Application of the simultaneous equation models to temporary disability prescriptions in primary health care centres

[EN] Non-medical characteristics of primary healthcare centres (PHCs) influence the prescription of temporary disability leaves (incidence and absence rates) due to anxiety, as studied in the Valencian Community (E Spain; 5,111,706 inhabitants, 2009), where 485 centres (66%) were analysed. A structural two-equation model was used to explain which centres' factors impact prescriptions more. This model determined the influence of PHCs' factors (location, delay in specialized care, sick leave duration, etc.) on the incidence and absence rates, and on the interdependence between both rates. The results suggest the need to improve centres' management (clinical guidelines) and labour market regulations, and to control the disability benefits paid. © 2013 © 2013 Taylor & Francis.Guadalajara Olmeda, MN.; Barrachina Martínez, I. (2014). Application of the simultaneous equation models to temporary disability prescriptions in primary health care centres. International Journal of Computer Mathematics. 91(2):252-260. doi:10.1080/0020716.2013.808334S25226091

Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain

[EN] Background and Objective More than 30% of patients with epilepsy have inadequate control of seizures with drug therapy. The goal of this study is to determine the budget impact (BI) of the introduction of brivaracetam to the portfolio of approved drugs in Spain as adjunctive therapy for the treatment of partial-onset epilepsy in patients over 16 years old with a 5-year time horizon in the Valencia Community, a Spanish region with a population of 5 million. Methods The BI model compares the pharmaceutical expenditure on antiepileptics in two scenarios: with and without brivaracetam. It assumes that the introduction and increased use of brivaracetam will lead to a proportional decrease in consumption of coexisting adjunctive antiepileptics and calculates the evolution of the consumption of brivaracetam over 5 years (2016-2020). The model was designed from the perspective of the Spanish National Health System. Data on the candidate population, consumption of antiepileptics, market share and pharmaceutical expenditure were obtained from real-world data. Finally, a sensitivity analysis was carried out on the set of variables involved in the evolution of costs using a Monte-Carlo simulation. Results The model estimates that the target population eligible for adjunctive antiepileptics will hold at around 2352 between 2016 and 2020. Annual expenditure on antiepileptics is approximately a,notsign3.6 million. The number of patients eligible for treatment with brivaracetam would increase from 42 to 179 and annual savings of 0.09-0.37% would be created, representing a,notsign 41,873 over 5 years (0.23% of the total budget). The sensitivity analysis corroborates that the probability of achieving savings with brivaracetam is around 84%. Conclusions Brivaracetam is a therapeutic alternative that allows savings for the health system in patients with non-controlled epilepsy in monotherapy, having a fixed, predictable annual cost (independent of dose) from the first day of treatment as the lack of need for titration means the patient is within a range of therapeutic doses from the first dose.This work was supported partially by the Instituto de Salud Carlos III-Ministerio de Economia y Competitividad and the European Union (FEDER [Fonds Europeen de Developpement Economique et Regional (European Fund for Economic and Regional Development)] funds)-FIS PI12/00037.Barrachina Martínez, I.; Vivas-Consuelo, D.; Piera-Balbastre, A. (2018). Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain. Clinical Drug Investigation. 38(4):353-363. https://doi.org/10.1007/s40261-017-0615-zS353363384World Health Organization (2017). Epilepsy fact sheet. http://www.who.int/mediacentre/factsheets/fs999/en/. Accessed 12 Jan 2016.Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy. Neurology. 2017;88:296–303.Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51:676–85.García-Ramos R, Pastor AG, Masjuan J, Sánchez C, Gil A. FEEN report on epilepsy in Spain [in Spanish]. Neurologia. 