What should the standard be for passing and mastery on the Critical Thinking about Health Test? A consensus study.

OBJECTIVE: Most health literacy measures rely on subjective self-assessment. The Critical Thinking about Health Test is an objective measure that includes two multiple-choice questions (MCQs) for each of the nine Informed Health Choices Key Concepts included in the educational resources for secondary schools. The objective of this study was to determine cut-off scores for passing (the border between having and not having a basic understanding and the ability to apply the nine concepts) and mastery (the border between having mastered and not having mastered them). DESIGN: Using a combination of two widely used methods: Angoff's and Nedelsky's, a panel judged the likelihood that an individual on the border of passing and another on the border of having mastered the concepts would answer each MCQ correctly. The cut-off scores were determined by summing up the probability of answering each MCQ correctly. Their independent assessments were summarised and discussed. A nominal group technique was used to reach a consensus. SETTING: The study was conducted in secondary schools in East Africa. PARTICIPANTS: The panel included eight individuals with 5 or more years' experience in the following areas: evaluation of critical thinking interventions, curriculum development, teaching of lower secondary school and evidence-informed decision-making. RESULTS: The panel agreed that for a passing score, students had to answer 9 of the 18 questions and for a mastery score, 14 out of 18 questions correctly. CONCLUSION: There was wide variation in the judgements made by individual panel members for many of the questions, but they quickly reached a consensus on the cut-off scores after discussions.

Lower secondary school students' scientific literacy and their proficiency in identifying and appraising health claims in news media: a secondary analysis using large-scale survey data.

OBJECTIVES: Scientific literacy is assumed necessary for appraising the reliability of health claims. Using a national science achievement test, we explored whether students located at the lower quartile on the latent trait (scientific literacy) scale were likely to identify a health claim in a fictitious brief news report, and whether students located at or above the upper quartile were likely to additionally request information relevant for appraising that claim. DESIGN: Secondary analysis of cross-sectional survey data. SETTING AND PARTICIPANTS: 2229 Norwegian 10th grade students (50% females) from 97 randomly sampled lower secondary schools who performed the test during April-May 2013. OUTCOME MEASURES: Using Rasch modelling, we linked item difficulty and student proficiency in science to locate the proficiencies associated with different percentiles on the latent trait scale. Estimates of students' proficiency, the difficulty of identifying the claim and the difficulty of making at least one request for information to appraise that claim, were reported in logits. RESULTS: Students who reached the lower quartile (located at -0.5 logits) on the scale were not likely to identify the health claim as their proficiency was below the difficulty estimate of that task (0.0 logits). Students who reached the upper quartile (located at 1.4 logits) were likely to identify the health claim but barely proficient at making one request for information (task difficulty located at 1.5 logits). Even those who performed at or above the 90th percentile typically made only one request for information, predominantly methodological aspects. CONCLUSIONS: When interpreting the skill to request relevant information as expressing students' proficiency in critical appraisal of health claims, we found that only students with very high proficiency in science possessed that skill. There is a need for teachers, healthcare professionals and researchers to collaborate to create learning resources for developing these lifelong learning skills.

Effect of telemedicine follow-up care of leg and foot ulcers: a systematic review.

BACKGROUND: Leg ulcers and diabetes-related foot ulcers are frequent and costly complications of their underlying diseases and thus represent a critical issue for public health. Since the population is aging, the prevalence of these conditions will probably increase considerably and require more resources. Treatment of leg and foot ulcers often demands frequent contact with the health care system, may pose great burden on the patient, and involves follow-up in both primary and specialist care. Telemedicine provides potential for more effective care management of leg and foot ulcers. The objective of this systematic review of the literature was to assess the effect of telemedicine follow-up care on clinical, behavioral or organizational outcomes among patients with leg and foot ulcers. METHODS: We searched Ovid MEDLINE (1980-), Ovid EMBASE (1980-), Clinical Trials in the Cochrane Library (via Wiley), Ebsco CINAHL with Fulltext (1981-) and SveMed + (1977-) up to May 2014 for relevant articles. We considered randomized controlled trials, non-randomized trials, controlled before-after studies and prospective cohort studies for inclusion and selected studies according to predefined criteria. Three reviewers independently assessed the included studies using the Cochrane Collaboration risk-of-bias tool. We performed a narrative synthesis of results and assessed the strength of evidence for each outcome using GRADE (grading of recommendations, assessment, development and evaluation). RESULTS: Only one non-randomized study was included. The study (n = 140) measured the effect of real-time interactive video consultation compared with face-to-face follow-up on healing time, adjusted healing ratio and the number of ulcers at 12 weeks among patients with neuropathic forefoot ulcerations. There were no statistically significant differences in results of the different outcomes between patients receiving telemedicine and traditional follow-up. We assessed the study to have a high risk of bias. CONCLUSIONS: There is insufficient evidence available to unambiguously determine whether telemedicine consultation of leg and foot ulcers is as effective as traditional follow-up.