BACKGROUND:The current level of shared decision-making (SDM) in healthcare remains below expectations, necessitating an evaluation. Current methods of measuring SDM measure perceived levels of SDM without verifying whether individuals truly understand the concept of SDM. Thus, a tool is needed that measures patients' comprehension of the SDM-concept. OBJECTIVE:To develop and validate a questionnaire that can assess the extent to which patients and the general public understand the concept of SDM, and to identify individual characteristics related to SDM-knowledge. METHODS:Developing the questionnaire was theory- and evidence-based, using established guidelines for questionnaire development, while integrating conceptual models for structuring SDM-knowledge. The questionnaire was tested and refined through expert reviews, pilot tests, and two validation studies. Clinimetric analyses included item analysis, internal consistency assessment (Cronbach's alpha), Rasch model testing, and hypothesis testing. RESULTS:A 24-item Shared Decision-Making Knowledge Questionnaire (SDM-K-Q) was developed, based on the responses of 210 patients and visitors of a large university hospital. It demonstrated good validity and reliability (Cronbach's alpha = 0.70 and Rasch model acceptance). Mean SDM-knowledge level among participants was 73.8 %. Significant predictors of SDM-knowledge included higher educational levels, healthcare occupation, and consistent appointment preparation, whereas a migration background was inversely correlated. DISCUSSION:The questionnaire appears to be an innovative, reliable tool to measure SDM-knowledge as a single construct and was able to differentiate between specific groups. Consistency was based on single administration. Further validation efforts should solidify effectiveness and establish threshold values to differentiate SDM-knowledge. PRACTICAL VALUE:The SDM-K-Q tool can appreciate the extent to which patients understand the concept of SDM. It may help identify knowledge gaps and evaluate the impact of educational interventions. Further utilization of the SDM-K-Q can assist in developing SDM implementation strategies. FUNDING:This research did not receive any funding.

Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1–12 years, admitted to a tertiary center, and compared this with home 6–8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58 Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.

IntroductionMultidisciplinary teams treating patients with newly diagnosed Colorectal Cancer (CRC) often encounter the appearance of Indeterminate Pulmonary Nodules (IPNs) that warrants follow–up with repetitive medical imaging and anxiety for patients. We determined the incidence of IPNs in patients with newly diagnosed CRC and developed and validated a model for individualized risk prediction of IPNs being lung metastases.Material and methodsNewly diagnosed CRC who underwent surgery between November 2011 to June 2014 were included to create the risk model, developed using both clinical experience and statistical selection. Discrimination and calibration slopes of the risk score were evaluated in an independent temporal validation sample. A nomogram is presented to assist clinicians in estimating an individual risk score.ResultsOut of 2111 CRC patients staged with chest CT, 204 (9.6%) had IPNs and 54/204 (26%) had lung metastases. We identified 4 predictors: “location of primary tumour”, “pathological nodal stage”, “size of the largest nodule” and “extrapulmonary synchronous metastases at diagnosis”. Discrimination of the final model in the validation sample was demonstrated by the difference in mean predicted risk between progressed cases en non-progressed cases (49% versus 21%, p = <0.001).ConclusionA prediction model with 4 clinical risk factors can be used to assist multidisciplinary teams in the prediction of individualized risk of lung metastases and imaging strategy in patients with IPNs and newly diagnosed colorectal cancer. The model performed well in new patients not included in the model development.

Non-specific chronic low back pain (NS CLBP) affects people of all ages, is a leading contributor of disability worldwide and generates a great economic burden. Coping styles and personality traits are an important factor that should be considered when choosing a rehabilitation approach. In this study we use the MPI-subtypes of chronic pain patients who effectively can be categorized into Dysfunctional-, Adaptive Coper-, Interpersonally Distressed- and Average -types. The purpose was to investigate which of the selected MPI-subtypes have a positive or negative treatment response from a multi-disciplinary rehabilitation program, to enable us to make better and data driven decisions if special treatments is needed.In total, 110 patients started the multidisciplinary rehabilitation program and 79 patients successfully completed the entire program, whereas 31 patients dropped out.Results show that participants that are considered the “Average type” benefit more from a multidisciplinary treatment that other subtypes.We recommend to continue the search with a greater dataset for predictors to influence treatment outcomes based on the applied multidisciplinary treatment.

