Design and validation of a scale to assess preferences of type 2 diabetic patients towards different nutritional supplements.

OBJECTIVES: To design and validate a scale to evaluate preferences of type 2 diabetic patients towards nutritional supplements (Madrid scale) and to discover those taste attributes that are more discriminating. CONTEXT: ambulatory patients with type 2 diabetes mellitus. MATERIALS AND METHODS: 18 controls and 106 type 2 diabetic patients received 2 of the 7 stimuli studied (6 nutritional supplements and a differential salty stimulus) and then completed both scales and a criterion question. Two weeks later, 30 diabetic patients received a retest. The psychometric properties of the Madrid scale were studied and the relative importance of each stimuli attribute was assessed. RESULTS: Feasibility: The Madrid scale consists of 8 questions and is completed in less than five minutes; Dimensionality: A single dimension which explains 45.1% of the variance. Reliability: Cronbach's , 0.806; intraclass correlation coefficient, 0.835 (95% confidence interval: 0.653-0.922). Concurrent validity: Correlation indexes of the corrected total score with the criterion question and the Modified Wine-Tasting Scale, 0.731 (p < 0.0005) and 0.774 (p < 0.0005), respectively. The scale discriminated between subjects younger and older than 75 years and between supplements and the differential stimulus. Preferences: Glucerna SR chocolate, Glucerna SR strawberry, Glucerna SR vanilla, Diasip vanilla, Clinutren vanilla and Resource diabet vanilla. CONCLUSION: The Madrid scale has adequate psychometric properties for its use in research and daily clinical practice.

Design and validation of a scale to assess preferences of type 2 diabetic patients towards different nutritional supplements / Diseño y validación de una escala para evaluar las preferencias de pacientes diabéticos tipo 2 de los diferentes suplementos nutritivos

Objectives: To design and validate a scale to evaluate preferences of type 2 diabetic patients towards nutritional supplements (Madrid scale) and to discover those taste attributes that are more discriminating. Context: ambulatory patients with type 2 diabetes mellitus. Materials and methods: 18 controls and 106 type 2 diabetic patients received 2 of the 7 stimuli studied (6 nutritional supplements and a differential salty stimulus) and then completed both scales and a criterion question. Two weeks later, 30 diabetic patients received a retest. The psychometric properties of the Madrid scale were studied and the relative importance of each stimuli attribute was assessed. Results: Feasibility: The Madrid scale consists of 8questions and is completed in less than five minutes; Dimensionality: A single dimension which explains 45.1%of the variance. Reliability: Cronbach’s , 0.806; intraclass correlation coefficient, 0.835 (95% confidence interval: 0.653-0.922). Concurrent validity: Correlation indexes of the corrected total score with the criterion question and the Modified Wine-Tasting Scale, 0.731 (p < 0.0005) and 0.774 (p < 0.0005), respectively. The scale discriminated between subjects younger and older than 75 years and between supplements and the differential stimulus. Preferences: Glucerna SR® chocolate, Glucerna SR® strawberry,Glucerna SR® vanilla, Diasip® vanilla, Clinutren®vanilla and Resource diabet® vanilla. Conclusion: The Madrid scale has adequate psychometric properties for its use in research and daily clinical practice

Objetivos: Diseñar y validar una escala (Escala de Madrid) para evaluar las preferencias de pacientes diabéticos tipo 2 de los diferentes suplementos nutritivos y descubrir aquellos atributos del sabor que son más discriminatorios. Con texto: pacientes ambulatorios con diabetes mellitus tipo 2.Materiales y métodos: 18 controles y 106 pacientes con diabetes tipo 2 recibieron 2 de los 7 estímulos estudiados (6 suplementos nutritivos y un estímulo salado diferencial) y posteriormente completaron ambas escalas y una pregunta criterio. Dos semanas después, se volvió a pasar el cuestionario a 30 pacientes diabéticos. Se estudiaron las propiedades psicométricas de la escala de Madrid y se evaluó la importancia relativa de cada atributo de los estímulos. Resultados: Realización: La Escala de Madrid comprende8 preguntas y se completa en menos de 5 minutos; Dimensionalidad: una única dimensión que explica el45,1% de la varianza. Fiabilidad: Alfa de Cronbach 0,806; coeficiente de correlación intra-clase 0,835 (intervalo de confianza al 95%: 0,653-0,922). Validez concurrente: índices de correlación para la puntuación total corregida con la pregunta criterio y la escala modificada de degustación de vinos, 0,731 (p < 0,0005) y 0,774 (p < 0,0005), respectivamente. La escala discriminaba entre los individuos menores y mayores de 75 años, y entre los suplementos y su estímulo diferencial. Preferencias: Glucerna SR® chocolate, Glucerna SR® fresa, Glucerna SR® vainilla, Diasip® vainilla, Clinutren® vainilla y Resource diabet® vainilla. Conclusión: La escala de Madrid posee propiedades psicométricas adecuadas para su uso en investigación y en la práctica clínica diaria

[Qualitative analysis of organizational innovations in Spanish public hospitals]. / Análisis cualitativo de las innovaciones organizativas en hospitales públicos españoles.

