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PubMed2003

Development and psychometric evaluation of the Flexilevel Scale of Shoulder Function.

BACKGROUND: Existing measures of self-reported shoulder function fail to measure effectively the full range of shoulder functioning. The classic approach for improving the reliability of a scale is adding items, but a scale with a substantial number of items imposes a large response burden on participants. A more efficient approach is to use modern psychometric methods to construct an adaptive scale in which patients respond only to items that are targeted at their level of shoulder function. METHODS: We developed a Flexilevel Scale of Shoulder Function (FLEX-SF). This scale includes three testlets that target low, medium, and high shoulder function. Scores on the testlets were equated to a common mathematical metric. DESIGN AND SUBJECTS: We developed an initial pool of 68 items. This pool was administered to 400 patients, and responses were calibrated using a rating scale model. Subsets of items were identified for an easy, medium difficulty, and hard testlet. Properties of the scale were evaluated in a 3-month longitudinal study of 200 shoulder patients. RESULTS: The FLEX-SF exhibited high reliability at both the scale level (intraclass correlation coefficient [3,1] = 0.90) and specific trait levels. The validity of the FLEX-SF was supported by its internal and external responsiveness (Guyatt responsiveness index = 1.12) and the pattern of its associations with other health status measures. CONCLUSIONS: The FLEX-SF can be used as a primary endpoint in clinical trials even when there are relatively few people in each treatment group. The scale also has excellent properties for use in clinical settings tracking individual changes over time.

Adult↗
PubMedDate not supplied

Predicting pressure ulcer risk in pediatric patients: the Braden Q Scale.

BACKGROUND: While there are valid and reliable pressure ulcer risk assessment tools available for adult patients, none exist for infants and children. To remedy this, the Braden Scale was adapted for use in pediatrics, calling it the Braden Q Scale. OBJECTIVE: The purpose of this study was to: (a) establish the predictive validity of the Braden Q Scale in an acutely ill pediatric population; (b) determine the critical cutoff point for classifying patient risk; and (c) determine the best time to assess patient risk. METHODS: A multisite prospective cohort descriptive study with a convenience sample of 322 patients on bedrest for at least 24 hours without pre-existing pressure ulcers or congenital heart disease were enrolled from three pediatric intensive care units (PICU). The Braden Q score and skin assessment were independently rated and data collectors were blind to the other measures. Patients were observed up to 3 times per week for 2 weeks and then once a week until PICU discharge for a median of 2 observations reflecting 887 skin assessments. RESULTS: Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I pressure ulcers, 54 (27%) were Stage II pressure ulcers, and 6 (3%) were Stage III pressure ulcers. Most pressure ulcers (57%) were present at the first observation. Using Stage II+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic (ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve (AUC) was 0.83. At a cutoff score of 16, the sensitivity was 0.88 and the specificity was 0.58. The Braden Q Scale was then modified to eliminate 4 subscales with an AUC <0.7. With 3 subscales (mobility, sensory perception, tissue perfusion/oxygenation) the AUC of this Modified Braden Q Scale was maintained at 0.84. At a cutoff score of 7, the sensitivity was 0.92 and the specificity was 0.59. CONCLUSIONS: The performance of the Braden Q Scale in a pediatric population is similar to that consistently reported for the Braden Scale in adult patients. The Modified Braden Q Scale, with 3 subscales, provides a shorter yet comparable tool.

Acute Disease↗
PubMedDate not supplied

United States Spanish short-form-36 health survey: scaling assumptions and reliability in elderly community-dwelling Mexican Americans.

BACKGROUND: Measuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences. OBJECTIVES: The purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women. METHOD: Health status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N = 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000. RESULTS: Missing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item's hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was.80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population. DISCUSSION: The US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.

Acculturation↗
PubMed2004

Reliability and validity of the back performance scale: observing activity limitation in patients with back pain.