Purpose Measuring exercise adherence is important in patients with chronic obstructive pulmonary disease (COPD). For this, the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) seems to be a promising instrument, and a Dutch version (RAdMAT-NL) is available. The aim of this study was to explore the dimensionality and construct validity of the RAdMAT-NL in patients with COPD. Secondly, we examined whether the items of the RAdMAT-NL could be summed to a single score. Patients and Methods This prospective study included 193 patients with COPD from 53 primary physiotherapy practices in The Netherlands and Belgium. Patients and their physiotherapist provided data including the RAdMAT-NL, at one, two, and three months after inclusion. Horn’s parallel analysis and exploratory factor analysis (EFA) were used to assess the dimensionality of the RAdMAT-NL. Fit to the dichotomous Rasch model for measurement was used to confirm the unidimensionality of the extracted RAdMAT-NL subscales and total scale. To evaluate construct validity, Spearman correlations with other indicators of adherence were calculated, including SIRAS score, percentage attendance and change in exercise skills. Results EFA identified two dimensions of the RAdMAT-NL, “Participation” (13 items) and “Communication” (3 items), explaining 50.8% of the total variance. Rasch analysis confirmed the unidimensionality of the two dimensions. The unidimensional Rasch model was rejected for a summed score of all 16 RAdMAT-NL items. Medium to large significant positive correlations between the RAdMAT-NL subscale participation and different measures of adherence supported its convergent validity. Conclusion The RAdMAT-NL exhibited two subscales that fitted the unidimensional Rasch model for objective measurement. Construct validity was supported by convergence with other established measures of adherence.

Introduction Successful completion of initial military training has been suggested to be predicted by physical abilities, cognitive abilities and non-cognitive abilities such as hardiness and grit. This study aimed to assess the psychometric properties of a Dutch version of a grit measurement scale: the NL-Grit scale. Methods We assessed the factor structure, unidimensionality of the subscales, discriminative quality of the rating scale and investigated to what extend the items together can reliably measure the entire range of grit levels in Dutch Marine recruits. We used data of Marine recruit training platoons of the Royal Netherlands Marine Corps. Results Principal component analysis reflected two subscales: ‘consistency of interests’ and ‘perseverance of effort’. Rasch analysis confirmed the unidimensionality of the intended subscales. Rasch rating scale analysis indicated that the five-point response scale was not used as intended by respondents. Disordered rating scale categories were collapsed to obtain ordered rating categories. The item and person parameters (grit levels) largely overlapped, indicating that the item spread was sufficient for measuring the entire range of grit trait levels. However, larger gaps between item location parameters suggested a low discriminative capacity of the NL-Grit scale for respondents with trait levels within the gaps. Conclusion Our evaluation of the NL-Grit scale suggests sound psychometric quality of the NL-Grit in Dutch Marine recruits. Reliability could be improved by adding items to fill the observed gaps in item content.

Aim to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers. Design A multinational cross-sectional study using Q-methodology. Methods First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed. Results The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility. Conclusions Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC. Impact Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.

Identification of low muscle mass becomes increasingly relevant due to its prognostic value in cancer patients. In clinical practice, mid-upper arm muscle circumference (MAMC) and bioelectrical impedance analysis (BIA) are often used to assess muscle mass. For muscle-mass assessment, computed tomography (CT) is considered as reference standard. We investigated concordance between CT, BIA, and MAMC, diagnostic accuracy of MAMC, and BIA to detect low muscle mass and their relation with the clinical outcome malnutrition provided with the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). This cross-sectional study included adult patients with advanced esophageal and gastrointestinal cancer. BIA, MAMC, and PG-SGA-SF were performed. Routine CT-scans were used to quantify psoas muscle index (PMI) and skeletal muscle area. Good concordance was found between CTPMI and both BIAFFMI (fat free mass index) (ICC 0.73), and BIAASMI (appendicular skeletal muscle index) (ICC 0.69) but not with MAMC (ICC 0.37). BIAFFMI (94%), BIAASMI (86%), and MAMC (86%) showed high specificity but low sensitivity. PG-SGA-SF modestly correlated with all muscle-mass measures (ranging from −0.17 to −0.43). Of all patients with low muscle mass, 62% were also classified with a PG-SGA-SF score of ≥4 points. Although CT remains the first choice, since both BIA and MAMC are easy to perform by dieticians, they have the potential to be used to detect low muscle mass in clinical practice.

to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers. A multinational cross-sectional study using Q-methodology. First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed. The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility. Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC. Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.

