Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

Background: QTc interval prolongation leads to serious complications, making it a concern for clinicians. Assessing the risk of QTc interval prolongation in the psychiatric population is important, as they are exposed to medications known to increase the risk of life-threatening arrhythmias. Aim: To validate the content of an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population. Methodology: Qualitative semi-structured interviews of cardiology experts were used to gather information on their approach in assessing the risk of drug-induced QTc prolongation at the time of prescribing. After the interview, an orientation to the algorithm was provided, followed by a self-administered survey which included quantitative (4-point Likert scale to rate their opinion on each decision step) and qualitative components to assess the algorithm's content validity. Results: Four themes emerged from the cardiologists' interviews, which pointed towards a lack of a unified protocol or a systematic approach when assessing QTc interval prolongation. Quantitative results showed average mean scores ranging from 3.08 to 3.67, 3.08 to 3.58, and 3.17 to 3.75, for the appropriateness; the safety; and the reliability of the references, respectively, of each decision step in the algorithm. Qualitative analysis of the open-ended questions showed that cardiologists supported implementing the algorithm, with slight modifications to make it simpler and less time consuming. Conclusion: Qualitative and quantitative results point towards positive indices for the algorithm's content validity. Further validation studies with other potential users of the algorithm (such as mental health practitioners) are needed

Current Advance in Small Bowel Tumors

Small intestinal tumors are difficult challenge to gastroenterologists. The difficulty in making a diagnosis of small intestinal tumor lies in the relative inaccessibility and absence of typical presentation. New endoscopic and radiologic technologies provide clear and fine anatomical visualization of the small bowel and are approved to improve the diagnostic sensitivity and accuracy. Patients at risk of small intestinal tumors might gain a benefit from proper surveillance with this new technology. Minimally invasive therapy is now available with advance of balloon assisted enteroscopy. This review describes the general aspect of the small intestinal tumors, focusing on the new modalities for diagnosis

Content validation of an algorithm for the assessment, management and monitoring of drug-induced qtc prolongation in the psychiatric population

Background: QTc interval (QTcI) prolongation leads to serious complications, making it a concern for clinicians. Assessing the risk of QTcI prolongation in the psychiatric population is important because they are exposed to multiple medications known to increase the risk of life-threatening arrhythmias. Aim: The study aims to validate the content of an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population. Methodology: Qualitative semi-structured interviews of cardiologists, to gather information regarding their approach in assessing the risk of drug-induced QTc prolongation at the time of prescribing. After the interview, an orientation to the algorithm was provided with a link to a cross-sectional, anonymous survey. The online survey included quantitative and qualitative components to gather feedback on the relevance and appropriateness of each step in the algorithm. Results: Interview responses were incorporated into 4 themes. Responses indicated a lack of a unified protocol when assessing QTcI prolongation, which supports the need of an algorithm that includes a verified risk scoring tool. Quantitative survey results showed a mean score ranging from 3.08 to 3.67 out of 4 for the appropriateness of the algorithm’s steps, 3.08 to 3.58 for the safety and 3.17 to 3.75 for the reliability of references used. Additional analysis using the modified kappa and I-CVI statistical measures indicate high validity of contents and high degree of agreement between raters. As per the open-ended questions, cardiologists supported the implementation of the algorithm; however, they recommended simplification of the steps as they appear to be cumbersome. Conclusion: The results demonstrate that the implementation of the algorithm after minor alterations can prove to be useful as a tool for the risk assessment of QTc prolongation. Further validation of the algorithm with mental health pharmacists and clinicians will be conducted as a separate phase of the study

An online module to evaluate the validity of an algorithm to assess the risk for drug-induced QTc prolongation in the psychiatric population

Introduction: QTc interval prolongation leads to serious complications making it a concern for all clinicians. Assessing the risk of QTc interval prolongation, especially in the psychiatric population, can be challenging for pharmacists due to the complexity of regimens in this population and the difficulty in retrieving the needed information for the risk assessment. Guidelines and protocols for QTc prolongation risk assessment may vary among clinicians and few algorithms exist that address the prevention, management or monitoring of drug-induced QTc prolongation in the psychiatric population. Hence, there is a need for a validated comprehensive algorithm that helps clinicians in with the assessment of the risk of QTc prolongation. The study aims to pilot an educational module that guides experts through an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population. Methods: This study involved developing an online education module using Articulate Presenter' to introduce a comprehensive literature-based algorithm to subject-matter experts. The orientation was followed by an anonymous, self-administered survey with quantitative and qualitative components to assess the content validity of the QTc Prolongation Algorithm. Results: Feedback from the first pilot test with faculty members indicated that the module's interface was crowded. The module was updated accordingly. The results from the second pilot test with cardiologists were that the module provided a thorough explanation of the algorithm steps and rationale. Furthermore, some cardiologists commented that the algorithm was time consuming, however, most supported the implementation of the algorithm saying that it is easy to use, systematic, step-based and would be helpful if implemented. Conclusion/Future Directions: The results show that the module was helpful in introducing cardiologists to the algorithm and that the implementation of the algorithm after minor alterations can prove to be useful as a tool for risk assessment of QTc prolongatio