Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines

BACKGROUND

Valid instruments to measure practitioners' attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated.

OBJECTIVE

To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al.

METHODS

A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners' characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed.

RESULTS

Item response rates ranged from 82 to 100%. In the test-retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5-0.8] for usefulness, 0.5 (0.3-0.6) for reliability, 0.4 (0.2-0.5) for individual competence, 0.5 (0.3-0.6) for organizational competence, 0.7 (0.5-0.8) for impracticality and 0.4 (0.3-0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory.

CONCLUSION

This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians' compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.

[Cultural adaptation and validation of questionnaires measuring satisfaction with the French health system]

Two questionnaires measuring satisfaction of the population with regard to health care offer were constructed from measures validated in the USA (the Consumer Satisfaction Survey Questionnaire or CSS, and the Visit-Specific Satisfaction questionnaire, the VSQ). This work was comprised two stages: i) translation and cultural adaptation of the American instrument to the French health care context, implicating 6 translators, users and experts; and ii) a telephone survey in the general population (n = 706) to test the psychometric qualities of the French instrument (content and internal validity). The French version, the CSS-VF comprises 9 scales: access to primary care, access to secondary care, scope for choice, health cover, communication with and competence of GPs, communication with specialists, competence of specialists, human qualities of practitioners and overall satisfaction. The VSQ-VF, which measures satisfaction with the last medical consultation is unidimensional. The results of the psychometric analyses are good overall, and endorse the use of these scales in assessment studies.

A correlation method for weight loss after gastroplasty

BACKGROUND

Prevalence of morbid obesity is increasing in western countries. As a consequence, bariatric surgery has intensively developed in the last decades. Someone facing the need for comparison between gastric restrictive procedures could find it useful to have a general expression for weight loss after surgery.

METHODS

A first approach of this issue can be made, taking into account two simple hypotheses: linear dependencies of weight variation versus sum of energy transfer, and of loss of energy versus weight. With the additional assumption of a constant energy income (the goal of surgery), one can obtain for the weight loss DeltaP=P(0)-P=(P(0)-B)(1-e(-betat)), where P and P(0) are the weight at time t and t(0), B and beta being adjustable constants.

RESULTS

A preliminary study has shown us that most of our weight loss data could be fitted using such an expression. The model was successfully tested on gastric banding and calibrated vertical banded gastroplasty data, but with greater emphasis on laparoscopic vertical banded gastroplasty.

CONCLUSION

We introduce a simple, exponential growth-like function that can be used for the fit of weight loss data of patients who underwent bariatric surgery in our surgical unit. Such a function could also be of practical interest for the survey of weight loss.

The LM Proring Band and left approach in laparoscopic vertical banded gastroplasty: preliminary results in 44 cases

BACKGROUND

Morbid obesity is one of the most important social and medical issues in Western countries. Many authors have adopted a minimally invasive approach to reproduce current bariatric operations. The aim of this study is to present a personal technique for laparoscopic vertical banded gastroplasty (LVBG) and the preliminary results of 44 patients.

METHODS

Patients fulfilled the indications for bariatric surgery and were followed prospectively. LVBG was performed in patients who refused laparoscopic banding because of port placement and adjustment, or in patients with hiatus hernia, with or without gastroesophageal reflux disease. The technique performed consisted of a laparoscopic Mason modified-MacLean gastroplasty using only 4 ports. The circular stapler was introduced in the left anterior axillary line subcostally using the same working port as the Endo-GIA stapler. A new device, a non-adjustable silicone ring, was placed as the collar around the lower end of the gastric pouch.

RESULTS

The 44 patients underwent a satisfactory LVBG with no conversions to open surgery. Mean operative time was 80 minutes (range 45-180), hospital stay was 4 days, and all 44 operations had an uneventful postoperative course. There were 40 women and 4 men, with mean age 42.5 years (24-59). Preoperative mean weight was 118.7 kg (84.5-184), with mean BMI 44.5 (35.6-60.1). 27 of the 44 patients were selected for analysis of weight loss, selection criteria being a sufficient amount of data (> 2 weight losses separated by at least 2 months). For these 27 patients, mean age 41.9 (26-59), preoperative weight 119.3 kg (95-145) and mean BMI 44.6 (38.3-53.6), weight loss data were fitted with an exponential growth function, using a quasi-Newton fit algorithm. The fitted coefficient was used to calculate % excess weight loss and BMI. Mean weight loss at 1, 3, 6 and 12 months was 9.2 kg (4.4-17.2), 24.5 kg (11.0-35.9), 29 kg (12.6-53.6), and 36.5 kg (12.8-66.5) respectively.

CONCLUSION

LVBG has given good results thus far and may be selected as a restrictive procedure. Weight loss and resolution of comorbidities occurred, and a considerable increase in self-confidence and quality of life were reported.

[Evaluation of somatostatin or octreotide efficacy in the treatment of external pancreatic fistulas]

AIM OF THE STUDY

To evaluate the prevalence of pancreatic pseudocyst after persistent fistula closure with somatostatin or octreotide. To compare the patient characteristics according to the subsequent presence or absence of pseudocyst.

