Training Substance Use Disorder Counselors in Cognitive Behavioral Therapy for Depression: Development and Initial Exploration of an Online Training Program.

INTRODUCTION: Evidence based psychotherapies (EBPs) remain underutilized. Models for EBP training and implementation that are cost-effective, minimally disruptive, and sufficiently flexible are needed. Internet-based technology is a promising platform, but questions remain about how this technology can address the barriers to implementation. We developed and examined the implementation of an online training for the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) intervention-a manualized, sixteen-session group depression treatment for individuals with substance use disorders (SUDs). We explored the feasibility of replacing in-person BRIGHT training with a self-paced, online training. METHODS: A highly partnered and iterative process was followed to translate the written BRIGHT manual and associated didactic training materials into a media rich, interactive, and detailed (12-16 h) online training. Subsequently, 8 volunteer counselors across 7 Veterans' Affairs SUD programs completed the training. Semi-structured interviews focused on the counselors' experiences and their plans for implementing BRIGHT groups. A template approach, using a mixture of deductive and inductive coding, was used for data analyses. FINDINGS: The most important barrier to completing training was a lack of protected time. Most counselors were not afforded protected time and reported a sometimes frustrating and fragmented training experience. Many used personal time at work and at home to complete the work. Facilitators to completing the training included positive reactions/attitudes towards the training modules, supervisor support, counselor dedication, and strong beliefs supporting providing services for depression. Many counselors were also concerned about the feasibility of fitting 16 group sessions (2h each) into their program's clinical schedule, but many had devised potential solutions or "work-arounds" to accommodate or approximate the recommended treatment course (e.g., using lunch times, reducing some content/exercises). CONCLUSION: This work contributes to the literature on implementation of complex EBPs and addresses the strengths and limitations of web-based technologies in supporting the implementation of EBPs.

A screening tool for dengue fever in children.

BACKGROUND: Dengue fever (DF) is a significant public health issue in Asia. We aimed to use clinical and laboratory data to derive a rapid and accurate case-finding tool for DF in children. METHODS: This retrospective study used 24 DF-related characteristics and clinical features (17 clinical; 7 laboratory) of 177 pediatric patients (69 diagnosed with DF). Data were psychometrically evaluated using a Rasch measurement model, and their values for predicting DF risk were evaluated. RESULTS: The 14-item scale (DF-14) fit the measurement model in assessing the likelihood of DF. When a cutoff point of -1.15 (in logit) of the DF-14 scale was used, the sensitivity was 0.76 and the specificity was 0.76. The area under the curve was 0.93 (95% confidence interval: 0.89-0.97). The DF-2 scale, comprised of white blood cell and platelet counts, was simple but clinically useful. CONCLUSIONS: Simple laboratory data, such as those in the DF-2 and DF-14 scales, are useful for the early detection of DF risk in children. The DF-14 scale helps discriminate DF from other febrile illnesses and may eliminate the need for a costly and time-consuming dengue confirmation test.

A web-based computerized adaptive testing (CAT) to assess patient perception in hospitalization.

BACKGROUND: Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient's bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients' bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital. OBJECTIVE: The purpose of this study was to evaluate the relative efficiency of computerized adaptive testing (CAT) and the precision of CAT-based measures of perceptions of hospitalized patients, as compared with those of nonadaptive testing (NAT). An Excel module of our CAT multicategory assessment is provided as an example. METHOD: A total of 200 patients who were discharged from the hospital responded to the CAT-based 18-item inpatient perception questionnaire on COW. The numbers of question administrated were recorded and the responses were calibrated using the Rasch model. They were compared with those from NAT to show the advantage of CAT over NAT. RESULTS: Patient measures derived from CAT and NAT were highly correlated (r = 0.98) and their measurement precisions were not statistically different (P = .14). CAT required fewer questions than NAT (an efficiency gain of 42%), suggesting a reduced burden for patients. There were no significant differences between groups in terms of gender and other demographic characteristics. CONCLUSIONS: CAT-based administration of surveys of patient perception substantially reduced patient burden without compromising the precision of measuring patients' perceptions of hospitalization. The Excel module of animation-CAT on the wireless COW that we developed is recommended for use in hospitals.

Applying the revised Chinese Job Content Questionnaire to assess psychosocial work conditions among Taiwan's hospital workers.

BACKGROUND: For hospital accreditation and health promotion reasons, we examined whether the 22-item Job Content Questionnaire (JCQ) could be applied to evaluate job strain of individual hospital employees and to determine the number of factors extracted from JCQ. Additionally, we developed an Excel module of self-evaluation diagnostic system for consultation with experts. METHODS: To develop an Excel-based self-evaluation diagnostic system for consultation to experts to make job strain assessment easier and quicker than ever, Rasch rating scale model was used to analyze data from 1,644 hospital employees who enrolled in 2008 for a job strain survey. We determined whether the 22-item Job Content Questionnaire (JCQ) could evaluate job strain of individual employees in work sites. The respective item responding to specific groups' occupational hazards causing job stress was investigated by using skewness coefficient with its 95% CI through item-by-item analyses. RESULTS: Each of those 22 items on the questionnaire was examined to have five factors. The prevalence rate of Chinese hospital workers with high job strain was 16.5%. CONCLUSIONS: Graphical representations of four quadrants, item-by-item bar chart plots and skewness 95% CI comparison generated in Excel can help employers and consultants of an organization focusing on a small number of key areas of concern for each worker in job strain.

Web-based computer adaptive assessment of individual perceptions of job satisfaction for hospital workplace employees.

