Developing the Polish Educational Needs Assessment Tool (Pol-ENAT) in rheumatoid arthritis and systemic sclerosis: a cross-cultural validation study using Rasch analysis

Objectives: To undertake cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) for use with people with rheumatoid arthritis (RA) and systemic sclerosis (Ssc) in Poland. Methods: The study involved two main phases: (i) cross-cultural adaptation of the ENAT from English into Polish and (ii) Cross-cultural validation of Pol-ENAT. The first phase followed an established process of cross-cultural adaptation of self-report measures. The second phase involved completion of the Pol-ENAT by patients and subjecting the data to Rasch analysis to assess the construct validity, reliability and cross-cultural invariance. Results: An adequate conceptual equivalence was achieved following the adaptation process. The dataset for validation comprised a total of 278 patients, 237 (85.3%) of which were female. In each disease group (145, RA and 133, SSC), the 7 domains of the Pol-ENAT were found to fit the Rasch model, 2(df)=16.953(14), p=0.259 and 8.132(14), p=0.882 for RA and SSc respectively. Reliability (person separation index, PSI>0.85) was high. Cross-cultural differential item functioning (DIF) was detected in some subscales and DIF-adjusted conversion tables were calibrated to enable cross-cultural comparison of data between Poland and the UK. Conclusion: Pol-ENAT is a robust measure of educational needs for people with RA and SSc in Poland. The tool has been shown to have sufficient cross-cultural validity to enable data pooling and comparisons between Poland and the UK

Chronic Serratiaodorifera Infra-vesical, Extra-peritoneal Pelvic Abscess: an Unexpected Finding in a Healthy 18 year Old Girl

Background: Serratiaodorifera (S. odorifera), a rare nosocomial human pathogen, is responsible for a few cases and outbreaks of sepsis in very sick hospitalized patients.Case Report: We report the case of an 18 year old healthy female patient with a chronic, deep, extra-peritoneal pelvic infection by S. odorifera in a Human Immunodeficiency Virus (HIV) endemic region. She had no  constitutional symptoms. In the Serratia genus, Serratiamarcescens is the most pathogenic, infecting virtually all human organ systems, where-as S. odoriferararely infects healthy patients. Our patient presented with chronicmild pelvic pain. Radiological evaluation revealed a cystic mass lesion of 80mm diameter which was thought to be an ovarian cyst. The mass could not be found at laparotomy. Repeat radiological evaluation revealed that the mass was extra-peritoneal with very thick walls. It was located para-vaginally, below and in front of the urinary bladder. Laparoscopic exploration nine months after laparotomy revealed an abscess with 200ml of pus. She was treated with antibiotics. Anaerobic culture yielded a profuse growth of S.odorifera. Histopathological tissue review confirmed a chronic suppurative abscess. We believe this was a community acquired S.  odorifera infection affecting an otherwise healthy patient. The patient was discharged home well eight days later.Key words: chronic pelvic abscess, community acquired, HIV infection, immunodeficiency, Serratiaodorifer

Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy

(East African Medical Journal: 2002 79 (11): 598-603

Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: A multicentre, single blind, randomised controlled trial

Objectives The Educational Needs Assessment Tool (ENAT) is a self-completed questionnaire, which allows patients with arthritis to prioritise their educational needs. The aim of this study was to evaluate the effects of needs-based patient education on self-efficacy, health outcomes and patient knowledge in people with rheumatoid arthritis (RA). Methods Patients with RA were enrolled into this multicentre, single-blind, parallel-group, pragmatic randomised controlled trial. Patients were randomised to either the intervention group (IG) where patients completed ENAT, responses of which were used by the clinical nurse specialist to guide patient education; or control group (CG) in which they received patient education without the use of ENAT. Patients were seen at weeks 0, 16 and 32. The primary outcome was selfefficacy (Arthritis Self Efficacy Scale (ASES)-Pain and ASES-Other symptoms). Secondary outcomes were health status (short form of Arthritis Impact Measurement Scale 2, AIMS2-SF) and patient knowledge questionnaire-RA. We investigated between-group differences using analysis of covariance, adjusting for baseline variables. Results A total of 132 patients were recruited (IG=70 and CG=62). Their mean (SD) age was 54 (12.3) years, 56 (13.3) years and disease duration 5.2 (4.9) years, 6.7 (8.9) years for IG and CG, respectively. There were significant between-group differences, in favour of IG at week 32 in the primary outcomes, ASES-Pain, mean difference (95% CI) -4.36 (1.17 to 7.55), t=-2.72, p=0.008 and ASES-Other symptoms, mean difference (95% CI) -5.84 (2.07 to 9.62), t=-3.07, p=0.003. In secondary outcomes, the between-group differences favoured IG in AIMS2-SF Symptoms and AIMS2-SF Affect. There were no between-group differences in other secondary outcomes. Conclusions The results suggest that needs-based education helps improve patients' self-efficacy and some aspects of health status