2011;26:548–55.Brodie MJ. Practical use of newer antiepileptic drugs as adjunctive therapy in focal epilepsy. CNS Drugs. 2015;29:893–904.Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314–9.Sánchez-álvarez JC, Gil-Nagel A, Casas-Fernández C, Mauri-Llerda JA, Salas-Puig J, Sancho-Rieger J. Drug-resistant epilepsy: current recommendations for diagnosis and treatment in Spain. Neurologia. 2012;27:575–84.Fazel S, Wolf A, Långström N, Newton CR, Lichtenstein P. Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study. Lancet. 2013;382(9905):1646–54. https://doi.org/10.1016/S0140-6736(13)60899-5.Villanueva V, Girón JM, Martín J, Lahuerta J, Dolz M, Cuesta M. Quality of life and economic impact of refractory epilepsy in Spain: the ESPERA study. Neurologia. 2013;28:195–204.Sancho J, Pena P, Rufo M, Palacios G, Masramon X, Rejas J, LINCE Study Collaborative Group. Health and non-health care resources use in the management of adult outpatients with drug-resistant epilepsy in Spain: a cost-of-illness study (LINCE study). Epilepsy Res. 2008;81:176–187.Laxer KD, Trinka E, Hirsch LJ, Cendes F, Langfitt J, Delanty N, et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014;37:59–70.Duncan JS, Duncan JS, Sander JW, Sisodiya SM, Walker MC. Adult epilepsy. Lancet. 2006;367:1087–100.European Medicines Agency (EMA). EPARs for authorised medicinal products for human use—Stelara. 2016. http://www.emea.europa.eu/humandocs/Humans/EPAR/stelara/stelara.htm. Accessed 29 Nov 2017.Biton V, Berkovic SF, Abou-Khalil B, Sperling MR, Johnson ME, Lu S. Brivaracetam as adjunctive treatment for uncontrolled partial epilepsy in adults: a phase III randomized, double-blind, placebo-controlled trial. Epilepsia. 2014;55:57–66.Ferlazzo E, Russo E, Mumoli L, Sueri C, Gasparini S, Palleria C, et al. Profile of brivaracetam and its potential in the treatment of epilepsy. Neuropsychiatr Dis Treat. 2015;11:2967–73.Sullivan SD, Mauskopf JA, Augustovski F, Caro JJ, Lee KM, Minchin M, et al. Budget impact analysis—principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health. 2014;17:5–14.European Medicines Agency. Vimpat. Summary of product characteristics. 2016. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000863/WC500050338.pdf. Accessed 27 Nov 2017.European Medicines Agency. Eslicarbazepine. Summary of product characteristics. 2017. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000988/WC500047225.pdf. Accessed 27 Nov 2017.European Medicines Agency. Perampanel. Summary of product characteristics. 2012. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/002434/WC500130840.pdf. Accessed 29 Nov 2017.European Medicines Agency. Retigabine. Summary of product characteristics. 2016;1–26. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001245/WC500104835.pdf. Accessed 29 Nov 2017.European Medicines Agency Zonisamide. Summary of product characteristics. 2017. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/004127/WC500204305.pdf. Accessed 29 Nov 2017.BOE (2010) Real Decreto-Ley 8/2010, de 20 de mayo, por el que se adoptan medidas extraordinarias para la reducción del déficit público. Boe 20/5/2010:45070–45128. https://www.boe.es/diario_boe/txt.php?id=BOE-A-2010-8228. Accessed 29 Nov 2017.Farmacéuticos CG de CO de BOTfarma. BOT Base de datos del medicamento. https://botplusweb.portalfarma.com/. Accessed 29 Nov 2017.AEMPS. Informe de Posicionamiento Terapéutico de brivaracetam (Briviact®) en epilepsia. 2017;1–7. https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IPT-brivaracetam-Briviact-epilepsia.pdf. Accessed 29 Nov 2017.Belén Ferro-Rey M, Roca-Cusachs A, Sicras-Mainar A, Álvarez-Martín C, de Salas-Cansado M. Fixed drug combinations in hypertension: a budget impact analysis for the spanish health system on the marketing of a fixed combination of olmesartan/amlodipine [in Spanish]. Aten Primaria. 2011;43:345–55.Simoens S. Pharmacoeconomics of anti-epileptic drugs as adjunctive therapy for refractory epilepsy. Expert Rev Pharmacoecon Outcomes Res. 2010;10(3):309–15.Borghs S, Thieffry S, Noack-Rink M, Dedeken P, Hong LS, Byram L, et al. Health care cost associated with the use of enzyme-inducing and non-enzyme-active antiepileptic drugs in the UK: a long-term retrospective matched cohort study. BMC Neurol. 2017;17:59

