Best practices in reporting analyses of questionnaires as objective rating scales of variable measures

BACKGROUND

The best practice model states that the highest quality of scientific information in a discipline should be used when addressing pertinent problems. The usefulness of any measure depends on the least allowable error, which implies that best practice approaches must be used during analyses of rating scales. However, modern theories of objective measurement in advanced statistics suggest there are some shortcomings in reports of questionnaire analyses.

AIM

To highlight some common problems in questionnaire data and suggest techniques of constructing objective measures during rating scale analysis.

DISCUSSION

Questionnaires are frequently used as rating scales of latent variables, such as knowledge, anxiety and outcomes of treatments. However, reports of the steps involved before generating the final 'measures' often fail to present known limitations and robust solutions to the problems common to questionnaire data. Most designers of questionnaires generate variable measures for either educational or clinical research purposes without providing adequate explanations of the steps taken to address inherent limitations that may worsen the error terms in the outcome measure.

CONCLUSION

Cursory attention is given to the problems in questionnaire analysis as most users do not convincingly justify the measurement techniques they used before they present variable estimation. Reporting the techniques used to address data complexity by engaging objective measurement parameters ensures best practice and emphasises the credibility of the outcome measure.

IMPLICATIONS FOR PRACTICE

Among researchers, using the techniques outlined here will lead to standardisation of questionnaire analysis and elimination of avoidable errors in constructing variable measures, resulting in high-quality data suitable for parametric statistics. For clinicians, these methods will simplify the interpretation of numerical measures to equivalent indicators on Wright maps, thus avoiding inconsistencies and misinterpretations of variable measure.

Developing the Metacognitive Awareness of Grit Scale for a better understanding of learners of English as a foreign language

The prominent impact of metacognition on learners' academic achievement is widely discussed. Learners armed with appropriate metacognitive strategies should witness enhancement in learning performance. Similarly, the concept of grit is also valued as a crucial factor contributing to the improvement of academic achievement. Nevertheless, discussion of the relationship between metacognition and grit or their collective influence on other educational and psychological variables is limited, not to mention that an instrument measuring learners' metacognitive awareness of grit is a desideratum. Hence, by incorporating the constructs of metacognition and grit, the present research developed a measurement scale to address this need, named the Metacognitive Awareness of Grit Scale (MCAGS). The MCAGS consists of four components and initially included 48 items. It was later distributed to 859 participants for the purpose of scale validation. Confirmatory factor analysis was applied to evaluate the scale's validity and explore the factor-item relationship. A final model containing 17 items was retained. Implications and future directions were discussed.

Is this a good questionnaire? Dimensionality and category functioning of questionnaires used in nursing research

BACKGROUND

Questionnaires are perhaps the most widely used measuring tools in nursing research, as many studies conducted by nurses focus on understanding the underlying complex factors that are amenable to questionnaires. However, most questionnaires used in nursing research continue to display inadequate evidence of validity under the traditional methods while ignoring the modern Rasch techniques with better proofs of objective measurement.

AIM

To draw researchers' attention to the recurrent limitations of the classical approach to questionnaire design and to suggest advanced psychometric analysis exemplified in Rasch methodology as a more appropriate alternative.

DISCUSSION

For questionnaire data to be suitable for statistical analysis, transparent demonstration of mathematical assumptions embodied in the questionnaire is compulsory. The failure to engage contemporary measurement models in designing good questionnaires raises concerns about researchers' awareness of the application and usefulness of the evidence generated by the modern approach. This paper illustrates with examples the problems inherent in the traditional or classical test theory and advanced dimensionality and category functioning as requisite psychometric properties of a questionnaire. It also outlines several diagnostic parameters that proponents of Rasch techniques recommend for testing.

CONCLUSION

Traditional methods of assessing and analysing a questionnaire's psychometric properties are no longer tenable because the modern Rasch approach offers exemplary proofs of questionnaire validity rooted in objective measurement theories.

IMPLICATIONS FOR PRACTICE

Nurse researchers using questionnaires for clinical decisions and education purposes should apply the fundamental principles of objective measurements demonstrated in Rasch theory.

