Development of the Thalassaemia Adult Life Index (ThALI)

Abstract: Background: Beta Thalassaemia Major (βTM) is a chronic genetic illness whereby the challenges faced by patients exposes them to increased risk of psychosocial issues. Despite this, a disease-specific tool to measure the impact of this illness on adult patients has yet to be developed. Methods: In collaboration with βTM adult patients, this study aimed to develop a comprehensive, disease-specific, easy to use psychometrically sound tool to measure the impact of chelation and transfusion dependent βTM in a cross-cultural patient group in England.The Thalassaemia Life Index (ThALI) was developed in two stages – item generation and pre-testing and item reduction – in collaboration with service users. Recruited adult patients shaped the design of the instrument including its statements and subscales. Standard item reduction techniques were used to develop the instrument. Results: The final version of the ThALI encompasses 35 statements and five sub-scales - general physical health, coping, body image, appearance and confidence, social relationships and autonomy. This endorses the multidimensionality of quality of life (QoL). The factor structure of the ThALI is highly stable and its internal consistency is high (alpha = 0.87 for the overall scale; 0.83–0.94 for its subscales). The ThALI has sound scaling assumptions, acceptability and score variability. Content validity was confirmed by experts and service user interviewees. The loadings for the items retained were adequate and the item discriminant validity sound. Conclusions: The ThALI covers the impact of βTM in adult patients. Preliminary testing shows its multidimensionality to be reliable and valid. The national authentication of the tool with patients treated in Centres of Excellence will aim to provide further evidence regarding the ThALI’s psychometric properties. Once authenticated, the ThALI may be utilised in research and in clinical settings to assess the effects of new therapies and/or interventions from the patients’ perspective to inform practice and/or to identify areas of concern

Translation and preliminary validation of the Greek version of the Xerostomia Inventory in older people

Introduction: The Xerostomia Inventory (XI) has been developed to assess self-perceived xerostomia. The aim of this study was to describe the translation and the preliminary validation of the XI in older Greeks. Materials and methods: The XI was translated into Greek and then back translated into English. Minor modifications were performed after a pilot testing and the final scale was interviewer-administered in 100 older participants visiting Open Care Community Centers for Older People in Athens. The preliminary validation procedure included calculation of the internal consistency reliability using Cronbach's α coefficient and corrected item-total correlations, principal component analysis, investigation of the discriminant validity by testing any variation related to sociomedical and oral variables and concurrent validity assessing the correlation between the XI and the response to a single question about self-perceived mouth dryness. Results: The factor analysis XI revealed a modified seven-item scale (XI-7), showing good internal consistency (Cronbach's α: 0.78). There were significant correlations with self-perceived mouth dryness, indicating satisfying concurrent validity, and significant differences related to depression, diabetes, antidepressive medications and polypharmacy showing acceptable discriminant validity. Conclusions: The preliminary investigation of the Greek version of the Xerostomia Inventory revealed a 7-item questionnaire that demonstrated good internal consistency and validity and will be further tested in older patients. © 2015 Published by Elsevier Masson SAS

Oral health related quality of life in older people: Preliminary validation of the Greek version of the Geriatric Oral Health Assessment Index (GOHAI)

Introduction: The Geriatric Oral Health Assessment Index (GOHAI) has been developed for the patient-reported assessment of oral health problems in older people. The aims of the present study were to translate the GOHAI into the Greek language, adapt the Greek version culturally, and perform a preliminary validation in an older Greek population. Materials and methods: GOHAI was translated from English into Greek by two bilingual translators and then back translated. The translated version was interviewer-administered in a sample of 100 older people. Internal consistency reliability and principal component analysis with Varimax rotation was performed. Concurrent and discriminant validity and test-retest reliability were assessed. Descriptive statistics and analysis between variables were also performed. Results: GOHAI showed satisfying internal consistency (Cronbach's a: 0.88), while the Exploratory Factor Analysis revealed three factors requiring further investigation. The scale showed satisfying concurrent validity with significant correlations with the general single-item questions. Discriminant validity was acceptable identifying differences in relation to medical conditions and medications used. Conclusions: The acceptable internal consistency and validity of the Greek version of the GOHAI recorded in the present study encourages its use in older people. The present translation of the GOHAI merits further validation in a larger cohort as well as in a geriatric context. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved

