Development of the Malay Language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19): content validity & face validity analysis.

OBJECTIVE: This study aimed to assess the content and face validity index of the development of the understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19) in the Malay language. METHODS: The development of the MUAPHQ C-19 was conducted in two stages. Stage I resulted in the generation of the instrument's items (development), and stage II resulted in the performance of the instrument's items (judgement and quantification). Six-panel experts related to the study field and ten general public participated to evaluate the validity of the MUAPHQ C-19. The content validity index (CVI), content validity ratio (CVR) and face validity index (FVI) were analysed using Microsoft Excel. RESULTS: There were 54 items and four domains, namely the understanding, attitude, practice and health literacy towards COVID-19, identified in the MUAPHQ C-19 (Version 1.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVR for all items was above 0.7, except for one item in the health literacy domain. Ten items were revised to improve the item's clarity, and two items were deleted due to the low CVR value and redundancy, respectively. The I-FVI exceeded the cut-off value of 0.83 except for five items from the attitude domain and four from the practice domains. Thus, seven of these items were revised to increase the clarity of items, while another two were deleted due to low I-FVI scores. Otherwise, the S-FVI/Ave for every domain exceeded the cut-off point of 0.9, which is considered acceptable. Thus, 50-item MUAPHQ C-19 (Version 3.0) was generated following the content and face validity analysis. CONCLUSIONS: The questionnaire development, content validity, and face validity process are lengthy and iterative. The assessment of the instruments' items by the content experts and the respondents is essential to guarantee the instrument's validity. Our content and face validity study has finalised the MUAPHQ C-19 version that is ready for the next phase of questionnaire validation, using Exploratory and Confirmatory Factor Analysis.

Constructing and Validating Iranians' COVID-19-related Stressors (ICRS) and Its Relation with Mental Health: SEM Approach

Background: The outbreak of coronavirus disease 2019 (COVID-19) has caused stress and anxiety for various parts of society all over the world. This concern and stress are not limited to being affected by COVID-19 because this condition has also caused changes in people's lifestyles. Objective(s): The purpose of this study was to design and evaluate the validity and reliability of the COVID-19-related stressors questionnaire and determine the contribution of each of the stressors to the prediction of mental health in the Iranian population. Method(s): This descriptive-analytical and correlational study was performed on 301 volunteers living in Tehran, Iran. Due to the prevalence of COVID-19, questionnaires were distributed by convenience sampling method and online conduction. The instruments used in the present study were the researcher-made questionnaire on Iranians' COVID-19-related stressors (ICRS) and the mental health questionnaire general health questionnaire (GHQ-12). Content validity (qualitative and quantitative), face validity, structural validity (exploratory factor analysis), Cronbach's alpha, and logistic regression were used to analyze the data. Statistical analysis was performed by SPSS version 24 and AMOS24 software. Result(s): In exploratory factor analysis, the final 25 items were obtained in seven factors with an explanation of 66.25% variance. The results of logistic regression analysis showed that worrying about changing economic status, getting COVID-19 and change in lifestyle increased the chance of developing mental health disorder up to 1.29 (OR = 1.29), 1.28 (OR = 1.28), and 1.18 times (OR = 1.18), respectively. The variable of changing family interactions reduces the chance of developing a mental health disorder by 0.85 times (OR = 0.85). Conclusion(s): The COVID-19-related stressors questionnaire is valid and can be used in future research. Identifying the most im-portant stressors associated with the COVID-19 pandemic and determining each contribution to mental health prediction will help health policymakers to make better decisions.Copyright © 2023, Author(s).

Patient satisfaction and patient costs associated with telephone clinic appointments in Inflammatory Bowel Disease (IBD) following the pandemic

Background: Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Method(s): A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Result(s): 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either 'very satisfied' or 'somewhat satisfied' with their most recent telephone consultation, while 22 (6%) were either 'very dissatisfied' or 'somewhat dissatisfied'. 247/408 (61%) were also either 'very satisfied' or 'somewhat satisfied' with the ease of accessing further care if required, compared to 33/408 (8%) who were either 'very dissatisfied' or 'somewhat dissatisfied'. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future;147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was 5.55 (S.D. = 15.74, n=408), compared to 43.42 (S.D. = 31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion(s): Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments. (Figure Presented).