Mathematical modelling of kidney disease stages in patients diagnosed with diabetes mellitus II

[EN] The direct costs associated with diabetes mellitus represent 8% of total healthcare expenditure in Spain, amounting to around 6 billion euros per year [1]. The overall prevalence of diabetes in people over 18 years of age (adjusted for age and sex) is estimated at 13.8% in 2010 [2], with type 2 (T2DM) being the most common type of diabetes, accounting for 85-95% of all diabetes cases in high-income countries [3]. T2DM is associated with multiple diseases such as chronic kidney disease [4], retinopathy, pyelonephritis, heart attack or stroke [5]. It is estimated that 35% of patients with T2DM develop diabetic kidney disease [6]. Treatment of end-stage renal disease requires expensive treatments such as haemodialysis and kidney transplantation. The objective of this study is to evaluate in patients with T2DM the degree of renal damage and the risk of suffering complications according to their socio-demographic, clinical and morbidity characteristics and to obtain the weight of the variables that have most influence.Escobar Carrera, X.; González-De Julián, S.; Barrachina Martínez, I. (2021). Mathematical modelling of kidney disease stages in patients diagnosed with diabetes mellitus II. Universitat Politècnica de València. 96-100. http://hdl.handle.net/10251/1905669610

Tucumanin, a β-hydroxy-γ-lactone bistetrahydrofuranic acetogenin from Annona cherimolia, is a potent inhibitor of mitochondrial complex I

A new β-hydroxy-γ-methyl-γ-lactone bistetrahydrofuranic acetogenin, tucumanin, with the infrequent symmetrical threo/trans/threo/trans/ threo relative configuration at the tetrahydrofuran rings was isolated from Annona cherimolia (Annonaceae) seeds. The inhibitory potency on the mitochondrial complex I of acetogenins with this relative configuration (tucumanin and asimicin) was compared with that shown by the corresponding pairs with an asymmetrical threo/trans/threo/trans/erythro relative configuration (laherradurin/rolliniastatin-2, and itrabin/molvizarin). All these compounds act as selective inhibitors of mitochondrial complex 1 in the 0.18 - 1.55 nM range.Fil: Barrachina, Isabel. Universidad de Valencia; EspañaFil: Neske, Adriana. Universidad Nacional de Tucumán; ArgentinaFil: Granell, Susana. Universidad de Valencia; EspañaFil: Bermejo, Almudena. Universidad de Valencia; EspañaFil: Chahboune, Nadia. Universidad de Valencia; EspañaFil: El Aouad, Noureddine. Universidad de Valencia; EspañaFil: Alvarez, Olga. Universidad Nacional de Tucumán; ArgentinaFil: Bardon, Alicia del Valle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Química del Noroeste. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia. Instituto de Química del Noroeste; Argentina. Universidad Nacional de Tucumán; ArgentinaFil: Zafra Polo, M. Carmen. Universidad de Valencia; Españ

Telenursing: The view of care professionals in selected EU countries. A pilot study