Background The purpose of the study was to evaluate differences between prescribed and recommended protein intake in moderate-preterm (MP) and late-preterm (LP) infants and examine the contribution of the first week's prescribed protein intake to growth until term age. Methods Data on intake and anthropometrics were collected retrospectively in 235 preterm infants admitted to our general hospital's neonatal ward: 60 MP (32(0/7)-33(6/7) weeks' gestational age) and 175 LP (34(0/7)-36(6/7) weeks' gestational age). Differences between prescribed and recommended protein intake during the first postnatal week and z-score change for weight and head circumference (HC) between birth and term age were calculated. Multiple regression was used to evaluate the independent contribution of first week's prescribed protein intake to growth until term age. Results At day 7, 58% of MP and 19% of LP infants reached recommended protein intake. At term age, mean z-score change was -0.4 for weight and +0.1 for HC. Mean protein intake (g/kg/d) was associated with z-score change of +0.34 (95% CI, 0.14-0.53; P < .001) for weight and +0.25 (95% CI, 0-0.5; P = .03) for HC. Reaching recommended protein intake at day 7 was only independently associated with weight z-score change (+0.22 [95% CI, 0.04-0.41; P = .002]). Conclusion First week's prescribed protein intake does not meet recommended intake. Higher protein intakes in the first postnatal week result in increased weight gain and head growth until term age. Desirability and feasibility of increasing the protein intake need careful consideration and further discussion.

Background Hip fracture in the elderly is associated with increased morbidity and mortality. Pneumonia during hospitalization is not uncommon and is associated with poorer outcomes, such as an increased risk of readmission and higher mortality rates. We aim to identify independent predictive factors for developing pneumonia during hospitalization in this group and also assessed the effect pneumonia has on hospital-stay, in-hospital and 30-day mortality. Methods Retrospective cohort study with prospectively collected data from hospitalized elderly hip fracture patients between January 2015 and January 2017. Examined predictors were age, gender, pre-fracture living situation, pre-fracture mobility score, pre-fracture ADL-status, history of dementia, diabetes, congestive heart failure, chronic obstructive pulmonary disease and prior stroke, ASA-score, anemia at admission, surgery within 48 hours, surgical procedure and anesthesia used. Multivariable regression analysis including resampling methods (bootstrapping) was used to examine the effects of predictors. Results Of 407 patients, 62 (15.2%) were treated for pneumonia during hospitalization. Only gender, surgery within 48 hours and history of COPD differed significantly at baseline between the groups with and without pneumonia. Adjusted for age and gender, we observed a 1.6 times longer hospital-stay (95% CI 1.4-1.9, p<0.001), higher in-hospital mortality (OR 8.0, 95% CI 2.97-22.29) and 30-day mortality (OR 3.22, 95% CI 1.44-6.94) in the pneumonia-group. Pneumonia explained 9.1% of the variance in the length of hospital-stay aside from age and gender. Eight candidate predictors from the univariate analyses with a p<0.20 were selected for a multivariable logistic regression in 1000 bootstrap samples. Gender and history of COPD were most often found to have a p<0.10 (61.3% and 58.2%, respectively) in the bootstrap analyses and more than 80% stability in their B-coefficient signs. The discriminative quality of these two variables alone resulted in an AUC of 61.7% (95% CI 54%-69%). Conclusion Pneumonia resulted in longer hospital-stay and higher mortality rates. Of the 15 selected potential risk-factors for developing pneumonia during admission, male gender and history of COPD appeared to have the best potential as predictors. The other risk-factors had poorer performance, probably due to the few events and limited occurrence of some candidate variables in our study population.