CoV-Sym: The development of a psychometrically validated patient reported outcome measure for COVID19

Background: Patient reported outcome measures (PROMs) provide a standardised method to capture patient perspectives which can be used in comparative effectiveness research to inform the evaluation of treatment. Thus far, PROMs have focussed on the long-term sequelae of COVID-19 rather than the acute illness and initial recovery period. Aim(s): To design a psychometrically validated COVID-19 specific PROM to be used in the acute and recovery phase of illness. Method(s): A review of existing literature, evaluation of existing PROMs, input from local experts (n=15) and in-depth qualitative concept elicitation interviews with patients (n=8) were used to create a conceptual framework which informed the generation of items included in the PROM. Cognitive interviews with patients (n=8) were then used to develop and refine the items for inclusion in the PROM and confirm the content and face validity of the draft tool. A nominal group meeting of the expert panel (n=6) was held to confirm the final items for inclusion. Result(s): The CoV-Sym PROM consists of 19 domains and 44 items which are scored using a five-point Likert scale to enable objective measurement of patients' symptomatic recovery from acute COVID-19 illness. Questions address physical, psychological and social domains. Cognitive interviews revealed acceptable content and face validity. Conclusion(s): With the involvement of both patients and experts in the development and validation process, we have created the first COVID-19 specific PROM to measure patient's symptomatic recovery from acute COVID-19 infection. It is ready for further psychometric testing to confirm reliability and responsiveness, the results of which will be presented.

Awareness and Preference of Students Towards Covid-19 Vaccine in University of Calabar

A Descriptive cross-sectional survey was conducted to assess the awareness and preference of students towards Covid-19 vaccine, University of Calabar. A total of 358 students from the Department of Nursing Science, University of Calabar were sampled through simple random sampling technique. The instrument of data collection was a structured questionnaire. Data collected were analyzed using frequencies, percentage, charts and means. The hypothesis was tested for significance at 0.05 level of significance, using the Chi-square (X2) analysis. The findings of the study revealed that 51.1% of the study participants expressed high awareness towards COVID-19 vaccine whereas 48.9% demonstrated low awareness. 54.7% exhibited positive preference toward the covid-19 vaccination, while 45.3% showed negative preference. There is no statistical influence between age and knowledge of covid-19 vaccine among students in University of Calabar .There is no statistical influence between year of study and attitude of students towards covid19 vaccine in University of Calabar. Findings reveal that study participants were aware of covid-19 vaccine perhaps could not utilize because of fear of complications. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Patient experience of their Primary Biliary Cholangitis (PBC) management compared to clinical practice guidelines