Background With the growth of digital nursing, several studies have focused on recording patients' views on remote care, or specialised nurse staffing aspects. This is the first international survey on telenursing focused exclusively on clinical nurses that analyses the dimensions of usefulness, acceptability, and appropriateness of telenursing from the staff point of view. Methods A previously validated structured questionnaire including demographic variables, 18 responses with a Likert-5 scale, three dichotomous questions, and one overall percentual estimation of holistic nursing care susceptible to being undertaken by telenursing, was administered (from 1 September to 30 November 2022) to 225 clinical and community nurses from three selected EU countries. Data analysis: descriptive data, classical and Rasch testing. Results The results show adequacy of the model for measurement of the domains of usefulness, acceptability, and appropriateness of telenursing (overall Cronbach's alpha 0.945, Kaiser-Meyer-Olkin 0.952 and Bartlett's p < 0.001). Answers in favour of telenursing ranked 4 out of 5 in Likert scale, both globally and by the three domains. Rasch: reliability coefficient 0.94, Warm's main weighted likelihood estimate reliability 0.95. In the ANOVA analysis, the results for Portugal were significantly higher than those for Spain and Poland, both overall and for each of the dimensions. Respondents with bachelor's, master's and doctoral degrees score significantly higher than those with certificates or diplomas. Multiple regression did not yield additional data of interest. Conclusions The tested model proved to be valid, but although the majority of nurses are in favour of telenursing, given the nature of the care, which is mainly face-to-face, according to the respondents, the chances of carrying out their activities by telenursing is only 35.3%. The survey provides useful information on what can be expected from the implementation of telenursing and the questionnaire proves to be a useful tool to be applied in other countries.info:eu-repo/semantics/publishedVersio

Data Envelopment Analysis Applications on Primary Health Care Using Exogenous Variables and Health Outcomes

[EN] A data envelopment analysis was used to evaluate the efficiency of 18 primary healthcare centres in a health district of the Valencian Community, Spain. Factor analysis was used as a first step in order to identify the most explanatory variables to be incorporated in the models. Included as variable inputs were the ratios of general practitioners, nurses, and costs; as output variables, those included were consultations, emergencies, avoidable hospitalisations, and prescription efficiency; as exogenous variables, those included were the percentage of population over 65 and a multimorbidity index. Confidence intervals were calculated using bootstrapping to correct possible biases. Efficient organisations within the set were identified, although the results depend on the models used and the introduction of exogenous variables. Pharmaceutical expenditure showed the greatest slack and room for improvement in its management. Data envelopment analysis allows an evaluation of efficiency that is focussed on achieving better results and a proper distribution and use of healthcare resources, although it needs the desired goals of the healthcare managers to be clearly identified, as the perspective of the analysis influences the results, as does including variables that measure the achievements and outcomes of the healthcare services.This research was funded by "Conselleria de Hacienda y Modelo Economico de la Comunitat Valenciana (Spain)", file number HIECPU/2019/1, in the context of the Project "Desarrollo de un Modelo para el analisis de la eficiencia en las Unidades Basicas de Salud de atencion primaria en un departamento de Salud perteneciente al mapa sanitario de la Comunidad Valenciana".González-De Julián, S.; Barrachina Martínez, I.; Vivas-Consuelo, D.; Bonet-Pla, Á.; Usó-Talamantes, R. (2021). Data Envelopment Analysis Applications on Primary Health Care Using Exogenous Variables and Health Outcomes. Sustainability. 13(3):1-18. https://doi.org/10.3390/su1303133711813

Impact of age and gender in the pharmaceutical expenditure of anxiolytics in primary health care

Elsevier user license: Permitted: For non-commercial purposes: Read, print & download Text & data mine Translate the article Not Permitted: Reuse portions or extracts from the article in other works Redistribute or republish the final article Sell or re-use for commercial purposesStudy the prescription of anxiolytics in Primary Health Care measured by the number of daily doses prescribed (DDD) to each patient (adjusting for age and gender) in order to quantify the pharmaceutical expenditure of anxiolytics.Guadalajara Olmeda, MN.; De La Poza, E.; Barrachina Martínez, I.; Vivas Consuelo, DJJ. (2011). Impact of age and gender in the pharmaceutical expenditure of anxiolytics in primary health care. Value in Health. 14(7):A300-A300. https://doi.org/10.1016/j.jval.2011.08.373SA300A30014

Nutrición enteral

Este trabajo nos introduce en la administración de la nutrición enteral, haciendo una revisión de los aspectos a tener en cuenta tanto en sus indicaciones, vias, tipos, métodos, cuidados y complicaciones más importantes

Probabilistic study of the effect of anti-epileptic drugs under uncertainty: Cost-effectiveness analysis