STUDY DESIGN: A single group design to examine reliability and validity of the Back Performance Scale. OBJECTIVES: To examine intertester reliability, test-retest reliability, and concurrent validity of the Back Performance Scale. SUMMARY OF BACKGROUND DATA: The Back Performance Scale is a condition-specific performance measure of activity limitation in patients with back pain. It includes five tests of daily activities requiring mobility of the trunk: sock test, pick-up test, roll-up test, fingertip-to-floor test, and lift test. Discriminative ability and responsiveness to important change have previously been demonstrated. METHODS: A total of 41 patients with back pain participated in the study. Two physiotherapists examined test performances concurrently, but independently. The patients filled in three questionnaires, two reflecting perceived disability (Der Funktionsfragenbogen Hannover, Roland-Morris Disability Questionnaire) as well as one for fear avoidance of daily activities and work (Fear Avoidance Belief Questionnaire). One physiotherapist retested the patients after 2 to 3 days. RESULTS: Intertester agreement of the Back Performance Scale sum score was very high (intraclass correlation coefficient 2.1): 0.996. Within-patient standard deviation (sw) on the 16-point Back Performance Scale was very low: 0.25. Test-retest reliability was high (intraclass correlation coefficient = 0.91, sw = 1.3). Intertester agreement of the separate tests was also very high, ranging from kappa= 0.90-1.00. Test-retest reliability was moderate to high (kappa= 0.55-0.83). A high correlation was demonstrated between the Back Performance Scale and the Der Funktionsfragenbogen Hannover: Spearman rho (rho) = 0.825, P < 0.01. Correlation between the Back Performance Scale and Roland-Morris Disability Questionnaire was moderate: rho = 0.454, P < 0.01. No correlation was demonstrated between the Back Performance Scale and the Fear Avoidance Belief Questionnaire. CONCLUSION: The Back Performance Scale appears to be a reliable and valid outcome measure of activity limitation.

Activities of Daily Living↗
PubMed2004

Radiological assessment of petroleum pipe scale from pipe-rattling operations.

Petroleum pipe scale, consisting of concentrated inorganic solids such as barium sulfate, can deposit on the inside of down-hole pipes during the normal course of oil field pumping operations. A portion of this scale has been shown to contain naturally occurring radioactive materials (NORM), predominantly compounds of radium. When these pipes are removed from the well, there is a potential for radiation doses to the oil field workers handling the pipes, especially as the pipes are cleaned for reuse. A thorough sampling and measurement protocol was applied under a variety of weather conditions in an outdoor laboratory to obtain an accurate indication of the radiological and aerodynamic characteristics of scale release and dust dispersion during petroleum pipe scale removal from out-of-service pipes with a restored, historically relevant outdoor pipe-cleaning machine. Exposure rate data were also obtained for both the pre-cleaned pipes, and the general area inhabited by workers during the descaling operation. Four radiation exposure pathways were investigated: inhalation of pipe scale dust generated during pipe rattling, incidental ingestion of the pipe scale dust, external exposure from uncleaned pipes, and external exposure from pipe scale dispersed on the ground. Pipes from three oil fields were rattled to collect as much industry-representative data as possible. The Ra specific activity of the pipe scale ranged from 33.6 +/- 0.4 to 65.5 +/- 0.7 Bq g, depending on the formation. A median atmospheric dust loading of 0.13 mg m was measured in the operator breathing zone. The respirable fraction was observed to be about 42% to 46%. Based on cleaning 20 pipes per day,250 d per year on average, annual committed effective doses for the operator and helper ranged from 0.11 mSv (11 mrem) to 0.45 mSv(45 mrem) for inhalation and from 19 microSv (1.9 mrem) to 97 microSv (9.7 mrem) for incidental ingestion. Worker annual external dose from the pipe racks ranged from 0 to 0.28 mSv (28 mrem). In the deposition experiment, more than 99% by weight of the deposited scale fell within 2 m of the machine centerline, the vast majority of which was in the downwind direction. The dose from this deposited material dominated the worker dose estimates. The annual external dose from dispersed material was estimated to be 2.8 mSv (280 mrem) for the operator and 4.1 mSv (410 mrem) for the helper.

Barium Sulfate↗
PubMed2005

Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT "behavior" scale.

OBJECTIVES: The original COMFORT scale, including both observational and physiologic items, has been validated for measuring distress in children admitted to a pediatric intensive care unit. However, physiologic variables are influenced by drugs given in the pediatric intensive care unit setting. The objectives of this study were to assess the usefulness of physiologic variables in judgment of sedation and to determine new cutoff points for the COMFORT "behavioral" scale (COMFORT-B), using only observational items. DESIGN: Prospective observational study. SETTING: Pediatric intensive care unit in a university hospital. PATIENTS: Seventy-eight patients admitted to the pediatric intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: COMFORT scores were obtained in this patient group. Similar to the original COMFORT scale validation, the expert opinion of nurses (Nurse Interpretation Score of Sedation) served to determine optimal cutoff scores for the COMFORT-B scale. A total of 843 combined COMFORT and Nurse Interpretation Score of Sedation scores were obtained in 78 patients. Cronbach's alpha for the COMFORT scale was .78, increasing to .84 when the physiologic items, blood pressure and heart rate, were excluded. COMFORT scores were significantly different for the three Nurse Interpretation Score of Sedation categories (Kruskal-Wallis, p < .001). According to the pediatric intensive care unit nurses, undersedation was present in 11% and oversedation in 3% of all observations. Cutoff points for the COMFORT-B scale were </=10 for oversedation and >/=23 for undersedation. The area in the COMFORT-B score between 11 and 22 does not adequately predict under- or oversedation, pointing to a need for supplemental observation. CONCLUSIONS: The COMFORT-B scale is a reliable alternative to the original COMFORT scale. The cutoff points of the COMFORT-B scale in conjunction with the Nurse Interpretation Score of Sedation facilitate the use of sedation algorithms on the pediatric intensive care unit.