Background and aims: Primary Biliary Cholangitis (PBC) is a chronic, cholestatic, autoimmune liver disease, which can have a profound impact on patients’ quality of life and a significant demand for healthcare services. PBC management guidelines were published in 2017 by European Association for the Study of the Liver (EASL), which include recommendations for daily dosage (13–15 mg/kg) of licensed first-line therapy (ursodeoxycholic acid (UDCA)) and referrals for alternative treatment if UDCA response is inadequate, of which obeticholic acid (OCA) is the only licensed treatment alongside other re-purposed agents. This study explored the efficacy of patient-clinician collaborations to manage PBC in accordance with EASL guidelines from a patient perspective. Method: A closed question questionnaire was designed focussing on the application of treatments and the inclusion of patients in the management of their PBC. The questionnaire was piloted with PBC Foundation service users during a focus group testing its reliability and face validity. A convenience sample was used and participants recruited via the PBC Foundation’s app during March 2022. Intercept Pharmaceuticals provided financial support and input into the questionnaire, however the PBC Foundation has retained editorial discretion over survey outputs. Results: 172 patients completed the survey. 154 respondents (90%) take UDCA and 132 respondents (77%) received a timely UDCA prescription (0–3 months after diagnosis). 91% of UDCA patients believe they are taking the recommended dosage however only 54% of UDCA patients report taking dosage within guidelines. Of those patients who are unresponsive or intolerant to UDCA, 68% were offered alternative treatment and 57% were included in discussions about the most suitable option. 22% of all patients take 2nd line treatment (5% OCA and 17% unlicensed). 8% of all patients take no treatment for PBC management. 54% of patients had no access to face-to-face clinical appointments and 39% had appointments delayed or cancelled during the COVID pandemic. Patient comfort in raising PBC related queries ranges from 86% in face-to-face meetings, 46% on the telephone and 31% on screen-calls. Latest blood test results were discussed with 73% of patients. 50% of patients believe they understand their test results and 40% say their test results help them manage their PBC. Conclusion: Unmet PBC patient needs are evident in numerous stages of the life-long clinical journey. Data indicates substantial disparity between published PBC treatment guidelines and actual care delivered to patients, particularly relating to optimal application of PBC management therapies and patient inclusion in important discussions (test results and further treatment referrals). Unmet needs have been exacerbated during the COVID pandemic when timely appointments in patients’ preferred formats were adversely affected.

Public perception and willingness to undergo cosmetic procedures during the COVID-19 pandemic: A cross-sectional study

Background: As a result of the spread of coronavirus disease (COVID-19) at the beginning of 2020, many governments, including Saudi Arabia, have suspended operations in many agencies. Most of the dermatologists have restricted their practice, including cosmetic procedures, to ensure social distancing. On May 7, 2020, Saudi authorities have reduced the restriction of COVID-19 virus preventative measures, allowing clinics to start accepting patients with following the ministry of health protocols. Purpose: To evaluate the public's perception and willingness to undergo cosmetic procedures during the COVID-19 outbreaks in Saudi Arabia. Methods: A descriptive, cross-sectional, questionnaire-based study was carried out among the individuals who lack typical symptoms of COVID-19 infection in Saudi Arabia. A self-designed web-based questionnaire was developed;content face validity and a pilot study were done. The questionnaire was distributed electronically from May 8 to May 31, 2020. Results: A total of 656 individuals who lack typical symptoms of COVID-19 infection were included in this analysis. Only 10.5% of participants expressed their will to do cosmetic procedures during the COVID-19 pandemic. More than 90% of the participants believed that the COVID-19 pandemic was either somewhat serious (52.9%) or very serious (38.7%). The willingness to do cosmetic procedures during the COVID-19 pandemic remained unaltered when the price was discounted (P < 0.001), and when infection control measures were ensured (P < 0.001). Conclusion: The COVID-19 pandemic had a negative impact on the practice of cosmetic dermatology. Fear of transferring the infection to a beloved home member is the main reason to avoid these procedures. Generating well-structured safety guidelines to decrease the risk of this unusual virus transmission in dermatology practice and creating financial incentives may help increase the public willingness to do these cosmetic procedures during this pandemic.

Assessment of Knowledge Regarding Infection Control Protocols among Dental Health Professionals during COVID-19 Pandemic: An Observational Cross-sectional Study

