[Validation of a Hebrew translation of the Gastroparesis Cardinal Symptom Index (GCSI)].

BACKGROUND: Symptom checklists used in clinical research of gastroparesis have not been evaluated for reliability or validity. The Gastroparesis Cardinal Symptom Index (GCSI) is a reliable, validated measure whereby patients score three groups of symptoms: nausea/vomiting, postprandial fullness/early satiety and bloating. AIM: The purpose of this study was to translate the GCSI into Hebrew and then validate the language of the translation for use in future studies. METHODOLOGY: The measure was first translated into Hebrew and then back-translated to English, followed by a comparison of the two versions. The English and Hebrew versions were then completed by 40 healthy bilingual volunteers, using a cross-over design, with half answering the English version first while the other half replied to the Hebrew version first. RESULTS: The internal consistency for both measures was moderate, the English slightly lower than the Hebrew (Cronbach's alpha 0.67 vs. 0.72). Intra-class correlation values were larger than 0.7 for all but one of the symptoms (item 3, "vomiting"), although a Wilcoxian signed-rank test found this correlation to be of borderline significance (z=-1.63, p=0.50). CONCLUSIONS: The Hebrew translation of the GCSI is valid for use in clinical research, although further psychometric testing is needed to test its value for this purpose. This manuscript describes the stages of measurement, translation and language validation, the difficulties that researches face and possible solutions when researches choose to use a measure which was developed in a different language.

Parental postoperative pain management: attitudes, assessment, and management.

OBJECTIVES: Previous studies suggested that parents frequently do not adequately treat postoperative pain that is experienced at home. Reasons for these parental practices have not been extensively studied. Aims of this study were to examine parental postoperative pain assessment and management practices at home as well potential attitudinal barriers to such pain practices. METHODS: This was a longitudinal study involving 132 parents of children who were aged 2 to 12 years and undergoing elective outpatient surgery. Parental attitudes about pain assessment and management were assessed preoperatively, and children's pain severity and analgesic administration were assessed postoperatively for the first 48 hours after discharge. RESULTS: Although postoperative parental ratings indicated significant pain, parents provided a median of only 1 dose of analgesics (range: 0-3) during the first 48 hours after surgery. In the attitudinal survey, parents' responses have indicated significant barriers. For example, 52% of parents indicated that analgesics are addictive, and 73% reported worries concerning adverse effects. Also, 37% of parents thought that "the less often children receive analgesics, the better they work." Regression analysis demonstrated that, overall, more preoperative attitudinal barriers to pain management were significantly associated with provision of fewer doses of analgesics by parents (P < .05). CONCLUSIONS: Parents detected pain in their children yet provided few doses of analgesics. Parents may benefit from interventions that provide them with information that addresses individual barriers regarding assessing and treating pain.

Testing mediation in nursing research: beyond Baron and Kenny.

BACKGROUND: R. M. Baron and D. A. Kenny (1986) defined mediation and described how to perform statistical tests of mediation hypotheses. Their approach to testing mediation has been used extensively in the nursing literature. However, many statisticians have identified problems with the Baron and Kenny approach. PURPOSE: The aim of this paper is to critically evaluate alternative approaches to testing mediation. APPROACH: The Baron and Kenny approach and its shortcomings are briefly reviewed. A critical analysis of 17 alternate methods in three categories is then presented: (a)causal steps, (b) difference in coefficients, and (c) product of coefficients. The evaluation focuses on Type I error rate control, power, ease of computation, and versatility of use. RESULTS: Of the methods that control Type I error rate adequately, the joint significance test of [alpha] and [beta], the asymmetric distribution of products test, and the test of the products using the percentile bootstrap method are the most powerful tests of mediation. Of these three, the joint significance test of [alpha] and [beta] is superior due to its computational ease and versatility of use. DISCUSSION: Knowledge development in nursing will benefit from continued research testing mediation models. Nurse researchers could move beyond the Baron and Kenny approach to utilize more robust tests of mediation.

Children's desire for perioperative information.

BACKGROUND: The purpose of this investigation was to identify what perioperative information children want to receive from the medical staff. METHODS: As a first step, we developed an instrument based on a qualitative study conducted with children in Great Britain, input from a focus group, and input from school children. On the day of surgery, 143 children aged 7-17 yr completed a 40-item assessment of desired surgical information and a measure of anxiety (State-Trait Anxiety Inventory for Children). Parents completed a measure assessing their child's temperament (Emotionality, Activity, Sociability, and Impulsivity Survey) and a measure of their own anxiety (State-Trait Anxiety Inventory). RESULTS: Results indicated that the vast majority of children had a desire for comprehensive information about their surgery, including information about pain and anesthesia, and procedural information and information about potential complications. The most highly endorsed items by children involved information about pain. Children who were more anxious endorsed a stronger desire for pain information and lesser tendency to avoid information. Younger children wanted to know what the perioperative environment would look like more than adolescent children. CONCLUSIONS: We conclude that the majority of children aged 7-17 yr who undergo surgery want to be given comprehensive perioperative information and health care providers should ensure adequate information regarding postoperative pain is provided.