Adolescent↗
PubMed2005

Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale.

BACKGROUND: Although scar evaluation tools are necessary for an evidence-based approach to scar management, there is as yet no generally accepted tool. The Patient and Observer Scar Assessment Scale was developed recently and found to be a useful subjective evaluation tool for burn scars. The authors tested the Patient and Observer Scar Assessment Scale on linear scars, the largest category of surgical scars. METHODS: One hundred linear surgical scars were assessed by three independent observers using the observer scale to evaluate vascularity, pigmentation, thickness, relief, pliability, and surface area. The patients evaluated their scars simultaneously and 2 weeks later using the patient scale for the following parameters: pain, itching, color, stiffness, thickness, and relief. RESULTS: The internal consistency of the observer and patient scales was good (Cronbach's alpha = 0.86 and 0.90, respectively). The reliability of the observer scale was good for the total score (r = 0.96, p < 0.001) and separate items (r > 0.86, p < 0.001) for three observers. Even a single observer evaluated scars reliably with respect to the total score (r = 0.88, p < 0.001) and the items vascularity, pigmentation, thickness, and surface area (r > 0.70, p < 0.001). The patient's intraobserver reliability was good for the total score (r = 0.94, p < 0.001) and separate items (r > 0.89, p < 0.001). The coefficient of variation of the total score was 10.4 percent for the observer scale and 15.8 percent for the patient scale, indicating good agreement. CONCLUSIONS: The Patient and Observer Scar Assessment Scale is an appropriate subjective tool for the evaluation of linear scars.

Adolescent↗
PubMed2002

Grading scales used in the management of aneurysmal subarachnoid hemorrhage: a critical review.

The use of grading scales to predict clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is commonplace. In recent times management of aSAH patients has developed such that surgical intervention is taking place earlier in the course of the illness. Given the complex and multifactoral clinical picture of these patients, there is an increased impetus to examine and reevaluate the relative merits and predictive characteristics of grading scales. The measurement characteristics and predictive power of the following instruments were reviewed: Fisher Scale (FS), Glasgow Coma Scale (GCS), Glasgow Outcome Score (GOS), Hunt and Hess (HH) Scale, Karnovsky Performance Scale (KPS), and the World Federation of Neurological Surgeons (WFNS) Scale. No uniformly conclusive findings were found when the HH Scale, GCS, and WFNS Scale were used to predict clinical outcomes. No instrument consistently outperformed any other across age or severity. Contradictory findings were reported. Difficulties were encountered in comparing instruments because of administration, scoring schemes, timing of assessments, and psychometric properties, such as interrater reliability. Reports on newly developed instruments often lacked the replication data necessary to effectively compare measures currently in use. The timing of measurements and the use of serial measures emerged as important factors in the prediction of clinical outcomes. Assessments taken close to the time of surgical intervention were found to have superior predictive abilities.

Adult↗
PubMed2003

Scale-dependent hierarchical adjustments of movement patterns in a long-range foraging seabird.

Foraging animals are expected to adjust their path according to the hierarchical spatial distribution of food resources and environmental factors. Studying such behaviour requires methods that allow for the detection of changes in pathways' characteristics across scales, i.e. a definition of scale boundaries and techniques to continuously monitor the precise movement of the animal over a sufficiently long period. We used a recently developed application of fractals, the changes in fractal dimension within a path and applied it to foraging trips over scales ranging across five orders of magnitude (10 m to 1000 km), using locations of wandering albatrosses (Diomedea exulans) recorded at 1 s intervals with a miniaturized global positioning system. Remarkably, all animals consistently showed the same pattern: the use of three scale-dependent nested domains where they adjust tortuosity to different environmental and behavioural constraints. At a small scale (ca. 100 m) they use a zigzag movement as they continuously adjust for optimal use of wind; at a medium scale (1-10 km), the movement shows changes in tortuosity consistent with food-searching behaviour; and at a large scale (greater than 10 km) the movement corresponds to commuting between patches and is probably influenced by large-scale weather systems. Our results demonstrate the possibility of identifying the hierarchical spatial scales at which long-ranging animals adjust their foraging behaviour, even in featureless environments such as oceans, and hence how to relate their movement patterns to environmental factors using an objective mathematical approach.