[EN] Epilepsy is one of the most ancient diseases. Despite the efforts of scientists and doctors to improve the quality of live of epileptic patients, the disease is still a mystery in many senses. Anti-epileptic drugs are fundamental to reduce epileptic seizures but it have some adverse effects, which influence the quality of life outcomes of the patients. In this paper, we study the effectiveness of anti-epileptic drugs taking into account the inherent uncertainty. We establish a model, which allows to represent the natural history of epilepsy, using Markov chains. After randomizing the mathematical model, we compute the first probability density function of the solution stochastic process applying the random variable transformation technique.We also take advantage of this method to determine the distribution of some key quantities in medical decision, such as the time until a certain proportion of the population remains in each state and the incremental cost-effectiveness ratio. The study is completed computing all these quantities using data available in the literature. In addition, regarding the incremental cost-effectiveness ratio, different third generation anti-epileptic treatments are compared with the Brivaracetam, a new third generation anti-epileptic drug.This work has been supported by the Spanish Ministerio de Economia, Industria y Competitividad (MINECO), the Agencia Estatal de Investigacion (AEI) and Fondo Europeo de Desarrollo Regional (FEDER UE) grant MTM2017-89664-P. Computations have been carried thanks to the collaboration of Raul San Julian Garces and Elena Lopez Navarro granted by European Union through the Operational Program of the European Regional Development Fund (ERDF)/European Social Fund (ESF) of the Valencian Community 2014-2020, grants GJIDI/2018/A/009 and GJIDI/2018/A/010, respectively.Barrachina Martínez, I.; Navarro-Quiles, A.; Ramos, M.; Romero, J.; Roselló, M.; Vivas-Consuelo, D. (2020). Probabilistic study of the effect of anti-epileptic drugs under uncertainty: Cost-effectiveness analysis. Mathematics. 8(7):1-19. https://doi.org/10.3390/math8071120S11987García-Ramos, R., García Pastor, A., Masjuan, J., Sánchez, C., & Gil, A. (2011). FEEN report on epilepsy in Spain. Neurología (English Edition), 26(9), 548-555. doi:10.1016/j.nrleng.2011.03.004Epilepsy http://www.who.int/mediacentre/factsheets/fs999/en/Población Estimada en España http://www.ine.es/inebaseDYN/cp30321Duncan, J. S., Sander, J. W., Sisodiya, S. M., & Walker, M. C. (2006). Adult epilepsy. The Lancet, 367(9516), 1087-1100. doi:10.1016/s0140-6736(06)68477-8Brodie, M. J. (2015). Practical Use of Newer Antiepileptic Drugs as Adjunctive Therapy in Focal Epilepsy. CNS Drugs, 29(11), 893-904. doi:10.1007/s40263-015-0285-4EPARs for Authorised Medicinal Products for Human Use Stelara http://www.emea.europa.eu/humandocs/Humans/EPAR/stelara/stelara.htmKristian, B., Wachtmeister, K., Stefan, F., & Forsgren, L. (2013). Retigabine as add-on treatment of refractory epilepsy - a cost-utility study in a Swedish setting. Acta Neurologica Scandinavica, 127(6), 419-426. doi:10.1111/ane.12077Martyn-St James, M., Glanville, J., McCool, R., Duffy, S., Cooper, J., Hugel, P., & Lane, P. W. (2012). The efficacy and safety of retigabine and other adjunctive treatments for refractory partial epilepsy: A systematic review and indirect comparison. Seizure, 21(9), 665-678. doi:10.1016/j.seizure.2012.07.011Cortés, J.-C., Navarro-Quiles, A., Romero, J.-V., & Roselló, M.-D. (2017). Randomizing the parameters of a Markov chain to model the stroke disease: A technical generalization of established computational methodologies towards improving real applications. Journal of Computational and Applied Mathematics, 324, 225-240. doi:10.1016/j.cam.2017.04.040Sonnenberg, F. A., & Beck, J. R. (1993). Markov Models in Medical Decision Making. Medical Decision Making, 13(4), 322-338. doi:10.1177/0272989x9301300409Barrachina-Martínez, I., Vivas-Consuelo, D., & Piera-Balbastre, A. (2017). Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain. Clinical Drug Investigation, 38(4), 353-363. doi:10.1007/s40261-017-0615-zSullivan, S. D., Mauskopf, J. A., Augustovski, F., Jaime Caro, J., Lee, K. M., Minchin, M., … Shau, W.-Y. (2014). Budget Impact Analysis—Principles of Good Practice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value in Health, 17(1), 5-14. doi:10.1016/j.jval.2013.08.2291Cortés, J.-C., Navarro-Quiles, A., Romero, J.-V., & Roselló, M.-D. (2018). Some results about randomized binary Markov chains: theory, computing and applications. International Journal of Computer Mathematics, 97(1-2), 141-156. doi:10.1080/00207160.2018.1440290Prieto, L., Sacristán, J. A., Antoñanzas, F., Rubio-Terrés, C., Pinto, J. L., & Rovira, J. (2004). Análisis coste-efectividad en la evaluación económica de intervenciones sanitarias. Medicina Clínica, 122(13), 505-510. doi:10.1016/s0025-7753(04)74288-8Karlsson, G., & Johannesson, M. (1996). The Decision Rules of Cost-Effectiveness Analysis. PharmacoEconomics, 9(2), 113-120. doi:10.2165/00019053-199609020-00003Mulhern, B., Rowen, D., Snape, D., Jacoby, A., Marson, T., Hughes, D., … Brazier, J. (2014). Valuations of epilepsy-specific health states: a comparison of patients with epilepsy and the general population. Epilepsy & Behavior, 36, 12-17. doi:10.1016/j.yebeh.2014.04.011BOT Base de Datos del Medicamento https://botplusweb.portalfarma.com/Informe de Posicionamiento Terapéutico de Brivaracetam (Briviact) en Epilepsia https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IPTbrivaracetam-Briviact-epilepsia.pdfSacristán, J. A., Oliva, J., Del Llano, J., Prieto, L., & Pinto, J. L. (2002). ¿Qué es una tecnología sanitaria eficiente en España? Gaceta Sanitaria, 16(4), 334-343. doi:10.1016/s0213-9111(02)71933-xBertram, M. Y., Lauer, J. A., De Joncheere, K., Edejer, T., Hutubessy, R., Kieny, M.-P., & Hill, S. R. (2016). Cost–effectiveness thresholds: pros and cons. Bulletin of the World Health Organization, 94(12), 925-930. doi:10.2471/blt.15.16441