OBJECTIVE: To determine the opinion of chief executive officers (CEOs) and physicians in public hospitals concerning new managerial trends. METHODS: We performed a qualitative study designed to determine the opinion of CEOs and physicians on the organizational innovations that affect more than one level of health management intervention. In-depth semi-structured interviews were conducted to identify behavior, experiences, opinions, knowledge and other personal and institutional aspects related to the study's aim. Focus groups (two study groups and one control group) were also used. Interaction between groups was used to obtain different types of information on the development of ideas, operational capacity, and the degree of consensus and disagreement on the subjects discussed. RESULTS: Comparison between the control and the study groups revealed that the new management trends added value in the following areas: economy of contracts, delegation, administrative decentralization, incentives, risk avoidance, process re-engineering, heath care continuity, competitiveness, leadership, information systems and client centeredness. CONCLUSIONS: Physicians are showing increased interest in organizational innovations while CEOs are ambivalent about their changing role and respective responsibilities. There is evidence of resistance to change. There is no single institutional model; institutional design depends on internal factors (cohesion and leadership) and external factors (environment, size and technology). The incipient development of innovations reveals the need for changes in the style and characteristics of management structure (composition, functions, responsibilities).

Análisis cualitativo de las innovaciones organizativas en hospitales públicos españoles / Qualitative analysis of organizational innovations in Spanish public hospitals

Objetivo: Conocer la opinión de directivos y clínicos de hospitales públicos sobre los institutos clínicos. Métodos: Estudio cualitativo que trata de responder a preguntas realizadas a gerentes y clínicos sobre las innovaciones organizativas que afectan a más de un nivel de intervención de la gestión sanitaria. Se aplican como técnicas: a) entrevistas en profundidad semiestructuradas con la finalidad de señalar los comportamientos, experiencias, opiniones, conocimientos y otros aspectos personales e institucionales objeto del estudio, y b) grupos de discusión, con un grupo de discusión control y dos grupos de discusión estudio se busca la interacción de los grupos para obtener distintos tipos de información relativos al desarrollo de las ideas, operatividad, grado de consenso y disenso en los temas tratados. Resultados: Realizada la comparación entre el grupo de control y los grupos de estudio, se pone de relieve que las nuevas formas organizativas incrementaron el valor en los siguientes conceptos: economía de contratos, delegación de funciones, descentralización administrativa, incentivación, aversión al riesgo, reingeniería de procesos, continuidad asistencial, competitividad, liderazgo, sistemas de información y orientación al cliente. Conclusiones: Existe un creciente interés de los clínicos por las innovaciones organizativas hospitalarias, postura ambivalente en los gestores clínicos ante los cambios de rol de sus respectivas responsabilidades. Se evidencia la resistencia a los cambios. No existe un modelo único de 'instituto', dependiendo los modelos existentes de influencias particulares en cuanto a factores internos (cohesión y liderazgo) y externos (entorno, tamaño y tecnología). El incipiente desarrollo de innovaciones pone de relieve la necesidad de cambios en el estilo y naturaleza de la estructura directiva (composición, funciones, responsabilidades) (AU)

Objective: To determine the opinion of chief executive officers (CEOs) and physicians in public hospitals concerning new managerial trends. Methods: We performed a qualitative study designed to determine the opinion of CEOs and physicians on the organizational innovations that affect more than one level of health management intervention. In-depth semi-structured interviews were conducted to identify behavior, experiences, opinions, knowledge and other personal and institutional aspects related to the study's aim. Focus groups (two study groups and one control group) were also used. Interaction between groups was used to obtain different types of information on the development of ideas, operational capacity, and the degree of consensus and disagreement on the subjects discussed. Results: Comparison between the control and the study groups revealed that the new management trends added value in the following areas: economy of contracts, delegation, administrative decentralization, incentives, risk avoidance, process re-engineering, heath care continuity, competitiveness, leadership, information systems and client centeredness. Conclusions: Physicians are showing increased interest in organizational innovations while CEOs are ambivalent about their changing role and respective responsibilities. There is evidence of resistance to change. There is no single institutional model; institutional design depends on internal factors (cohesion and leadership) and external factors (environment, size and technology). The incipient development of innovations reveals the need for changes in the style and characteristics of management structure (composition, functions, responsibilities) (AU)