Animals↗
PubMed1999

Dynamical scaling: the two-dimensional XY model following a quench.

To sensitively test scaling in the two-dimensional XY model quenched from high temperatures into the ordered phase, we study the difference between measured correlations and the (scaling) results of a Gaussian-closure approximation. We also directly compare various length scales. All of our results are consistent with dynamical scaling and an asymptotic growth law L approximately (t/ln[t/t(0)])(1/2), though with a time scale t(0) that depends on the length scale in question. We then reconstruct correlations from the minimal-energy configuration consistent with the vortex positions, and find them significantly different from the "natural" correlations - though both scale with L. This indicates that both topological (vortex) and nontopological "spin-wave" contributions to correlations are relevant arbitrarily late after the quench. We also present a consistent definition of dynamical scaling applicable more generally, and emphasize how to generalize our approach to other quenched systems where dynamical scaling is in question. Our approach directly applies to planar liquid-crystal systems.

Journal Article↗
PubMed2002

Second-order structure function scaling derivation from the Euler and magnetohydrodynamic equations.

An anomalous scaling paradigm that has recently come to be canonical has two features limiting its range of applicability: The driving and driven fields are separated dyamically and the driving field statistics is prescribed, in terms of the (inertial subrange) scaling of its second-order structure functions and of white-noise statistics in time. Then the spectrum of scaling exponents for the driven field, scalar or vector, depends parametrically on the driving. Here, the coupling of turbulent vorticity to the driving velocity field is considered. Using simple approximations and no white-noise statistics assumption, equations are derived for the evolution of two-point second-order correlations. The turbulent magnetohydrodynamic (MHD) case is treated in an analogous fashion. In the neutral case, the kinematic coupling between vorticity and velocity leads to a unique prediction for the scaling exponent of the second-order structure functions of the two turbulent fields. The velocity scaling exponent estimate is zeta(2)=3(1/2)-1 approximately equal to 0.732, i.e., close to experimental data. Unlike Kolmogorov scaling, this result is systematically derived from the Euler equations. The analogous scaling of MHD fields is now treated beyond the dynamo theory approximation. In contrast to the uniqueness found in the neutral case, predicted MHD scalings depend on one parameter, similar to the "plasma beta" parameter beta(T) relating kinetic to magnetic energy. The nature of predicted dependence of inertial-range scaling exponents on beta(T) agrees with an observed dichotomy between high-beta(T) and low-beta(T) turbulence regimes.

Journal Article↗
PubMed2004

Diffusion of passive scalar in a finite-scale random flow.

We consider a solvable model of the decay of scalar variance in a single-scale random velocity field. We show that if there is a separation between the flow scale k(-1 )(flow ) and the box size k(-1 )(box ) , the decay rate lambda proportional, variant ( k(box) / k(flow) )(2) is determined by the turbulent diffusion of the box-scale mode. Exponential decay at the rate lambda is preceded by a transient powerlike decay (the total scalar variance approximately t(-5/2) if the Corrsin invariant is zero, t(-3/2) otherwise) that lasts a time t approximately 1/lambda . Spectra are sharply peaked at k= k(box) . The box-scale peak acts as a slowly decaying source to a secondary peak at the flow scale. The variance spectrum at scales intermediate between the two peaks ( k(box) < 0) . The mixing of the flow-scale modes by the random flow produces, for the case of large Péclet number, a k(-1+delta) spectrum at k>> k(flow) , where delta proportional lambda is a small correction. Our solution thus elucidates the spectral make up of the "strange mode," combining small-scale structure and a decay law set by the largest scales.

Journal Article↗
PubMed2005

Finite-size scaling analysis of percolation in three-dimensional correlated binary Markov chain random fields.

