Using Cognitive Pre-Testing Methods in the Development of a New Evidenced-Based Pressure Ulcer Risk Assessment Instrument

Background: Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods: A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results: Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions: The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it’s impact on care processes and patient outcomes

TRAINING SOCIAL INFERENCE WITH MENTALLY RETARDED ADOLESCENTS

Mentally retarded individuals are characterized as having maladaptive behavior. Utilizing the model prescribed by Greenspan, social inference may be defined as the comprehension of social cues whose interpretation indicates the probabilities of action in a situation. Educators currently view cognitive strategy training as a viable technique to promote needed social competencies and enhance generalizability in a variety of academic, vocational, and interpersonal settings. Thus, the generalization of social inference by mentally retarded individuals may be enhanced through cognitive strategy training aimed at improving the discrimination of salient cues and the interpretation of their meaning. The research questions asked if training in social inference improved scores on the Test of Social Inference and if the number of training sessions was related to such improvement. The cognitive training technique used was higher-level questions. The design included a training condition where subjects were trained to improve their social inference through prompt questions, and a no-training condition where subjects were exposed to the training items but were not given prompts. Within each condition, there were three groups which differed only in the number of sessions received: one, three, or six sessions. An additional no-exposure to training materials group received only the dependent measure. The main ANOVA approached significant (p (LESSTHEQ) .06) for the main effect of condition. The main effect of number of sessions and the interaction of condition X number of sessions was not significant. Investigation of the variance of TSI scores between cells revealed high homogeneity of variance. There were no significant differences on range tests between groups of means with respect to TSI scores. A one-tailed t-test between means on the TSI for training condition and no-training condition subjects was significant. Descriptive data revealed 73% of the training condition subjects received TSI scores above the grand mean whereas only 37% of the no-training condition subjects received scores above the grand mean. This study may be interpreted as implying that higher-level questions improve social inference. Suggestions for future research are included

Oxygen tension modulates the effects of TNF alpha in compressed chondrocytes

This work was supported by a QMUL Principal EPSRC PhD studentship and project grants by the AO Foundation (S-09-83C) and UM High Impact Research Grant (UM.C/HIR/MOHE/ENG/44) from the Ministry of Higher Education Malaysia