Background: To prevent negative effects of early-onset psychiatric disorders on children's development, structured diagnostics are needed. However, validated diagnostic instruments (based on DSM-5) for children aged 7 years and younger are scarce. The Diagnostic Infant and Preschool Assessment (DIPA) is a diagnostic interview developed in the USA for measuring 16 psychiatric disorders in young children. The psychometric properties of the American version of the DIPA have been validated. Here we determined the accuracy of the psychometric properties of the Dutch DSM-5 based version of the DIPA for the corresponding population. Material and methods: Psychometric properties of the DSM-5 based version of the DIPA were determined based on a sample of 136 biological, foster, therapeutic foster and adoptive parents of clinically referred children and children involved in a serious accident (aged 1-7 years). In line with the American validation study, we included the following seven DIPA modules: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). We administered the DIPA, Trauma Symptom Checklist for Young Children (TSCYC) and Child Behavior Checklist (CBCL). Analyses were conducted with continuous outcomes (number of symptoms) and categorical outcomes (diagnoses). Results: The Dutch DSM-5 based version of the DIPA showed good internal consistency and interrater reliability with both continuous and categorical variables. The concurrent validity was good; we found a good concordance between the DIPA and corresponding questionnaires on both the symptom and diagnoses level. In addition, the divergence on symptom level between the DIPA and non-corresponding questionnaires was adequate, which indicated adequate divergent validity. Due to a limited number of positive cases, we could not draw conclusions regarding its psychometric properties in the GAD and OCD modules. Conclusions: Our study shows promising initial results regarding the reliability and validity of the Dutch version of the DIPA, that is based on the DSM-5. Therefore, we recommend the use of the DIPA in research and clinical practice. (C) 2020 The Author(s). Published by Elsevier Inc.

Resource parents are often insufficiently prepared for recognizing and managing posttraumatic stress symptoms (PTSS) in their traumatized foster children, which can put a successful foster placement at risk. The Resource Parent Curriculum (RPC) developed by the National Child Traumatic Stress Network is designed to increase resource parents' sensitivity towards child PTSS. This study explores the effect of the RPC on resource parents' recognition of child PTSS, resource parents' perceived upbringing stress in caring for their foster child, and child PTSS before entering the RPC (T0), after completing the RPC (T1) and at six-month follow-up (T2). Results (n = 108) show an increase in recognition of child PTSS and a decrease in resource parents' experienced upbringing stress and child PTSS over time. Findings suggest that the RPC increases resource parents' trauma sensitivity. However, child PTSS severity remains high. To address foster children's PTSS, child trauma-focused treatment appears needed in addition to the RPC.

Poor sleep quality during pregnancy is associated with both antepartum and postpartum depression and adverse birth outcomes. This study evaluated both objective and subjective sleep quality and the effects on the subsequent course of antepartum depressive symptoms in psychiatric patients. This observational explorative study was embedded in an ongoing study focusing on pregnant women with a mental disorder and was performed in 18 patients (24–29 weeks pregnant). Depressive symptoms were assessed throughout pregnancy using the Edinburgh Postnatal Depression Scale (EPDS) with 5-week intervals. Sleep was assessed with actigraphy, the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries at the start of the study. We studied correlations between sleep parameters and EPDS scores cross-sectionally using Spearman correlation. Next, we studied the course of antepartum EPDS scores over time per sleep parameter using generalized linear mixed modelling analysis. Objectively measured fragmentation index, total PSQI score and 4 PSQI subscales (sleep quality, sleep duration, sleep disturbances and daytime dysfunctions) were significantly correlated with EPDS scores when measured cross-sectionally at the start. Six objectively and subjectively measured sleep parameters had moderate to large effects on the course of depressive symptoms through the third trimester, but these effects were not statistically significant. More research is necessary to explore the causality of the direction between sleep problems and antepartum depressive symptoms we found in psychiatric patients.

This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function was measured using Alberta Infant Motor Scale. Of a total of 38 eligible children < 10 months of age at onset, nine cases had clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid; 11 had no meningitis and polymerase chain reaction positive for human parechovirus in nasopharyngeal aspirate, blood, urine, or feces; and in 18, no pathogen was identified (reference group).

The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy and patient satisfaction.