Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F)

OBJECTIVE

To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F).

METHOD

The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases).

RESULTS

No major cultural adaptations were needed. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (intraclass correlation coefficient=0.92) were good. CFA (CFI=0.92, TLI=0.90, RMSEA=0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning.

CONCLUSION

The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.

The impact of converting to an electronic health record on organizational culture and quality improvement

Implementing an information technology system can impact more than just quality of care and patient outcomes. The purpose of this 4-year, observational research project is to examine changes in organizational culture, quality improvement (QI) maturity, and quality of care following adoption of a single, electronic health record (EHR) system within an integrated healthcare network. The primary outcome measure, the Culture and Quality Questionnaire (CQQ), assesses the perceived culture of an organization and the degree of CQI maturity in seven quality management areas. Baseline surveys were distributed prior to conversion to the EHR. Subsequent data collection occurred at 12 months post "go live" and will occur at 24 and 36 months after the first hospital "go live". Secondary data were abstracted from routinely collected patient satisfaction measures and standard quality indicators. Contrary to expectation, our findings from the Baseline and 12-month follow-up data suggest that employees perceived the organizational culture as becoming more, rather than less, hierarchical. We also hypothesized that quality indicators would show improvement due to enhanced information flow and ease of information retrieval. This hypothesis was not supported by 1-year results. However, follow-up data from years two and three may provide different results.

A comprehensive method for the translation and cross-cultural validation of health status questionnaires

The FACIT (Functional Assessment of Chronic Illness Therapy) translation methodology has been in use for nearly 10 years and, during the course of that time, has emphasized a universal translation approach that includes multicountry review, the use of qualitative and quantitative methods in testing, and the exploration of new methods such as differential item functioning (DIF) analysis using item response theory to evaluate item equivalence. The FACIT translation methodology aims to establish equivalence of meaning and measurement between different country versions through the use of the decentered model of translation and advanced statistical methods.

Tamoxifen in breast cancer: symptom reporting

Clinical studies have traditionally identified treatment-specific side effects by comparison of voiced side effects in treatment and placebo arms of a study. Highly motivated women in a clinical trial may underreport drug-induced symptoms for medications which may be considered lifesaving. Affective symptoms during treatment of early breast cancer with tamoxifen (an estradiol receptor antagonist) were reported as infrequent by the manufacturer. However, reports suggest a higher rate of depression during general use. The objective of the present study was to examine the frequency of symptoms that might be side effects of tamoxifen and to relate them to the way the women attributed such symptoms. The exploratory study involved semistructured telephone interviews of 25 women who were taking tamoxifen. Textual analysis of the information was used to examine the symptoms described by the women. They were also asked whether any symptoms were related to the medication. The symptoms and their attribution were evaluated against a background of self-perceived stress. The principal finding was a pattern of ambivalence in attributing symptoms to the drug. Of all the symptomatic changes noted, the women only attributed 51% to tamoxifen. Flushes, fatigue, and depression were reported most frequently during treatment; flushes were readily attributed to tamoxifen but depression and fatigue were attributed to another factor by half of the symptomatic women. Women who reported moderate to high levels of life stress were less likely to attribute symptoms to drug therapy. The results suggest that women taking tamoxifen may not attribute known drug side effects to use of the medication.

Evaluation of myocardial protection by combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia in aorto-coronary bypass grafting

The concept of pretreatment of the myocardium with a pharmacological agent protecting the cell against ischemic and reperfusion injury is very attractive. Lidoflazine, a calcium overload blocker, predominantly membrane stabilizing, is able to prevent cell damage during ischemic arrest and reperfusion. The purpose of this study was to determine whether the combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia can provide, in clinical practice, better myocardial protection in aorto-coronary bypass grafting than St. Thomas' Hospital cardioplegia alone. As indices for myocardial protection, recovery of cardiac function, enzyme release, and clinical outcome were registered. Ninety-three patients undergoing aorto-coronary bypass surgery were studied. These patients were randomized into two groups in a double blind fashion. Patients in group A (n = 48) received lidoflazine 1 mg/kg intravenously over a period of 20 min before initiation of cardiopulmonary bypass. Group B (n = 45) receiving placebo, acted as a control group. Myocardial protection consisted of intermittent infusion of cold 4 degrees C St. Thomas' Hospital cardioplegia, topical slush ice, and systemic hypothermia (28 degrees C rectal). No significant differences between the two groups were noted in terms of recovery of cardiac function, enzyme release, incidence of myocardial infarction, low cardiac output, rhythm, and conduction disturbances. In conclusion, our data suggest that the combination of intravenous pretreatment with lidoflazine and St. Thomas' Hospital cardioplegia did not provide significant additional myocardial protection in the clinical situation.

Hb I alpha16 Lys leads to Glu and Hb Broussais alpha90 Lys leads to Asn in Australian families

This paper describes the finding of Hb 1 alpha16 Lys leads to Glu and Hb Broussais alpha90 Lys leads to Asn in Australian families. Neither of these variants has been previously described in the Australian population. The variants were detected in an electrophoretic screening of 2500 blood samples. Both variants were clinically silent. The haematological parameters were within normal limits and the peripheral blood morphology was normal.

Haemoglobin North Shore, beta134 Val replaced by Glu, a new unstable haemoglobin

A new mildly unstable haemoglobin, Hb North Shore (beta134 Val replaced by Glu) is described. It was found in a 4th generation Australian of Anglo-Celtic origin with a mild microcytic anaemia. The charge change involved is partially obscured as evidenced by the electrophoretic mobility of the native haemoglobin. The structural studies illustrate the usefulness of Staphylococcus aureus strain V8 protease as a specific cleavage enzyme at glutamyl residues.