bogota, Colombia) for surgery of prosthetic hip replacement that agreed to participate voluntarily in the study. Donor data such as age, gender, weight, smoker and type of anesthesia used during the surgical procedure were recorded, and the impact of these characteristics on the volume of tissue collection, mononuclear cell count and confluence time of cells with fibroblastoid morphology was evaluated. Correlation coefficients between quantitative variables were calculated with Spearman's correlation test, and the association between qualitative and quantitative variables was evaluated with biserial correlation coefficient. A significant correlation was observed between the age of the donors and the time necessary to obtain confluent cells in vitro (r = 0.2489, P = 0.0377); similarly, the correlation between the volume of bone marrow collected and the number of mononuclear cells obtained was significant (r = 0.7101, P = 0.0001). Although a negative correlation tendency was observed between the mononuclear cell count and the confluence time, this was not significant (r = -0.2041, P = 0.0950). No significant associations were observed between gender, smoking status or type of anesthesia and the expansion characteristics of human mesenchymal stromal cells. Bone marrow donor age and the tissue collection volume impact the time of obtaining MSC in vitro and the mononuclear cell count with which the culture starts. These conditions must be considered when the bone marrow is selected as the tissue for obtaining MSC.

Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology

PURPOSE

This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions.

MATERIALS AND METHODS

The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017.

RESULTS AND CONCLUSION

The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard. Implications for Rehabilitation Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.

Validating Resolution Revolution

Recent advances in instrumentation and image-processing software have resulted in a resolution revolution in cryo-electron microscopy (cryo-EM) and a surge in the popularity of this technique. However, despite technical progress and hundreds of structures determined so far, development of standards assessing the agreement between the cryo-EM map and the respective model has fallen behind. Here we establish a validation procedure evaluating this agreement and applied it to a set of 565 cryo-EM structures. Analysis of the results revealed that three-quarters of the validated structures exhibit moderate or low agreement between the map and the corresponding model, mostly due to limited structural features possessed by these maps. Model re-refinement significantly improved the agreement for only one-fifth of the structures, reaffirming the necessity to re-evaluate map resolution. The presented procedure provides an approach to re-estimate the resolution of cryo-EM map areas interpreted by the model.

Analysis of Six Reviews on the Quality of Instruments for the Evaluation of Interprofessional Education in German-Speaking Countries

Background: More and more institutions worldwide and in German-speaking countries are developing and establishing interprofessional seminars in undergraduate education of health professions. In order to evaluate the different didactic approaches and different outcomes regarding the anticipated interprofessional competencies, it is necessary to apply appropriate instruments. Cross-cultural instruments are particularly helpful for international comparability. The Interprofessional Education working group of the German Medical Association (GMA) aims at identifying existing instruments for the evaluation of interprofessional education in order to make recommendations for German-speaking countries. Methods: Systematic literature research was performed on the websites of international interprofessional organisations (CAIPE, EIPEN, AIPEN), as well as in the PubMed and Cinahl databases. Reviews focusing on quantitative instruments to evaluate competencies according to the modified Kirkpatrick competency levels were searched for. Psychometrics, language/country and setting, in which the instrument was applied, were recorded. Results: Six reviews out of 73 literature research hits were included. A large number of instruments were identified; however, their psychometrics and the applied setting were very heterogeneous. The instruments can mainly be assigned to Kirkpatrick levels 1, 2a & 2b. Most instruments have been developed in English but their psychometrics were not always reported rigorously. Only very few instruments are available in German. Conclusion: It is difficult to find appropriate instruments in German. Internationally, there are different approaches and objectives in the measurement and evaluation of interprofessional competencies. The question arises whether it makes sense to translate existing instruments or to go through the lengthy process of developing new ones. The evaluation of interprofessional seminars with quantitative instruments remains mainly on Kirkpatrick levels 1 and 2. Levels 3 and 4 can probably only be assessed with qualitative or mixed methods. German language instruments are necessary.

Analysis of Six Reviews on the Quality of Instruments for the Evaluation of Interprofessional Education in German-Speaking Countries

Background: More and more institutions worldwide and in German-speaking countries are developing and establishing interprofessional seminars in undergraduate education of health professions. In order to evaluate the different didactic approaches and different outcomes regarding the anticipated interprofessional competencies, it is necessary to apply appropriate instruments. Cross-cultural instruments are particularly helpful for international comparability. The Interprofessional Education working group of the German Medical Association (GMA) aims at identifying existing instruments for the evaluation of interprofessional education in order to make recommendations for German-speaking countries. Methods: Systematic literature research was performed on the websites of international interprofessional organisations (CAIPE, EIPEN, AIPEN), as well as in the PubMed and Cinahl databases. Reviews focusing on quantitative instruments to evaluate competencies according to the modified Kirkpatrick competency levels were searched for. Psychometrics, language/country and setting, in which the instrument was applied, were recorded. Results: Six reviews out of 73 literature research hits were included. A large number of instruments were identified; however, their psychometrics and the applied setting were very heterogeneous. The instruments can mainly be assigned to Kirkpatrick levels 1, 2a & 2b. Most instruments have been developed in English but their psychometrics were not always reported rigorously. Only very few instruments are available in German. Conclusion: It is difficult to find appropriate instruments in German. Internationally, there are different approaches and objectives in the measurement and evaluation of interprofessional competencies. The question arises whether it makes sense to translate existing instruments or to go through the lengthy process of developing new ones. The evaluation of interprofessional seminars with quantitative instruments remains mainly on Kirkpatrick levels 1 and 2. Levels 3 and 4 can probably only be assessed with qualitative or mixed methods. German language instruments are necessary.