Percolation and finite-size scaling properties in three-dimensional binary correlated Markov-chain random fields on a cubic lattice are computed by extensive Monte Carlo simulation. At short correlation scales, the percolation threshold in correlated random fields decreases as the correlation scale increases. The rate of decrease rapidly diminishes for correlation lengths larger than 2-3 lattice sites. At correlation scales of 4-6 lattice sites, the percolation threshold is found to be 0.126 +/- 0.001 for the Markov chain random fields, similar to that for sequential Gaussian and indicator random fields, which are evaluated for comparison. The average percolation threshold in finite-size lattices is a function of both, the correlation length and the finite lattice size. The universal scaling constants for mean cluster size and backbone fraction are found to be consistent with results on uncorrelated lattices. But prefactors of scaling relationships vary with correlation length. The squared radius of gyration of non-percolating clusters is found to scale with gamma/nu and its scaling prefactors are independent of the correlation scale. Prefactors are similar between the three random field generators evaluated. The percolation properties derived here are useful to account for finite-size effects on percolation in natural or man-made correlated systems.

Journal Article↗
PubMed2005

A scale space approach for automatically segmenting words from historical handwritten documents.

Many libraries, museums, and other organizations contain large collections of handwritten historical documents, for example, the papers of early presidents like George Washington at the Library of Congress. The first step in providing recognition/ retrieval tools is to automatically segment handwritten pages into words. State of the art segmentation techniques like the gap metrics algorithm have been mostly developed and tested on highly constrained documents like bank checks and postal addresses. There has been little work on full handwritten pages and this work has usually involved testing on clean artificial documents created for the purpose of research. Historical manuscript images, on the other hand, contain a great deal of noise and are much more challenging. Here, a novel scale space algorithm for automatically segmenting handwritten (historical) documents into words is described. First, the page is cleaned to remove margins. This is followed by a gray-level projection profile algorithm for finding lines in images. Each line image is then filtered with an anisotropic Laplacian at several scales. This procedure produces blobs which correspond to portions of characters at small scales and to words at larger scales. Crucial to the algorithm is scale selection, that is, finding the optimum scale at which blobs correspond to words. This is done by finding the maximum over scale of the extent or area of the blobs. This scale maximum is estimated using three different approaches. The blobs recovered at the optimum scale are then bounded with a rectangular box to recover the words. A postprocessing filtering step is performed to eliminate boxes of unusual size which are unlikely to correspond to words. The approach is tested on a number of different data sets and it is shown that, on 100 sampled documents from the George Washington corpus of handwritten document images, a total error rate of 17 percent is observed. The technique outperforms a state-of-the-art gap metrics word-segmentation algorithm on this collection.

Abstracting and Indexing↗
PubMed2006

An amino acid "transmembrane tendency" scale that approaches the theoretical limit to accuracy for prediction of transmembrane helices: relationship to biological hydrophobicity.

Hydrophobicity analyses applied to databases of soluble and transmembrane (TM) proteins of known structure were used to resolve total genomic hydrophobicity profiles into (helical) TM sequences and mainly "subhydrophobic" soluble components. This information was used to define a refined "hydrophobicity"-type TM sequence prediction scale that should approach the theoretical limit of accuracy. The refinement procedure involved adjusting scale values to eliminate differences between the average amino acid composition of populations TM and soluble sequences of equal hydrophobicity, a required property of a scale having maximum accuracy. Application of this procedure to different hydrophobicity scales caused them to collapse to essentially a single TM tendency scale. As expected, when different scales were compared, the TM tendency scale was the most accurate at predicting TM sequences. It was especially highly correlated (r = 0.95) to the biological hydrophobicity scale, derived experimentally from the percent TM conformation formed by artificial sequences passing though the translocon. It was also found that resolution of total genomic sequence data into TM and soluble components could be used to define the percent probability that a sequence with a specific hydrophobicity value forms a TM segment. Application of the TM tendency scale to whole genomic data revealed an overlap of TM and soluble sequences in the "semihydrophobic" range. This raises the possibility that a significant number of proteins have sequences that can switch between TM and non-TM states. Such proteins may exist in moonlighting forms having properties very different from those of the predominant conformation.

Algorithms↗
PubMed2006

A comparison of the psychometric properties of three cigarette withdrawal scales.