Validation of a New Telenursing Questionnaire: Testing the Test

Abstract: Background: Existing surveys on telenursing refer to specific areas of nursing after the implementation of a programme, but telenursing in general has not been fully evaluated from a prospective approach. Aim: Design and statistical validation of a telenursing questionnaire. Methods: A new questionnaire was designed with 18 paired (to avoid leading) questions (Likert-5) plus three dichotomous questions (randomly ordered, inspired by existing validated tests) to analyse the dimensions of: acceptance, usefulness and appropriateness of telenursing from the nursing point of view (7 min test). The questionnaire was validated by classical tests and item response tests (Rasch) using six computer-generated databases with different response profiles (tendency to be positioned against, neutral and positioned in favour) with two degrees of agreement between each pair of responses for each option. Results: Classical testing: Cronbach’s alphas (from 0.8 to 0.95), Kaiser–Meyer–Olkin (KMO) (0.93 to 0.95) and a significant p < 0.0001 for Bartlett’s test of sphericity were obtained. Rasch analysis: Reliability coefficients (0.94). Warm’s mean weighted likelihood estimates (0.94). Extreme infit-t and outfit-t values (+1.61 to −1.98). Conclusions: Both the classical test and the Rasch approaches confirm the usefulness of the new test for assessing nurses’ positioning in relation to telenursing.info:eu-repo/semantics/publishedVersio