Psychometric testing of a checklist for procedural training of peripheral intravenous insertion.

BACKGROUND: Nurses, medical technologists, nuclear medicine technologists, pre-hospital providers, and medical students are a few groups of healthcare learners asked to learn intravenous (IV) cannulation in their training (J Surg Educ. 69:536-43, 2012). Despite the fact that IV cannulation has been taught to several health professions, it is difficult to find a psychometrically validated checklist to guide teaching this skill in the simulated procedural training (Pediatrics 124: 610-9, 2009, J Assoc Vasc Access 21: 196-204, 2016). In the absence of a pragmatic, valid checklist for the initial teaching of peripheral IV skills in the simulation procedural skills lab, this investigation sought to describe the process and create a psychometrically valid checklist. METHODS: Expert raters used Lawshe's method for identifying valid items from the universe of items for IV insertion. Gwet's AC2 and generalizability (G) theory was used assess inter-rater reliability. RESULTS: The literature and in-house IV checklists were examined for steps to inserting a peripheral IV, and the steps were compiled into a survey and sent to experts who rated each item. Of the 37 potential steps, 16 steps were identified as being psychometrically valid. The checklist content validity index was .82. Inter-rater reliability was .94 (95% CI .91-.98). Good inter-rater reliability was confirmed using generalizability theory. CONCLUSIONS: This study created and provided evidence of content validity and reliability for this checklist using Lawshe's methodology. As such, this method of evaluating a checklist for validity and reliability evidence can be followed for other healthcare checklists. This checklist can be used for teaching IV placement in healthcare students in the simulation procedural training lab.

A Method for Functional Task Alignment Analysis of an Arthrocentesis Simulator.

INTRODUCTION: During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation. METHODS: Potential performance checklist items were gathered from published arthrocentesis guidelines and aggregated into a performance checklist using Lawshe's method. An expert panel used this performance checklist and an FTA analysis questionnaire to evaluate a simulator's ability to respond to the physical actions required by the performance checklist. RESULTS: Thirteen items, from a pool of 39, were included on the performance checklist. Experts had mixed reviews of the simulator's FTA and its suitability for use in simulation. Unexpectedly, some positive FTA was found for several tasks where the simulator lacked functionality. CONCLUSIONS: By developing a detailed list of specific tasks required to complete a clinical procedure, and surveying experts on the simulator's response to those actions, educators can gain insight into the simulator's clinical accuracy and suitability. Unexpected of positive FTA ratings of function deficits suggest that further revision of the survey method is required.

HIV prevalence and associated risk behaviors in New York City's house ball community.

OBJECTIVES: We measured HIV seroprevalence and associated risk factors among persons in New York City's house ball community. METHODS: In 2004 we conducted a venue-based risk-behavior survey and HIV testing in the house ball community. RESULTS: Of the 504 study participants, 67% were male, 14% female, and 18% transgender. Mean age was 24 years (range=15-52 years); 55% were Black, and 40% were Latino. More than 85% of participants had previously been tested for HIV, although only 60% had been tested in the previous 12 months. Of the 84 (17%) persons who tested positive for HIV in our study, 61 (73%) were unaware of their HIV status. A logistic regression analysis on data from 371 participants who had had a male sexual partner in the previous 12 months showed that HIV-infected participants were more likely than were HIV-negative participants to be Black, to be older than 29 years, and not to have been tested for HIV in the previous 12 months. CONCLUSIONS: Culturally specific community-level prevention efforts are warranted to reduce risk behaviors and increase the frequency of HIV testing in New York City's house ball community.

A reconstituted in vitro clot model for evaluating laser thrombolysis.

BACKGROUND/OBJECTIVE: Laser thrombolysis is the selective removal of thrombus from occluded blood vessels using laser energy. A reconstituted clot model with reproducible optical absorption properties was developed to evaluate the effect of various laser parameters on thrombus removal rate. STUDY DESIGN/MATERIALS AND METHODS: Reconstituted clots were made with known fibrinogen concentrations and hematocrits. Ex vivo clots were collected from ten swine. Four red gelatin phantoms were prepared. Mass removal rates and ablation efficiencies were determined using a 577 nm, 1 microsec pulsed dye laser. The ablation efficiencies of the three clot models were compared at an energy of 25 mJ and a repetition rate of 4 Hz. In addition, the reconstituted clot model was ablated as pulse energy and repetition rate were varied with average power held constant at 100 mW. RESULTS: The mean ablation efficiency for ex vivo clots ranged from 0.4 +/- 0.1 to 3.4 +/- 0.7 microg/mJ/pulse, with significant differences between groups (ANOVA p < 0.05). Reconstituted clots of varied fibrinogen content had ablation efficiencies of 1.5 +/- 0.2 to 1.6 +/- 0.3 microg/mJ/pulse at this energy and repetition rate. Gelatin ablation efficiency was inversely proportional to protein content and ranged from 0.5 +/- 0.3 to 2.0 +/- 0.7 microg/mJ/pulse. Reconstituted clot mass removal rates (in microg/s) were clinically similar for settings ranging from 13 mJ at 8 Hz to 33 mJ at 3 Hz. CONCLUSIONS: The reconstituted model clot is a reproducible and biologically relevant thrombolysis target. Ex vivo clot lacks reproducibility between individuals and gelatin phantoms lack clinical relevance. At a constant average power, varying laser parameters did not affect mass removal rates to a clinically significant degree.