On the Practical Consequences of Misfit in Mokken Scaling

Mokken scale analysis is a popular method to evaluate the psychometric quality of clinical and personality questionnaires and their individual items. Although many empirical papers report on the extent to which sets of items form Mokken scales, there is less attention for the effect of violations of commonly used rules of thumb. In this study, the authors investigated the practical consequences of retaining or removing items with psychometric properties that do not comply with these rules of thumb. Using simulated data, they concluded that items with low scalability had some influence on the reliability of test scores, person ordering and selection, and criterion-related validity estimates. Removing the misfitting items from the scale had, in general, a small effect on the outcomes. Although important outcome variables were fairly robust against scale violations in some conditions, authors conclude that researchers should not rely exclusively on algorithms allowing automatic selection of items. In particular, content validity must be taken into account to build sensible psychometric instruments

Triggers of acute attacks of gout, does age of gout onset matter?: a primary care based cross-sectional study

Objectives To determine the proportion of people with gout who self-report triggers of acute attacks; identify the commonly reported triggers, and examine the disease and demographic features associated with self-reporting any trigger(s) of acute attacks of gout. Methods Individuals with gout were asked to fill a questionnaire enquiring about triggers that precipitated their acute gout attacks. Binary logistic regression was used to compute odds ratio (OR) and 95% confidence intervals (CI) to examine the association between having ≥1 self-reported trigger of acute gout and disease and demographic risk factors and to adjust for covariates. All statistical analyses were performed using STATA. Results 550 participants returned completed questionnaires. 206 (37.5%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45%). Patients who had onset of gout before the age of 50 years were significantly more likely to identify a trigger for precipitating their acute gout attacks (aOR (95%CI) 1.73 (1.12–2.68) after adjusting for covariates. Conclusion Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout. Less than 20% people self-reported acute gout attacks from conventionally accepted triggers of gout e.g. alcohol, red-meat intake, while c.5% reported novel triggers such as dehydration, injury or physical activity, and weather extremes

Editorial introduction: decision making, reasoning, context and perspective

This edition includes articles based on presentations to an international conference in March 2019 at the University of West London (UWL) in the United Kingdom, on the subject of “Shared Decision-Making, Person-Centred Care & The Values Agenda”—a conference organized by UWL's European Institute for Person Centred Health and Social Care, in collaboration with the European Society for Person Centred Healthcare and the Collaborating Centre for Valuesbased Practice at St. Catherine's College, Oxford, U

Clinical cases Zinner syndrome: a case report and literature review

Abstract Introduction and objective: Zinner syndrome is a rare congenital abnormality of the mesonephric duct (Wolffian) consisting of unilateral renal agenesis, seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Abnormalities involving the contralateral seminal vesicle or ejaculatory duct are extremely rare. We present the therapeutic approach in a patient with renal agensesis and large contralateral seminal vesicle cyst. Patient, Method and Results: A 24 years old patient known with right congenital solitary kidney presents with dysuria, pollakiuria, nocturia, hypospermia, ejaculatory pain and diffuse hypogastric and perineal pain. The imaging exams (abdominal ultrasound, contrast-enhanced computed tomography) reveal a cystic mass of the lower mid-abdomen of 14/11 cm with mass-effect, the absence of the left kidney, grade II right hydronephrosis and right megaureter. Preoperatively, the transonic mass has been interpreted as a seminal vesicle cyst. We performed the robotic-assisted laparoscopic cyst resection by using an approach similar as for radical prostatectomy. The intraoperative assessment revealed a cystic mass with a point of origin in the right seminal vesicle, contralateral to the renal agenesis, with an aspect suggestive for Zinner syndrome. Conclusions: Zinner syndrome is a rare urological condition that must be suspected in the young adult with recurrent irritative-obstructive lower urinary tract symptoms associated with pelvic pain syndrome, pelvic cystic mass, unilateral renal agenesis and significant alteration in sperm parameters. The conservative approach is limited to asymptomatic cases. The robotic-assisted minimally invasive approach facilitates the accurate delineation and isolation of anatomical structures, in a territory where subsequent to pericystic inflammation and changes in surgical plans, the classic surgical approach to adjacent structures proves difficult