Students' perceptions of the educational environment in a Greek Dental School, as measured by DREEM

Aim: The aim of this study was to estimate the dental students perceptions of their educational environment and to identify any differences related both to their gender and semester of studies. Materials and methods: The translated and validated in Greek Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed to all 2ndto 5th-year students of the Athens Dental School. The questionnaire consisted of 50 statements organised in five subscales (perceptions of learning, teachers, atmosphere, academic self-perceptions and social self-perceptions). Internal validity was checked with Cronbach alpha. Confirmatory factor analysis (CFA) was performed under the same conditions as the original inventory. Mean statement, subscale and overall scores were calculated and given as percentages. Results: The response rate was 64%. Overall Cronbach alpha was 0.93 (excellent). CFA produced five meaningful subscales, not matching the original ones. The overall DREEM mean score was 56%. Gender did not influence the findings. The students’ perceptions of the educational environment with the exception of the academic selfperceptions were more positive in the pre-clinical years. Statistically significant differences were revealed only for the ‘learning’ subscale between the 3rd-and the 4th-year students. Seventy-eight percent of the statements were in the positive side. The lowest scores were related to students’ stress, tiredness and lack of appropriate feedback from the teachers, and the highest were related to accommodation, school friends and perceptions that they feel socially comfortable in class. Conclusions: Students’ perceptions of the educational environment were reasonably positive, with no gender difference. However, some weaknesses were identified, particularly in the clinical years. Further research is needed to clarify appropriate interventions

Immunotherapy-responsive limbic encephalitis with antibodies to glutamic acid decarboxylase

Glutamic acid decarboxylase (GAD) has been recently identified as a target of humoral autoimmunity in a small subgroup of patients with non-paraneoplastic limbic encephalitis (NPLE). We present a patient with NPLE and positive anti-GAD antibodies who showed significant improvement after long-term immunotherapy. A 48-year old female was admitted with a two-year history of anterograde amnesia and seizures. Brain MRI revealed bilateral lesions of medial temporal lobes. Screening for anti-neuronal antibodies showed high anti-GAD titers in both serum and cerebrospinal fluid (CSF) with strong evidence of intrathecal production. The patient received treatment with prednisolone and long-term plasma exchange. During a 12-month follow-up, she exhibited complete seizure remission and an improvement in memory and visuo-spatial skills. Anti-GAD antibodies may serve as a useful marker to identify a subset of NPLE patients that respond to immunoregulatory treatment. © 2014 Elsevier B.V

Personality characteristics and individual factors associated with PTSD in firefighters one month after extended wildfires

Background: Firefighters participate in activities with intense physical and psychological stress and are constantly at risk to develop various psychopathological reactions. Aims: To investigate psychological reactions in firefighters one month after devastating wildfires in Greece, during August 2007, which lead to the devastation of large areas and the death of 43 people among whom three were firefighters. Methods: One month after the wildfires, a joint task force of mental health clinicians was organized in order to provide psychological support and to investigate the psychological consequences of wildfires to firefighters. One hundred and two firefighters, living within the fire-devastated area, who were on duty for the whole period of wildfires were interviewed and assessed with the use of several questionnaires and inventories. Results: Post-traumatic stress disorder (PTSD) was detected in 18.6% of firefighters. Multiple logistic regression found that existence of fear of dying during firefighting, insomnia and increased scores in neuroticism, as well as in depression subscale of the SCL-90, were significantly associated with greater likelihood for having PTSD. Additionally those firefighters who worked permanently had 70% lower probability of having PTSD vs. those seasonally employed. Conclusions: Insomnia, depressive symptoms, as well as personality characteristics as neuroticism and the perception of fear of imminent death during firefighting operations may precipitate the development of PTSD in firefighters. Within this context, mental health clinicians should be aware that the early detection of these predisposing factors may facilitate the prevention and mitigation of PTSD in firefighters particularly those who are seasonally employed. © 2017 The Nordic Psychiatric Association

If you could change one thing in your school, what would this be? 469 suggestions of 429 medical graduates