Handling missing data through prevention strategies in self-administered questionnaires: a discussion paper

BACKGROUND

Self-administered questionnaires are efficient and low-cost ways of collecting data with wide cohorts. Nonetheless, their use in studies can result in a high occurrence of missing data, which can affect the statistical power, representativeness and generalisability of the findings. Imputation methods have been considered efficient statistical techniques for managing missing data. However, they have also been associated with limits, such as the risk of under-estimation of the effect, lower statistical power and decrease of correlation among variables. Recent studies have highlighted the importance of using prevention strategies to avoid missing data before the data are analysed.

AIM

To identify strategies for preventing the occurrence of missing data and to discuss their effects, as well as their methodological and statistical considerations.

DISCUSSION

The article discusses prevention strategies related to the administration format and follow-up and reminders. Strategies such as the use of electronic tablets, email and telephone reminders are associated with lower rates of missing data in self-administered questionnaires. However, methodological and statistical limits, including the absence of a comparison group and statistical validation of the reported results, limits the capacity to establish robust consensus.

CONCLUSION

Prevention strategies represent relevant and feasible avenues for handling missing data in a wide range of clinical, nursing and epidemiological research. More projects based on robust design are needed to ensure accurate and reliable data are collected from patients, families, communities and clinicians.

IMPLICATIONS FOR PRACTICE

It is important for clinicians and nurses to understand the phenomenon of missing data and the strategies available to prevent missing data, to collect data representing the patients' and families' perspectives and experiences.

Developing a self-administered questionnaire: methods and considerations

BACKGROUND

Using a structured process to develop a self-administered questionnaire provides a robust tool for collecting data that enhances the credibility of the results. Describing this process mitigates any complexity and confusion for the nurse researcher which can be generated by many sources of information that either lack detail or have complex statistical approaches.

AIM

To discuss the development of a self-administered questionnaire with a focus on face, content, construct validity and reliability testing.

DISCUSSION

Adopting a well-established, sequential, five-step approach ensures that important concepts of questionnaire development are addressed: assessing existing tools and qualitative data, if available; drafting of the questionnaire with consideration for question styles, comprehension, acquiescent bias and face validity; expert panel review to establish content validity and inter-rater reliability; pilot testing to assess construct validity; and exploratory factor analysis to establish reliability testing. This approach results in a robust and credible tool for collecting data.

CONCLUSION

This article provides nurse researchers with a structured process for developing self-administered questionnaires.

IMPLICATIONS FOR PRACTICE

Investing time and effort to assess a newly developed questionnaire for validity and reliability and consider question styles, comprehension and acquiescent bias results in an improved and strengthened tool for collecting data. This in turn enhances the quality and credibility of a study's findings.

Steering light in fiber-optic medical devices: a patent review

INTRODUCTION

Steering light is relevant to many medical applications that require tissue illumination, sensing, or modification. To control the propagation direction of light beams, a great variety of innovative fiber-optic medical devices have been designed.

AREAS COVERED

This review provides a comprehensive overview of the patent literature on light beam control in fiber-optic medical devices. The Web of Science Derwent Innovation Index database was scanned, and 81 patents on fiber-optic devices published in the last 20 years (2001-2021) were retrieved and categorized based on the working principle to steer light (refraction/reflection, scattering, diffraction) and the design strategy that was employed (within fiber, at fiber end, outside fiber).

EXPERT OPINION

Patents describing medical devices were found for all categories, except for generating diffraction at the fiber end surface. The insight in the different designs reveals that there are still several opportunities to design innovative devices that can collect light at an angle off-axis, reduce the angular distribution of light, or split light into multiple beams.

Focal therapy for localized cancer: a patent review

INTRODUCTION

Conventional cancer treatments such as radical surgery and systemic therapy targeting the organ or organ system might have side effects because of damage to the surrounding tissue. For this reason, there is a need for new instruments that focally treat cancer.

AREAS COVERED

This review provides a comprehensive overview of the patent literature on minimally and noninvasive focal therapy instruments to treat localized cancer. The medical section of the Google Patents database was scanned, and 128 patents on focal therapy instruments published in the last two decades (2000-2021) were retrieved and classified. The classification is based on the treatment target (cancer cell or network of cancer cells), treatment purpose (destroy the cancerous structure or disable its function), and treatment means (energy, matter, or a combination of both).