Introduction: It is necessary to prioritize occupational welfare, safety of dental students and health professionals to reduce coronavirus transmission, to offer the best benefit for patients. Aim: To assess knowledge regarding standard operating procedures to be adhered in clinical setting during pandemic amongst undergraduate, postgraduate dental students and dental interns of dental colleges in northwest region, Karnataka. Materials and Methods: This observational cross-sectional study was undertaken in dental colleges in northwest region, Karnataka from January 2021 to February 2021. Sample size was estimated to be 360 based on a pilot study. Participants were selected by the simple random sampling technique and were interviewed using a questionnaire comprising of 20 close-ended questions. The questionnaire was evaluated for reliability with Cronbach's α value of 0.82, face validity 0.85%, and content validity ratio 0.76. The collected data was entered in MS Excel and analysed using Statistical Package of the Social Science (IBM-SPSS) statistics-version 21 using descriptive analysis, Chi-square analysis, spearman's correlation coefficient test, and regression. Results: The mean age of the participants was 24.6±1.35 years with marked gender distribution of 261 (72.5%) females and 99 (27.5%) males. Overall knowledge score for the standard operating procedure to be adhered during the pandemic was found to be 10.92±1.96 (undergraduates), 12.68±1.80 (postgraduates) and 11.55±1.82 (interns). More than half of the respondents 57.78% displayed a moderate level of knowledge. Spearman's correlation coefficient test revealed a high statistically significant difference between awareness about Coronavirus disease 2019 (COVID-19) among participants and recommended masks during the procedure. Conclusion: Postgraduate students had higher knowledge regarding standard operating procedures to be adhered in dental clinics compared to undergraduate students and interns. It's necessary that dental students are aware of latest infection control guidelines and implement them into their practices right from beginning.

Factors Related to Nurses and Physicians’ Knowledge and Attitudes Towards Palliative Care

Background: Changes in the course of diseases, their treatment, and care provision result in the need for a specific type of care known as palliative care. Medical staff’s knowledge and awareness of palliative care is important in this regard. Objectives: This study aims to examine the caregivers’ knowledge and awareness of palliative care and to determine the related predictors. Methods: In this cross-sectional study, 277 subjects were selected from among the caregivers working in the selected teaching hospitals in Iran through non-randomized sampling method. The subjects were asked to fill the online questionnaire which consisted of 3 sections including demographic data, knowledge, and attitude toward palliative care. Descriptive, inferential statistics, correlation and regression analyses were performed. Results: The mean scores of care providers’ attitude and knowledge were 140.90 ± 11.56 and 19.36 ± 2.73 respectively. There was a significant relationships between some variables such as working place, education level, age, palliative care-related working expe-rience, and the necessity to pass training courses and the mean scores of attitude and knowledge. Conclusions: Since palliative care providers’ level of knowledge and attitude were reported to be moderate, training courses at different levels in the form of clinical courses should be offered with the aim of improving care providers’ skills and scientific abilities. It is essential to include the related topics in the curricula of academic programs.

Digital diabetes care: How well equipped are patients and what do they think about it

Aims: Covid-19 precipitated an abrupt shift to non-face- to- face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods: We surveyed 1,000 people with diabetes (500 type 1, 500 type 2) from our local, largely deprived community with a user-approved questionnaire, tested for face validity and readability. Results: Response rate was 376/1000 (38%);132 (35%) type 1 diabetes, 218 (58%) type 2 diabetes, 1% other and 6% blank. Age of respondents was: ≤30, 0%;31-40, 4%;41-50, 7%;51-60, 12%;61-70, 17%;71-80, 52%;81-90, 3%;and blank, 5%. Treatment was: diet alone, 11%;diet and tablets, 39%;diet and insulin injections, 24%;diet, tablets and glucagon-like peptide-1 receptor agonist, 2%;insulin pump, 9%;and blank, 6%. Some 22% were attending the hospital clinic;74% not and 4% blank. Only 40% patients had access to a video calling device and only 35% had ever used it. Separate Likert scales showed: 79% strongly preferred or preferred face-to- face consultation, 17% strongly preferred or preferred telephone;and only 6% strongly preferred or preferred video consultation;66% recognised limitations in examination, weight and blood pressure checks with digital. Summary: Our survey, representative of type 1 and type 2 diabetes and of all treatment modalities but with underrepresentation of very young respondents, reveals that most patients did not have equipment for digital consultation and 79% preferred face-to- face consultation.