Quality management of clinical-practical instruction for Practical Year medical students in Germany - proposal for a catalogue of criteria from the German Society of Medical Education

Objectives: Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities.

Methods: In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany.

Results: The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed.

Conclusions: The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

Organic food processing: a framework for concept, starting definitions and evaluation

In 2007 EU Regulation (EC) 834/2007 introduced principles and criteria for organic food processing. These regulations have been analysed and discussed in several scientific publications and research project reports. Recently, organic food quality was described by principles, aspects and criteria. These principles from organic agriculture were verified and adapted for organic food processing. Different levels for evaluation were suggested. In another document, underlying paradigms and consumer perception of organic food were reviewed against functional food, resulting in identifying integral product identity as the underlying paradigm and a holistic quality view connected to naturalness as consumers' perception of organic food quality. In a European study, the quality concept was applied to the organic food chain, resulting in a problem, namely that clear principles and related criteria were missing to evaluate processing methods. Therefore the goal of this paper is to describe and discuss the topic of organic food processing to make it operational. A conceptual background for organic food processing is given by verifying the underlying paradigms and principles of organic farming and organic food as well as on organic processing. The proposed definition connects organic processing to related systems such as minimal, sustainable and careful, gentle processing, and describes clear principles and related criteria. Based on food examples, such as milk with different heat treatments, the concept and definitions were verified. Organic processing can be defined by clear paradigms and principles and evaluated according criteria from a multidimensional approach. Further work has to be done on developing indicators and parameters for assessment of organic food quality.

A matter of taste: evaluating the quality of qualitative research

Driven by an impetus to standardize, numerous checklists have been devised to address quality in qualitative research, but these standards and the mindset driving them offer no language with which to speak about taste, or the aesthetic sensibilities that play such a key role in evaluating the goodness of any object. In this article, quality appraisal in qualitative research is considered in the context of taste, that is, in the discernment involved in judging the value of research and in the recognition of the key role reviewer preferences, sensibilities and membership in one or more taste communities play in these judgements. The evaluation of a study is accomplished by evaluating one or more reports from that study, and such reports may be conceived as art forms amenable to the same criteria for appraisal as poems or paintings. Taste implies judgements about the quality of objects and a person's ability to sift through and select from a store of knowledge that knowledge appropriate to judge its value. What binds a community of practitioners (here reviewers of qualitative studies) together is taste-making, or the constant refinements of judgements concerning what constitutes good and bad practice.

Research across the disciplines: a road map for quality criteria in empirical ethics research

BACKGROUND

Research in the field of Empirical Ethics (EE) uses a broad variety of empirical methodologies, such as surveys, interviews and observation, developed in disciplines such as sociology, anthropology, and psychology. Whereas these empirical disciplines see themselves as purely descriptive, EE also aims at normative reflection. Currently there is literature about the quality of empirical research in ethics, but little or no reflection on specific methodological aspects that must be considered when conducting interdisciplinary empirical ethics. Furthermore, poor methodology in an EE study results in misleading ethical analyses, evaluations or recommendations. This not only deprives the study of scientific and social value, but also risks ethical misjudgement.

DISCUSSION

While empirical and normative-ethical research projects have quality criteria in their own right, we focus on the specific quality criteria for EE research. We develop a tentative list of quality criteria--a "road map"--tailored to interdisciplinary research in EE, to guide assessments of research quality. These quality criteria fall into the categories of primary research question, theoretical framework and methods, relevance, interdisciplinary research practice and research ethics and scientific ethos.

SUMMARY

EE research is an important and innovative development in bioethics. However, a lack of standards has led to concerns about and even rejection of EE by various scholars. Our suggested orientation list of criteria, presented in the form of reflective questions, cannot be considered definitive, but serves as a tool to provoke systematic reflection during the planning and composition of an EE research study. These criteria need to be tested in different EE research settings and further refined.

Integrating care for people with depression: developments in the Netherlands

Introduction

In this article we describe the history and present state of integrated care for people with depression in the Netherlands. The central question is: what are the developments in integrated care for people with depression in the Netherlands?

Methods

We describe these developments from the role of an observer, and make use of several sources: important Dutch policy documents and research documents, our own national survey carried out in 2007, a number of reports and project descriptions and searches in PubMed and Google. Also key people were contacted to supply additional information.

Results

In the Netherlands two separate phases can be distinguished within integrated care for people with depression. From the beginning of the 1990s, specialized secondary Mental Health Care (MHC) began to develop care programmes, including programmes for people with depression. The implementation of these care programmes has taken years. Mass usage of care programmes only went ahead once the large-scale mergers between ambulatory and clinical MHC organizations around 2000 had taken effect. An analysis of these programmes shows, that they did not lead to integration with primary care. This changed in the second phase from around 2000. Then attention was directed more towards strengthening the GP within the treatment of depression, collaboration between primary and specialized care and the development of collective integrated care packages.

Discussion

We relate these developments to projects in other countries and discuss the scientific basis by using evidence of international literature reviews and metastudies. Some general recommendations are given about functional costing, the physical presence of MHC specialists in the primary care sector and the use of a common national standard for both primary care and specialized MHC.