EXPERT OPINION

We found patents describing instruments for all groups, except for the instruments that destroy a cancer cell network structure by applying matter (e.g. particles) to the network. The description of the different treatment types may serve as a source of inspiration for new focal therapy instruments to treat localized cancer.

Evidence and practice: a review of vignettes in qualitative research

BACKGROUND

Developing and working through a PhD research study requires tenacity, continuous development and application of knowledge. It is paramount when researching sensitive topics to consider carefully the construction of tools for collecting data, to ensure the study is ethically robust and explicitly addresses the research question.

AIM

To explore how novice researchers can develop insight into aspects of the research process by developing vignettes as a research tool.

DISCUSSION

This article focuses on the use of vignettes to collect data as part of a qualitative PhD study investigating making decisions in the best interests of and on behalf of people with advanced dementia. Developing vignettes is a purposeful, conscious process. It is equally important to ensure that vignettes are derived from literature, have an evidence base, are carefully constructed and peer-reviewed, and are suitable to achieve the research's aims.

CONCLUSION

Using and analysing a vignette enables novice researchers to make sense of aspects of the qualitative research process and engage with it to appreciate terminology.

IMPLICATIONS FOR PRACTICE

Vignettes can provide an effective platform for discussion when researching topics where participants may be reluctant to share sensitive real-life experiences.

Evidencing diversity: development of a structured tool for investigating teaching of pressure injury on people with darker skin tones

BACKGROUND

Dismantling structural racism challenges nurses to consider the extent to which issues of inclusion, diversity and race are operationalised in day-to-day professional practice. This includes nurse education. To be truly effective, any examination of teaching content in nurse education needs to be investigated through document analysis plus observation in the classroom. However, tools to ensure consistency between these methods of collecting data are limited.

AIM

To design a structured tool for collecting data by analysing teaching materials and observing teaching on pressure injuries and people with darker skin tones.

DISCUSSION

This novel approach of using a single tool provides a unique opportunity to explore teaching materials and what is actually taught in the classroom. The data collected can assist with comparative analysis, enabling an in-depth view of curriculum content.

CONCLUSION

The nuanced and subtle data gathered using the complementarity of analysis between teaching materials and teaching observations in the exemplar tool presented created a unique data set for examination.

IMPLICATIONS FOR PRACTICE

This tool has broad applications for nurse researchers, particularly for examining topics that are often perceived to be sensitive, such as race and skin tone. It can be used for in-depth scrutiny of classroom teaching, to develop and influence curriculum content and team discussions, and in larger studies exploring nurse education content.

Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study

Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.

Patient Preferences to Assess Value IN Gene Therapies: Protocol Development for the PAVING Study in Hemophilia

Introduction: Gene therapies are innovative therapies that are increasingly being developed. However, health technology assessment (HTA) and payer decision making on these therapies is impeded by uncertainties, especially regarding long-term outcomes. Through measuring patient preferences regarding gene therapies, the importance of unique elements that go beyond health gain can be quantified and inform value assessments. We designed a study, namely the Patient preferences to Assess Value IN Gene therapies (PAVING) study, that can inform HTA and payers by investigating trade-offs that adult Belgian hemophilia A and B patients are willing to make when asked to choose between a standard of care and gene therapy.

Methods and Analysis: An eight-step approach was taken to establish the protocol for this study: (1) stated preference method selection, (2) initial attributes identification, (3) stakeholder (HTA and payer) needs identification, (4) patient relevant attributes and information needs identification, (5) level identification and choice task construction, (6) educational tool design, (7) survey integration, and (8) piloting and pretesting. In the end, a threshold technique survey was designed using the attributes “Annual bleeding rate,” “Chance to stop prophylaxis,” “Time that side effects have been studied,” and “Quality of Life.”

Ethics and Dissemination: The Medical Ethics Committee of UZ KU Leuven/Research approved the study. Results from the study will be presented to stakeholders and patients at conferences and in peer-reviewed journals. We hope that results from the PAVING study can inform decision makers on the acceptability of uncertainties and the value of gene therapies to patients.