PATIENTS AND METHODS

This retrospective study from January 1994 to August 1999 included 15 patients with an external pancreatic fistula. Fistula closure was observed for all patients with somatostatin or octreotide. CT scan was performed 66 +/- 34 days after the end of this treatment.

RESULTS

CT scan was normal in 9 patients (favorable group) and showed pancreatic pseudocyst (failure group) in 6 patients. Pancreatic fistula etiologies were different between the two groups. The 5 patients presenting pancreatic fistula after duodenopancreatectomy belonged to the favorable group. Six of the 10 patients presenting pancreatic fistula after pseudocyst drainage belonged to the failure group. There were no other differences between the two groups.

CONCLUSION

Persistent pancreatic fistula can be cured with somatostatin or octreotide. However, fistulas occurring after duodenopancreatectomy are more easily cured with somatostatin or octreotide than fistulas occurring after external pseudocyst drainage. Somatostatin or octreotide cannot be considered to be an effective treatment for pancreatic fistula occurring after pseudocyst drainage, despite the fact that 40% of them were permanently cured.

The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation

This article reports on the main developmental stages and on the preliminary psychometric assessment of the final French version of the SF-36. A standard forward/backward translation procedure was followed. When translating survey items, the emphasis was placed on conceptual equivalence. When translating response choices, we attempted to select a set of response choices that replicate the U.S. version. The distance between the response choices was checked using visual analogue scales (N = 30). The adaptation procedure also included formal ratings of the difficulty of the translation, of the quality of the translation, and of the equivalence between the American source version and the French target version. The face validity was checked during lay panel sessions at which the translated questionnaire was administered to subjects from the general public, hospital employees, and subjects with a low level of education. Standard psychometric techniques were used to evaluate the cultural adaptation of the SF-36, using data from a general population survey. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert-type scaling construction) of the SF-36 were satisfied. The results support the claim that the scaling properties of the French version of the SF-36 are adequate and that health outcomes may be reliably assessed using this version of the instrument.

[Comparative study of actual costs of radiotherapy and its value]

PURPOSE

Financial costs from "Z" procedures were evaluated and compared with the amount of direct costs that are needed for the annual activity of a radiation oncology department.

MATERIALS AND METHODS

The various components, particularly staff earnings that are estimated for each procedure according to their category and working time, were cumulated for calculation of direct loads.

RESULTS

Comparisons between direct expenses and the total amount of Z procedures led to the following results: the global cost is the same; at analysis of therapeutic procedures, however, this apparent similarity masks some very significant gaps; valorization of Z procedures is much lower than that of the corresponding real loads, especially when therapeutic procedures are quite different from techniques that are considered as "standard"; these differences do not apply to all the components of radiation therapy procedures. In particular, medical steps would be uniformly underestimated, while irradiation per se is overestimated.

CONCLUSION

The authors suggest modifications of the general objectives and items of the nomenclature of radiotherapy and brachytherapy procedures.

An international questionnaire to explore neurotoxic symptoms

EURONEST (European Neurotoxic Solvents Toxicity) is a concerted action within the European Communities to use standardized methods available in all countries. The product of this effort is a new symptom questionnaire, EUROQUEST (European Questionnaire). The original version was developed in English. To obtain transcultural reliability, the translation of questionnaires into other languages must be validated. We adopted a procedure with translation, back translation, and agreement between translators. Ten other European countries also followed the same translation procedure for EUROQUEST.

Comparative study of sucralfate versus cimetidine in the treatment of acute gastroduodenal ulcer. Randomized trial with 667 patients

Six-hundred sixty-seven patients with endoscopically proven peptic ulcer were included in a randomized, multicenter trial to assess the comparative efficacy of sucralfate and cimetidine. One hundred eighty-seven patients with gastric ulcer and 480 patients with duodenal ulcer completed the study. Ulcer healing was evaluated endoscopically at six weeks for duodenal ulcer and at eight weeks for gastric ulcer. Patients with unhealed ulcer at this time were assigned to the other therapy for a second period of six or eight weeks of treatment (crossover). In patients with duodenal gastric ulcer, pain relief and healing were not significantly different in the two groups. Eighty-eight percent of duodenal ulcers and 73 percent of gastric ulcers healed with six weeks of sucralfate treatment. Reported side effects and symptoms, pooled together for duodenal and gastric ulcer, were more significant in the sucralfate group (7.5 percent) than in the cimetidine group (3.7 percent). Constipation was the most frequent symptom recorded. In conclusion, sucralfate and cimetidine are both excellent healing agents for short-term treatment of duodenal and gastric ulcer. Both give rapid relief of symptoms without severe side effects.

[Presence of papilloma group viral antigen in an esophageal condyloma in man]

A case of esophageal Papilloma is reported. The viral condyloma was diagnosed by standard histological methods and confirmed by immuno-fluorescence and immuno-peroxidase technics against genus specific Papilloma virus antigens (i. e. capsid specific proteic antigen). These antigens were localized in the nuclei of koilocytic cells. These results confirm the association between proliferative lesions appearing on the mucosal epithelium and Papilloma viruses, which are suspected to be oncogenic in other malpighian tissues.