3D printed models decentralise surgical skills training for retrograde intrarenal surgery and percutaneous nephrolithotomy in the COVID-19 era

Introduction & Objectives: Imparting the required psychomotor skills for trainees to become proficient in Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) is tricky for surgical educators, due to the challenging nature of the procedures and the lack of realistic simulators. The current COVID-19 pandemic has compounded these issues by reducing learning opportunities for trainees through reduced case numbers and availability of surgical skills courses. To address these contemporaneous issues, we have developed 3D printed inexpensive combined RIRS and PCNL training models for both in-person and video conference skills training. Materials & Methods: Anonymised Computed Tomography data was used to develop the training model, using medical image processing software (3D Slicer, version 4.12, Harvard, USA). The model was 3D printed using flesh-coloured resin which best approximated the appearance of the collecting system during ureteroscopy. The face validity of the simulator was assessed by surgical educators for its suitability for both in-person and remote training. Results: The RIRS and PCNL training model was evaluated by expert Urologists involved in the national training of the procedures and found to be more realistic and affordable when compared to available alternatives. The 3D printed model was developed for under €3, allowing multiple identical copies to be 3D printed for both in-person courses and scheduled video conferencing workshops with the models distributed to each participating centre beforehand. This “hub and spoke” method of surgical skills training is greatly facilitated by the affordability of the 3D printed models. Conclusions: We have developed an inexpensive combined RIRS and PCNL training model for both in-person and remote training at USANZ and other international training courses. 3D printed simulators have great future potential in the training of endourological and other urological procedures, enhancing connectivity and facilitating the decentralisation of training courses for the acquisition of key surgical skills.

Translation, Cultural Adaptation, and Content Validation of the Palliative Care Self-Efficacy Scale for Use in the Swedish Context.

The Palliative Care Self-Efficacy Scale (PCSE) is a valid instrument in English for assessing healthcare professionals' self-efficacy in providing palliative care; it has not been translated into Swedish. The aim of this study was to describe the translation, cultural adaptation, and content-validation process of the PCSE scale. In this study, forward and backward translations, pretesting including an expert panel (n = 7), and cognitive interviewing with possible healthcare professionals (physicians, nurses, and assistant nurses) (n = 10) were performed. Experts in palliative care rated items on a Likert scale based on their understandability, clarity, sensitivity, and relevance. The item-level content validity index (I-CVI) and modified kappa statistics were calculated. Healthcare professionals were interviewed using the think-aloud method. The translation and validation process resulted in the final version of the PCSE scale. The average I-CVI for sensitivity was evaluated and approved. Most of the items were approved for clarity, some items lacked understandability, but a majority of the items were considered relevant. The healthcare professionals agreed that the items in the questionnaire evoked emotions, but were relevant for healthcare professionals. Thus, the Palliative Care Self-Efficacy scale is relevant for assessing healthcare professionals' self-efficacy in palliative care in a Swedish care context. Further research using psychometric tests is required.

The potential of low-fidelity arthroscopic simulation training in trauma and orthopaedic surgery: A systematic review of experimental studies

Aim: In an era of budget tightening and work-hour guideline reductions that have significantly reduced surgical exposure, low-fidelity arthroscopic simulators have an essential role to play in surgical training. The COVID-19 pandemic has only further amplified the need for alternative training models, as 91% of orthopaedic trainees have had elective procedures cancelled. The purpose of this systematic review is to synopsise the limited literature regarding the effectiveness of low-fidelity training models in the instruction of novices, and to formulate recommendations for future studies. Method: The Embase, PubMed, Web of Science and Scopus databases were electronically searched. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies and review studies were excluded. Risk of bias assessments were also conducted for all studies. Results: 16 studies were identified. Using the PRISMA algorithm, 6 studies were deemed relevant. A cross-study comparison revealed lowfidelity arthroscopic simulators reduced time to completion outcomes (P<0.05), increased ASSET scores (P<0.01) and confirmed face validity and transfer of skills (cadaver, live patients). Conclusions: Low-fidelity simulator training significantly improves the arthroscopic performance of novices, without the high setup costs and practical constraints of high-fidelity equivalents. Low-fidelity arthroscopic simulators remain a promising training apparatus in an era of reduced surgical exposure (COVID-19). We have identified the need for consistent outcome measures with greater sample sizes across future studies. We recommend the use of standardised pre-intervention teaching (e.g., ABOS curriculum) and further transference, construct, and face validity evaluations to support future result interpretations.