A practical guide to the systematic application of nominal group technique

BACKGROUND

Nominal group technique (NGT) is a highly structured, commonly used way of exploring areas of interest and developing consensus. However, it is sometimes conflated with focus group methods.

AIM

To provide a rationale for selecting NGT as a research method and to examine its systematic application in a doctoral Q-methodology study exploring nursing students' perspectives of preserving dignity in care.

DISCUSSION

An outline of NGT is provided, and it is distinguished from focus group methods. As well as providing a step-by-step guide to using NGT, each step is illustrated with its practical application in the study, and the lessons learned concerning the limitations and strengths of NGT in the context of one study are shared.

CONCLUSION

When applied systematically, NGT enables nurse researchers to collaborate in a meaningful and engaging way with participants and generate tangible outcomes relatively quickly.

IMPLICATIONS FOR PRACTICE

This paper offers practical insight into the use of NGT to explore perceptions and develop consensus.

Using legitimation criteria to establish rigour in sequential mixed-methods research

BACKGROUND

Despite the extensive use of mixed methods across health sciences, there has been a limited discussion about the methodological rigour and quality in mixed methods research (MMR). Although the empirical and methodological literature about mixed methods is increasing, there are few practical examples of the implementation of rigour criteria.

AIM

To discuss and illustrate the application of 'legitimation criteria' to the design and conduct of a sequential exploratory MMR study of nurse educators' challenges when teaching undergraduate students.

DISCUSSION

The legitimation criteria can establish philosophical and methodological validity and rigour in MMR. MMR is complex and daunting, so maintaining rigour is crucial in ensuring the conclusions drawn are plausible and researchers, practitioners and policymakers use them to guide research and practice.

CONCLUSION

The legitimation criteria are specific to MMR and are useful in improving the conduct and execution of studies. They enable researchers to maintain quality throughout their studies, from the development of a research question to the generation of conclusions.

IMPLICATIONS FOR PRACTICE

This illustration of the legitimation criteria for the design and conduct of MMR will guide researchers in establishing rigour and lessen the threats to their studies' validity.

Validity and reliability of the psychometric properties of a child abuse questionnaire

BACKGROUND

Few valid and reliable measures of professional self-efficacy and its influence on reporting child abuse and neglect (CAN) are available.

AIM

To test the psychometric properties of the Child Abuse and Neglect Reporting Self-Efficacy (CANRSE) (English) questionnaire.

DISCUSSION

The Psychometric Grading Framework graded the strength of the psychometric properties of CANRSE (English) as 'good'. CANRSE can be measured using this tool, having been tested with a cohort of Australian health professionals. CANRSE can be used in Australian healthcare settings and will benefit health disciplines by examining the influence of self-efficacy on CAN reporting in clinical practice and research.

CONCLUSION

The psychometric properties of CANRSE (English) provide evidence to support the assertion that it is a reliable instrument to measure self-efficacy in reporting CAN cases.

IMPLICATIONS FOR PRACTICE

The validity and reliability of CANRSE (English) have been established. Future research should focus on larger studies testing a shorter version of the tool.

Developing front-end devices for improved sample preparation in MS-based proteome analysis

Chemical analysis has long relied on instrumentation, from the simplest (eg, burets) to the more sophisticated (eg, mass spectrometers) to facilitate precision measurements. Regardless of their complexity, the development of a new instrumental device can be a valued approach to address problems in science. In this perspective, we outline the process of novel device design, from early phase conception to the manufacturing and testing of the tool or gadget. Focus is placed on the development of improved front-end devices to facilitate protein sample manipulations ahead of mass spectrometry, which therefore augment the proteomics workflow. Highlighted are some of the many training secrets, choices, and challenges that are inherent to the often iterative process of device design. In hopes of inspiring others to pursue instrument design to address relevant research questions, we present a summary list of points to consider prior to innovating their own devices.

Conducting nursing research in low- and middle-income countries: experiences, challenges and solutions

BACKGROUND

Conducting nursing research in low- and middle-income countries (LMICs) balances challenges and opportunities. Understanding the shared experiences of researchers who have completed studies in diverse cultural contexts using various methodologies is important, to advance global nursing research and to build health research capacity and sustainability strategies.