BACKGROUND: To develop a web-based computer adaptive testing (CAT) application for efficiently collecting data regarding workers' perceptions of job satisfaction, we examined whether a 37-item Job Content Questionnaire (JCQ-37) could evaluate the job satisfaction of individual employees as a single construct. METHODS: The JCQ-37 makes data collection via CAT on the internet easy, viable and fast. A Rasch rating scale model was applied to analyze data from 300 randomly selected hospital employees who participated in job-satisfaction surveys in 2008 and 2009 via non-adaptive and computer-adaptive testing, respectively. RESULTS: Of the 37 items on the questionnaire, 24 items fit the model fairly well. Person-separation reliability for the 2008 surveys was 0.88. Measures from both years and item-8 job satisfaction for groups were successfully evaluated through item-by-item analyses by using t-test. Workers aged 26 - 35 felt that job satisfaction was significantly worse in 2009 than in 2008. CONCLUSIONS: A Web-CAT developed in the present paper was shown to be more efficient than traditional computer-based or pen-and-paper assessments at collecting data regarding workers' perceptions of job content.

Reliability of 95% confidence interval revealed by expected quality-of-life scores: an example of nasopharyngeal carcinoma patients after radiotherapy using EORTC QLQ-C 30.

BACKGROUND: Many researchers use observed questionnaire scores to evaluate score reliability and to make conclusions and inferences regarding quality-of-life outcomes. The amount of false alarms from medical diagnoses that would be avoided if observed scores were substituted with expected scores is interesting, and understanding these differences is important for the care of cancer patients. Using expected scores to estimate the reliability of 95% confidence intervals (CIs) is rarely reported in published papers. We investigated the reliability of patient responses to a quality-of-life questionnaire and made recommendations for future studies of the quality of life of patients. METHODS: A total of 115 patients completed the EORTC core questionnaire QLQ-C30 (version 3) after radiotherapy. The observed response scores, assumed to be one-dimensional, were summed and transformed into expected scores using the Rasch rating scale model with WINSTEPS software. A series of simulations was performed using a unified bootstrap procedure after manipulating scenarios with different questionnaire lengths and patient numbers to estimate the reliability at 95% confidence intervals. Skewness analyses of the 95% CIs were compared to detect different effects between groups according to the two data sets of observed and expected response scores. RESULTS: We found that (1) it is necessary to report CIs for reliability and skewness coefficients in papers; (2) data derived from expected response scores are preferable to making inferences; and (3) visual representations displaying the 95% CIs of skewness values applied to item-by-item analyses can provide a useful interpretation of quality-of-life outcomes. CONCLUSION: Reliability coefficients can be reported with 95% CIs by statistical software to evaluate the internal consistency of respondent scores on questionnaire items. The SPSS syntax procedures for estimating the reliability of the 95% CI, expected score generation and visual skewness analyses are demonstrated in this study. We recommend that effect sizes such as a 95% CI be reported along with p values reporting significant differences in quality-of-life studies.

A randomized trial comparing two models of web-based training in cognitive-behavioral therapy for substance abuse counselors.

This study compared training outcomes obtained by 147 substance abuse counselors who completed eight self-paced online modules on cognitive-behavioral therapy (CBT) and attended a series of four weekly group supervision sessions using Web conferencing software. Participants were randomly assigned to two conditions that systematically varied the degree to which they explicitly promoted adherence to the CBT protocol and the degree of control that they afforded participants over the sequence and relative emphasis of the training curriculum. Outcomes were assessed at baseline and immediately following training. Counselors in both conditions demonstrated similar improvements in CBT knowledge and self-efficacy. Counselors in the low-fidelity condition demonstrated greater improvement on one of three measures of job-related burnout when compared to the high-fidelity condition. The study concludes that it is feasible to implement a technology-based training intervention with a geographically diverse sample of practitioners, that two training conditions applied to these samples of real-world counselors do not produce statistically or clinically significant differences in knowledge or self-efficacy, and that further research is needed to evaluate how a flexible training model may influence clinician behavior and patient outcomes.

Clinico-pathological features of intussusception in children beyond five years old.

BACKGROUND: The pathoetiology and outcomes of intussusception in older children are different from those in young children. This study aims to investigate the characteristics and outcomes of intussusception in children older than 5 years in a tertiary referring hospital. METHODS: A retrospective review of patients aged older than five years having received a postoperative or roentgenographic diagnosis of intussusception between 1988 and 2005 was conducted. The clinical presentations, diagnostic and treatment methods, and outcomes of all cases were reviewed. RESULTS: A total of 12 cases were recorded. They were eight males and four females, with a median age of 7.6 years (range 5.0-11.1 years). Four (33.3%) children had symptoms lasting more than one week before a prompt diagnosis was made. The most commonly encountered symptom was abdominal pain (100%), followed by nausea/vomiting (75.0%). Recurrent intussusception occurred in 33% of cases. Abdominal sonogram identified intussusceptum in all patients when this procedure was performed. Six patients were treated operatively. Lead lesions including two malignant lymphomas, one Meckel diverticulum, and one colon polyp were found in 4 cases. Three of the four lead points were diagnosed and treated by colonoscopy preoperatively. Complications after operations were adhesive ileus (33.3%) and recurrent intussusception (16.7%). All patients remained well, including those who had lead points identified after prompt treatments. CONCLUSIONS: Intussusception in older children presents a higher frequency of persistent symptoms, lead points, and recurrence. Pediatricians need to be aware of the etiology and treatment options for intussusception in older children.