Cross-cultural validation of the Portuguese version of the Educational Needs Assessment Tool (PortENAT)

OBJECTIVESTo undertake a cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) into Portuguese.METHODSThe first phase of this research (cross-cultural adaptation) utilised a well-established translation method comprising five sequential steps: forward-translation, synthesis of translations, back-translation, expert committee and field-testing of the adapted version. The second phase involved collecting data from 123 patients and subjecting them to Rasch analysis for validity testing including cross-cultural invariance.RESULTSThe translation and field-testing phase went smoothly giving rise to minor adjustments in the phrasing of some items. The preliminary analysis of the 39 items, revealed some deviations from the model with the overall item-person interaction fit statistics 2(df) = 56.025 (39), p = 0.038. Significant item-item correlations caused artificial inflation of the internal consistency, therefore violating the model assumption of local independence of items. To correct this, all locally dependent items were then grouped into their respective domains, creating a 7 testlet-scale which demonstrated a good fit to the Rasch model, 2(df) = 2.625 (7), p = 0.917 and internal consistency PSI = 0.975. Analysis of the pooled (Portuguese and the English) data revealed cross-cultural DIF, requiring adjustments in two testlets: 'treatments' and 'support' which ensured cross-cultural equivalence.CONCLUSIONSThis study confirms the Portuguese ENAT is a robust unidimensional tool with which to assess the educational needs of Portuguese people with RA. Cross-cultural adjustments are required only if the data from Portugal and the UK are pooled or compared. The tool is now available for use in clinical practice and research

Cross-cultural validation of the Portuguese version of the Educational Needs Assessment Tool (PortENAT)

Objectives: To undertake a cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) into Portuguese. Methods: The first phase of this research (cross-cultural adaptation) utilised a well-established translation method comprising five sequential steps: forward- -translation, synthesis of translations, back-translation, expert committee and field-testing of the adapted version. The second phase involved collecting data from 123 patients and subjecting them to Rasch analysis for validity testing including cross-cultural invariance. Results: The translation and field-testing phase went smoothly giving rise to minor adjustments in the phrasing of some items. The preliminary analysis of the 39 items, revealed some deviations from the model with the overall item-person interaction fit statistics 2(df) = 56.025 (39), p = 0.038. Significant item-item correlations caused artificial inflation of the internal consistency, therefore violating the model assumption of local independence of items. To correct this, all locally dependent items were then grouped into their respective domains, creating a 7 testlet-scale which demonstrated a good fit to the Rasch model, 2(df) = 2.625 (7), p = 0.917 and internal consistency PSI = 0.975. Analysis of the pooled (Portuguese and the English) data revealed cross-cultural DIF, requiring adjustments in two testlets: ‘treatments’ and ‘support’ which ensured cross- -cultural equivalence. Conclusions: This study confirms the Portuguese ENAT is a robust unidimensional tool with which to assess the educational needs of Portuguese people with RA. Cross-cultural adjustments are required only if the data from Portugal and the UK are pooled or compared. The tool is now available for use in clinical practice and research

Educational needs in people with ankylosing spondylitis and psoriatic arthritis: A cross-sectional study

Objective: To assess the educational needs of people with Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA), test differences across patient subgroups and identify factors independently associated with their educational needs.Methods: This was a cross-sectional analytic study. Patients with AS and PsA completed the Portuguese version of the Educational Needs Assessment Tool (PortENAT). Data were Rasch-transformed before descriptive and inferential analyses were undertaken. Univariable and multivariable analyses were used to determine differences between patient subgroups and factors independently associated with their educational needs.Results: The study included 121 patients with AS and 132 with PsA. The level of educational needs varied by diagnostic group, but higher needs for both subgroups were reported regarding the “Disease process”, “Feelings” and “Managing pain” domains. Overall, patients with AS had a higher level of educational needs than those with PsA. In both disease groups, female gender was independently associated with higher educational needs. In the PsA group, a shorter disease duration was independently associated with higher educational needs in the following domains: “Managing pain”, “Movement” and “Feelings”.Conclusion: Educational needs vary by diagnostic group, gender and disease duration. These differences merit consideration in the design of patient education interventions