AIM

To provide a reflexive account using a case-study methodology of transactions and processes conducted during a study in a LMIC.

DISCUSSION

Lessons learned from the study include the importance of preplanning, being flexible and creative, engaging local collaborators early in planning, establishing good rapport and respectful relationships with gatekeepers and collaborators, having a backup plan, appreciating cultural differences, and sharing findings.

CONCLUSION

Conducting research in LMICs is complex, especially negotiating access and obtaining ethical approval. Understanding the issues will benefit future research and prepare nurse researchers who take on the challenges and rewards of conducting international research in LMICs.

IMPLICATIONS FOR PRACTICE

This paper provides a roadmap to help novice researchers conduct research in LMICs.

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument

OBJECTIVES

To describe the development process of an instrument to assess the ability to manage daily oral hygiene and the cause of impaired oral hygiene. The instrument is initially aimed for use by the dental team in the ageing population.

BACKGROUND

Oral hygiene is an important component of oral health. Inability to manage oral hygiene combined with other risk factors often results in poor oral health and impaired quality of life.

METHODS

A guideline for instrument development was used during the construction of the instrument. The method included three phases: I. planning: the purpose and target group of the instrument were determined, and a literature review and qualitative focus-group study were conducted; II. construction: objectives were formulated, and a pool of items was built; and III. evaluation and validation, which included two pilot studies, interviews, item analyses and revision of the instrument.

RESULTS

The planning and construction phases resulted in an instrument with 47 items comprising three parts: (a) interview, (b) clinical examination and (c) observation of activities of daily living (oral hygiene). After two pilot studies, the instrument was found to have good content validity. Analyses of qualitative and quantitative data resulted in a reduction in the number of items to 33.

CONCLUSION

OHAI can be a valuable tool as a preventive method to identify older adults at risk of impaired oral health. However, the instrument needs further evaluation before wider use.

Designing and Facilitating Collaborative Research Design and Data Analysis Workshops: Lessons Learned in the Healthy Neighborhoods Study

One impediment to expanding the prevalence and quality of community-engaged research is a shortage of instructive resources for collaboratively designing research instruments and analyzing data with community members. This article describes how a consortium of community residents, grassroots community organizations, and academic and public institutions implemented collaborative research design and data analysis processes as part of a participatory action research (PAR) study investigating the relationship between neighborhoods and health in the greater Boston area. We report how nine different groups of community residents were engaged in developing a multi-dimensional survey instrument, generating and testing hypotheses, and interpreting descriptive statistics and preliminary findings. We conclude by reflecting on the importance of balancing planned strategies for building and sustaining resident engagement with improvisational facilitation that is responsive to residents’ characteristics, interests and needs in the design and execution of collaborative research design and data analysis processes.

The challenges of researching drug-related emergency department presentations using reviews of medical charts

BACKGROUND

Health research through review of medical charts is a useful way to understand presentations related to the effects and burden of illness, disease and substance misuse. However, the design and methods used in studies can affect their validity and reliability. It is therefore vital to ensure a strong study design and to use appropriate methodologies.

AIM

To highlight some of the challenges nurse researchers face when designing and conducting research using reviews of medical charts.

DISCUSSION

This paper provides an approach for conducting research using retrospective reviews of charts and potential solutions to inherent challenges involved in such reviews. Using a systematic and scientific approach can maximise the benefits, minimise the limitations, and improve the rigour and impact of nursing research.

CONCLUSION

This paper advances methodological discourse about the challenges inherent when using medical charts for data collection. Despite the inherent challenges, medical charts are an important source of information about injury, disease and substance misuse.

IMPLICATIONS FOR PRACTICE

Nursing staff may face challenges when conducting research using patient medical charts. The quality of data abstracted from medical charts is affected by the data abstraction process used as well as the quality and accuracy of clinical documentation.

Instrumentation for Vibrational Circular Dichroism Spectroscopy: Method Comparison and Newer Developments

Vibrational circular dichroism (VCD) is a widely used standard method for determination of absolute stereochemistry, and somewhat less so for biomolecule characterization and following dynamic processes. Over the last few decades, different VCD instrument designs have developed for various purposes, and reliable commercial instrumentation is now available. This review will briefly survey historical and currently used instrument designs and describe some aspects of more recently reported developments. An important factor in applying VCD to conformational studies is theoretical modeling of spectra for various structures, techniques for which are briefly surveyed.