AIMS: To compare the psychometric properties of three cigarette withdrawal scales. DESIGN: An internet cohort study. PARTICIPANTS: Each of 4,644 current (44%), former (49%) and never smokers (7%) completed the three scales via the internet. A subsample completed the scales again after 14 days (n=1309), and indicated their smoking status after 42 days (n=1431). MEASUREMENTS: The Cigarette Withdrawal Scale (CWS), the Wisconsin Withdrawal Scale (WWS) and the Minnesota Withdrawal Form (MWF). FINDINGS: All three scales covered the main elements in the Diagnostic and Statistical Manual version IV (DSM-IV) and the International Classification of Diseases version 10 (ICD-10) definitions of tobacco withdrawal, but WWS did not cover weight gain. Factor analyses indicated that only six factors were present in WWS, instead of the expected seven factors. Cronbach's alpha coefficients (0.76-0.93) were high for all scales. Test-retest coefficients were in the range of 0.66-0.86 for CWS and WWS, but were somewhat lower for some MWF items (range 0.52-0.80). In 324 ex-smokers who had quit smoking 31 days or less before baseline, craving predicted relapse at 14-day follow-up (CWS: odds ratio=1.53 per point, P=0.003; WWS: odds ratio=1.40, P=0.04; MWF: odds ratio=1.49, P=0.002). In 34 baseline smokers who had quit smoking by 14-day retest, an increase in craving (WWS and MWF), depressed mood (MWF) and difficulty concentrating (WWS) between baseline and retest predicted relapse at 42-day follow-up. In terms of construct validity, scales performed similarly, but performance on some key tests (e.g. withdrawal will increase post-cessation) were inadequate, due perhaps to methodological limitations. CONCLUSIONS: No scale showed a decisive advantage over the others. MWF has the advantage of brevity.

Adult↗
PubMed2004

Nurse competence scale: development and psychometric testing.

BACKGROUND: Self-assessment assists nurses to maintain and improve their practice by identifying their strengths and areas that may need to be further developed. Professional competence profiles encourage them to take an active part in the learning process of continuing education. Although competence recognition offers a way to motivate practising nurses to produce quality care, few measuring tools are available for this purpose. AIM: This paper describes the development and testing of the Nurse Competence Scale, an instrument with which the level of nurse competence can be assessed in different hospital work environments. METHODS: The categories of the Nurse Competence Scale were derived from Benner's From Novice to Expert competency framework. A seven-step approach, including literature review and six expert groups, was used to identify and validate the indicators of nurse competence. After a pilot test, psychometric testing of the Nurse Competence Scale (content, construct and concurrent validity, and internal consistency) was undertaken with 498 nurses. The 73-item scale consists of seven categories, with responses on a visual analogy scale format. The frequency of using competencies was additionally tested with a four-point scale. RESULTS: Self-assessed overall scores indicated a high level of competence across categories. The Nurse Competence Scale data were normally distributed. The higher the frequency of using competencies, the higher was the self-assessed level of competence. Age and length of work experience had a positive but not very strong correlation with level of competence. According to the item analysis, the categories of the Nurse Competence Scale showed good internal consistency. CONCLUSION: The results provide strong evidence of the reliability and validity of the Nurse Competence Scale.

Adult↗
PubMed2007

At-sea distribution and scale-dependent foraging behaviour of petrels and albatrosses: a comparative study.

1. In order to study and predict population distribution, it is crucial to identify and understand factors affecting individual movement decisions at different scales. Movements of foraging animals should be adjusted to the hierarchical spatial distribution of resources in the environment and this scale-dependent response to environmental heterogeneity should differ according to the forager's characteristics and exploited habitats. 2. Using First-Passage Time analysis, we studied scales of search effort and habitat used by individuals of seven sympatric Indian Ocean Procellariiform species fitted with satellite transmitters. We characterized their search effort distribution and examined whether species differ in scale-dependent adjustments of their movements according to the marine environment exploited. 3. All species and almost all individuals (91% of 122 individuals) exhibited an Area-Restricted Search (ARS) during foraging. At a regional scale (1000s km), foraging ranges showed a large spatial overlap between species. At a smaller scale (100s km, at which an increase in search effort occurred), a segregation in environmental characteristics of ARS zones (where search effort is high) was found between species. 4. Spatial scales at which individuals increased their search effort differed between species and also between exploited habitats, indicating a similar movement adjustment for predators foraging in the same habitat. ARS zones of the two populations of wandering albatross Diomedea exulans (Crozet and Kerguelen) were similar in their adjustments (i.e. same ARS scale) as well as in their environmental characteristics. These two populations showed a weak spatial overlap in their foraging distribution, with males foraging in more southerly waters than females in both populations. 5. This study demonstrates that predators of several species adjust their foraging behaviour to the heterogeneous environment and these scale-dependent movement adjustments depend on both forager and environment characteristics.

Animal Migration↗