OBJECTIVE The I CAN! questionnaire is an instrument for measuring the outcomes of medical curricula, based mainly on the Tuning project. The questionnaire is under construction and validation. It consists of 105 closed questions and the open question "if you could change one thing in your school, what would this be?". This paper presents the responses of medical graduates to this open question. METHOD The questionnaire was distributed to the graduates of six medical schools in Greece during the summer and autumn 2009 graduation periods, and to residents and specialist doctors during a primary health care conference in Greece (5.2.2010). The responses to the open question were grouped into categories and subcategories according to their conceptual content, and their frequency was calculated. RESULTS Questionnaires were collected from 408 new graduates of six medical schools (357 and 51 during the summer and autumn graduations, respectively): 45% male, 55% female; from Athens 148 (48% of its graduates), Thrace 38 (81%), Ioannina 12 (17%), Crete 32 (47%), and Thessaly 31 (100%). In addition, 21 questionnaires were collected from residents and specialist doctors. A total of 469 changes were proposed, related mainly to the curriculum (212) and teachers (215), and fewer to other elements of the educational environment (42). The suggestions included: increase in practical exercises (129) and clinical experience (8), introduction of practical subjects (21), exclusion of highly specialized subjects (12), changes in the timetable (6), the way of teaching (108), the method of student assessment (62), and the attitude (31) and selection (14) of the teachers. Only a few suggested changes were related to students' issues (10) and the administration of their school (30). CONCLUSIONS The majority of suggestions of the medical graduates recommended curriculum reform and a student-centered attitude from the teachers. The findings of this study, which are similar to those previously derived from students (80% preclinical) from the same medical schools, support the precept that changes in the medical curricula in Greece are essential, and may provide the impetus for immediate action by the medical faculties. © Athens Medical Society

I CAN! A graduate self-completion questionnaire for evaluating medical curriculum outcomes: How to use it, and preliminary findings on Greek medical education outcomes

Objective Although valid instruments are available for measuring the educational environment during the 6-year period of undergraduate medical study, there was no tool for measuring the end-product of the medical curriculum, i.e. the abilities of the "medical graduate". The I CAN! questionnaire, based on the tuning-medicine project, is an instrument designed to measure this. The construction and validation of the questionnaire Greek, and graduates' answers to the open question "if you could change one thing in your school, what would this be?" have been described elsewhere. The aim of this paper was to present how of the instrument works and the responses of medical graduates to its closed questions. METHOD The I CAN! questionnaire consists of 104 randomly arranged closed questions, based on the tuning-medicine level-two learning outcomes for undergraduate medical education in Europe, organized into 16 level-one outcomes, 12 for medical competencies and 4 for professionalism. The questionnaire was distributed to the graduates of Greek medical schools during the summer and autumn 2009 graduation. Their responses were coded (disagree absolutely=0, disagree=20, disagree moderately=40, agree moderately=60, agree=80, agree absolutely=100). The mean question, level-one outcomes and overall scores were calculated, and interpreted as: <50 very poor, 50-60.9 poor, 61-70.9 fairly poor, 71-78.9 fairly good, 79-88.9 good, 89-100 very good. Results Completed questionnaires were provided by 408 graduates of 6 medical schools, representing 55% of the total graduate population: 45% male, 55% female. They were graduates of the Universities of: Athens 148 (48% of graduates), Thessaloniki 147 (71%), Thrace 38 (81%), Ioannina 12 (17%), Crete 32 (47%), and Thessaly 31 (100%). On average they self-assessed their overall ability at 74% (i.e., in the "moderately good" interpretation zone), their ability to prescribe drugs 65% and to apply evidence-based medicine 68%, being a global doctor 80% and possessing professional atributes 83%. They considered themselves weaker in specific areas: Carrying out blood transfusion (37%), requesting autopsy (52%), administering intravenous therapy and using infusion devices (55%), completing correctly a death certificate (57%), matching appropriate drugs and other treatment to the clinical context (58%), and using diagnostic and therapeutic options available through other health professions (59%). They reported strength in: messuring blood pressure (96%), carrying out electrocardiography (92%), will to succeed (92%), maintaining confidentiality (91%), recognizing their own limits and asking for help (88%). Conclusions The I CAN! self-assessment questionnaire can identify the perceived strengths and weaknesses of medical graduates, offering the basis for implementation of a SWOT analysis (strengths, weaknesses, opportunities, threats) and evidence-based educational policy. Medical schools could use the instrument to monitor progress towards competence of tomorrow's doctors, and to assess effectiveness of policy changes. If all European medical schools were to use it on every graduate cohort, a time series database could be created to serve administrative, research and other purposes. © Athens Medical Society