The development and testing of the Person-centred Practice Inventory - Staff (PCPI-S)

Objective

The aim of the study was to develop and test an instrument, underpinned by a recognized theoretical framework, that examines how staff perceive person-centred practice, using proven methods of instrument design and psychometric analysis.

Design

The study used a mixed method multiphase research design involving: two Delphi studies to agree definitions and items to measure the constructs aligned to the person-centred practice theoretical framework (Phase 1); and a large-scale quantitative cross-sectional survey (Phase 2).

Setting

Phase 1 was an international study involving representatives from seven countries across Europe and Australia, with Phase 2 conducted in one country across five organizations.

Participants

Two international panels of experts (n = 33) in person-centred practice took part in the Delphi study and a randomly selected sample of registered nurses (n = 703, 23.8%) drawn from across a wide range of clinical settings completed the Person-centred Practice Inventory - Staff (PCPI-S).

Main Outcome Measures

The main outcome is to establish a measure of staff perceptions of person-centred Practice.

Results

Broad consensus on definitions relating to 17 constructs drawn from a person-centred practice framework was achieved after two rounds; likewise with the generation of 108 items to measure the constructs; a final instrument comprising 59 items with proven psychometric properties was achieved.

Conclusions

The PCPI-S is psychometrically acceptable instrument validated by an international expert panel that maps specifically to a theoretical framework for person-centred practice and provides a generic measure of person-centredness.

Mini review: Instrumentation for vibrational circular dichroism spectroscopy, still a role for dispersive instruments

Vibrational circular dichroism (VCD) has become a standard method for determination of absolute stereochemistry, particularly now that reliable commercial instrumentation has become available. These instruments use a now well-documented Fourier transform infrared-based approach to measure VCD that has virtually displaced initial dispersive infrared-based designs. Nonetheless, many papers have appeared reporting dispersive VCD data, especially for biopolymers. Instrumentation designed with these original methods, particularly after more recent updates optimizing performance in selected spectral regions, has been shown still to have advantages for specific applications. This article presents a mini-review of dispersive VCD instrument designs and includes sample spectra obtained for various biopolymer (particularly peptide) samples. Complementary reviews of Fourier transform-VCD designs are broadly available.

It is time for a better clip applier - 3 mm, percutaneous, non-crushing and locking

INTRODUCTION

Since the advent of laparoscopy there have been attempts to minimize abdominal wall incisions. For this purpose smaller instruments have been produced. Our aim was to develop the first 3 mm percutaneous clip applier and to make it better than the standard clips of today.

MATERIAL AND METHODS

The ClipTip clip is made of Nitinol and has a crocodile shaped jaws, which when apposed effectively seal vessels. The shaft operates as a retractable needle permitting percutaneous insertion. Closing, reopening and reclosing is possible. The physical properties of the device were compared to three commercially available clip appliers. Surgeries were performed on porcine animals by experienced surgeons.

RESULTS

In comparison to available clips, the superiority of the ClipTip is a combination of wide effective length alongside the ability to withstand strong forces. In live animal studies the Cliptip was inserted into the peritoneal cavity without any injuries. Vessels were ligated successfully and no clip dislodgement or leakage occurred.

CONCLUSIONS

We developed the next generation clip applier with better properties. Advantages include its length, the needleoscopic caliber, non-crushing effect, locking mechanism and wide aperture. The device has performed safely and effectively in pre-clinical tests. Further studies are planned in humans.

Effects of Instrument Handle Design on Dental Hygienists' Forearm Muscle Activity During Scaling

Purpose: The purpose of this study was to determine the effects of 4 different commercially available instrument handle designs (A. 16 grams and 12.7 mm diameter, B. 23 grams and 11.1 mm diameter, C. 21 grams and 7.9 mm diameter and D. 18 grams and 6.35 mm diameter) on the muscle activity of four forearm muscles during a simulated scaling experience.Methods: A convenience sample of 27 (n=27) dental hygienists used a Columbia 13/14 curet with four different instrument handles to scale artificial calculus from typodont teeth. Each participant's muscle activity was measured using surface electromyography (sEMG).Results: Similar muscle activity was generated when scaling with instruments at 16, 18, and 21 grams with varying diameter handles. Instrument B generated significantly more muscle activity when compared to each of the other instrument handle designs (p=0.001, p=0.002, p=0.039). The lower left quadrant displayed significantly less muscle activity during scaling than the upper and lower right quadrants (p=0.026, p=0.000), although no significant interaction effect was found with instruments within quadrants. Most participants (62.96%) preferred instrument A, which was rated more comfortable based on weight when compared to the other instruments tested.Conclusions: Instrument handle design has an effect on forearm muscle activity when scaling in a simulated environment. The heaviest instrument with a relatively large diameter (B 11.1 mm and 23 g) generated significantly more overall mean muscle activity compared to the other three instruments. Similar amounts of muscle activity were produced by instruments weighing between 16 and 21 g. Participants' instrument preferences were more affected by handle diameter than weight. Results support the need for further research to determine the impact of these findings on muscle load related to risk of musculoskeletal disorders in a real-world setting.

The Effect of Stainless Steel and Silicone Instruments on Hand Comfort and Strength: A pilot study

Purpose: Many dental hygienists experience musculoskeletal pain during the course of their careers, often as a result of the sustained grips on instruments and repetitive movements employed during clinical practice. Current research suggests that lighter instruments with a larger diameter reduce force and load on the hand during scaling procedures; therefore, the texture and weight of silicone handles is designed to decrease the strain placed on the hand and fingers. The purpose of this research is to investigate and compare the effect of silicone instrument handles and traditional stainless steel instrument handles on hand comfort and strength.Methods: This pilot study used a comparative cross-sectional study design. A convenience sample of dental hygiene students (n= 23) participated in two simulated scaling sessions for 30 minutes, one week apart. During the first session, students were required to use traditional stainless steel instruments (10mm diameter and 21-26g weight), while during the second session students used instruments with silicone handles. Students were required to complete a Hand Health Profile and perform hand strength tests following each session. Paired t-tests were used to determine significant differences between the grip strength, pinch strength and hand health profiles scores after using stainless steel and silicone instrument handles.Results: The data analyses revealed a statistically significant improvement in grip strength (p<0.02), key pinch strength (p<0.05) and overall hand comfort (p<0.001).Conclusions: This study suggests that the use of silicone instrument handles may improve hand comfort and reduce hand fatigue. These findings should prompt further investigation on ergonomic instrument design.

Stacked, Mutually Rotated Diffraction Gratings as Enablers of Portable Visible Spectrometry

Two-dimensional color CMOS cameras have become ubiquitous. They promise to support ubiquitous spectrometry. When raw illumination levels can be measured by such cameras, their use for spectrometry depends on using as many pixels as possible and on being able to calibrate images at point-of-use. Stacked, mutually rotated transmission diffraction gratings provide a means to generate multi-order, wide dynamic range dispersed visible spectra suitable for absorption, reflection, and fluorescence spectrometry. The theoretical basis for dispersion, resolution, and normalization of such spectra are derived, and initial characterization is reported.

Helping Respondents Provide Good Answers in Web Surveys

This paper reports on a series of experiments to explore ways to use the technology of Web surveys to help respondents provide well-formed answers to questions that may be difficult to answer. Specifically, we focus on the use of drop-down or select lists and JavaScript lookup tables as alternatives to open text fields for the collection of information on prescription drugs. The first two experiments were conducted among members of opt-in panels in the U.S. The third experiment was conducted in the 2013 Health and Retirement Study Internet Survey. Respondents in each of the studies were randomly assigned to one of three input methods: text field, drop box, or JavaScript lookup, and asked to provide the names of prescription drugs they were taking. We compare both the quality of answers obtained using the three methods, and the effort (time) taken to provide such answers. We examine differences in performance on the three input format types by key respondent demographics and Internet experience. We discuss some of the technical challenges of implementing complex question types and offer some recommendations for the use of such tools in Web surveys.

Next-generation robotic surgery--from the aspect of surgical robots developed by industry

At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.

Review of the endovascular approach to mitral valve disease

The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be briefly described.

Measuring preparedness for mammography in women with intellectual disabilities: a validation study of the Mammography Preparedness Measure

BACKGROUND

Women with intellectual disabilities have similar breast cancer rates as the general population, but lower rates of regular mammography and higher breast cancer mortality rates. Although prior qualitative work demonstrates that women with intellectual disabilities face unique, disability-specific barriers to mammography, the present authors lack standardized, validated instruments for measuring knowledge of breast cancer screening in this population. In addition, much research related to adults with intellectual disabilities focuses on family or carer perspectives, rather than involving women with intellectual disabilities, themselves.

METHODS

The present authors first pilot tested a general population instrument measuring breast cancer knowledge, and found that it did not perform adequately in women with intellectual disabilities. In response, the present authors developed the Mammography Preparedness Measure (MPM), a direct short interview tool to measure knowledge and preparedness in women with intellectual disabilities, themselves, rather than relying on caregiver or other reports, and using inclusive methodology. The present authors validated the MPM by assessing test-retest reliability.

RESULTS

Average test-retest per cent agreement of 84%, ranging from 74 to 91% agreement per item, with an overall kappa of 0.59.

CONCLUSION

The MPM appears to be a valid instrument appropriate for measuring mammography preparedness in women with intellectual disabilities. The success of this innovative tool suggests that direct, rather than informant-directed tools can be developed to measure health knowledge and cancer screening readiness in adults with intellectual disabilities, an important measure in studying and reducing disparities.

Application of 3-dimensional printing in hand surgery for production of a novel bone reduction clamp

Three-dimensional printing is being rapidly incorporated in the medical field to produce external prosthetics for improved cosmesis and fabricated molds to aid in presurgical planning. Biomedically engineered products from 3-dimensional printers are also utilized as implantable devices for knee arthroplasty, airway orthoses, and other surgical procedures. Although at first expensive and conceptually difficult to construct, 3-dimensional printing is now becoming more affordable and widely accessible. In hand surgery, like many other specialties, new or customized instruments would be desirable; however, the overall production cost restricts their development. We are presenting our step-by-step experience in creating a bone reduction clamp for finger fractures using 3-dimensional printing technology. Using free, downloadable software, a 3-dimensional model of a bone reduction clamp for hand fractures was created based on the senior author's (M.V.M.) specific design, previous experience, and preferences for fracture fixation. Once deemed satisfactory, the computer files were sent to a 3-dimensional printing company for the production of the prototypes. Multiple plastic prototypes were made and adjusted, affording a fast, low-cost working model of the proposed clamp. Once a workable design was obtained, a printing company produced the surgical clamp prototype directly from the 3-dimensional model represented in the computer files. This prototype was used in the operating room, meeting the expectations of the surgeon. Three-dimensional printing is affordable and offers the benefits of reducing production time and nurturing innovations in hand surgery. This article presents a step-by-step description of our design process using online software programs and 3-dimensional printing services. As medical technology advances, it is important that hand surgeons remain aware of available resources, are knowledgeable about how the process works, and are able to take advantage of opportunities in order to advance the field.

Disruptive by design: a perspective on engineering in analytical chemistry

Perhaps paradoxically, we argue that the biological sciences are "data-limited". In contrast to the glut of DNA sequencing data available, high-throughput protein analysis is expensive and largely inaccessible. Hence, we posit that access to robust protein-level data is inadequate. Here, we use the framework of the formal engineering design process to both identify and understand the problems facing measurement science in the 21st century. In particular, discussion centers on the notable challenge of realizing protein analyses that are as effective (and transformative) as genomics tools. This Perspective looks through the lens of a case study on protein biomarker validation and verification, to highlight the importance of iterative design in realizing significant advances over currently available measurement capabilities in the candidate or targeted proteomics space. The Perspective follows a podium presentation given by the author at The 16th International Conference on Miniaturized Systems for Chemistry and Life Sciences (μTAS 2012), specifically focusing on novel targeted proteomic measurement tools based in microfluidic design. The role of unmet needs identification, iteration in concept generation and development, and the existing gap in rapid prototyping tools for separations are all discussed.