Allison P Squires

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Objective. To examine the screening practices of family practitioners (FPs) and pediatricians for type 2 diabetes (T2D) in adolescents. Design. Cross-sectional study. Setting and participants. The researchers randomly sampled 700 pediatricians and 700 FPs who participated in direct patient care using the American Medical Association Physician Masterfile using a mail survey. Exclusion criteria included providers who were residents, hospital staff, retirees, or employed by federally owned medical facilities, certified with a subspecialty, or over age 70. Main outcome measures. Providers were given a hypothetical case of an obese, female, teenaged patient with concurrent associated risk factors for T2D (family history of T2D, minority race, signs of insulin resistance) and asked what initial screening tests they would order. Respondents were then informed of the updated American Diabetes Association (ADA) guidelines that added hemoglobin A1c as a screening test to diagnose diabetes. The survey then asked if knowing this change in recommendation has changed or will change their screening practices in adolescents. Main results. 1400 surveys were mailed. After 2 were excluded due to mailing issues, 52% of providers provided responses. Of these, 129 providers reported that they did not care for adolescents (age 10-17), resulting in 604 providers in the final sample, 398 pediatricians and 335 FPs. The vast majority (92%) said they would screen the hypothetical case for diabetes, with most initially ordering a fasting test (fasting plasma glucose or 2-hour glucose tolerance test) (63%) or A1c test (58%). Of the 58% who planned to order HbA1c, only 35% ordered it in combination with a fasting test. HbA1c was significantly more likely to be ordered by pediatricians than by FPs (P = 0.001). After being presented with the new guidelines, 84% said then would now order HbA1c, a 27% increase. Conclusion. In response to information about the new guidelines, providers were more likely to order A1c as part of initial testing. Due to the lower test performance in children and increased cost of the test, the use of HbA1c without fasting tests may result in missed diagnosis of T2D in adolescents as well as increased health care costs.

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The literature supports that organizations that create working conditions with positive practice environments improve nurses' job satisfaction and reduce turnover in hospital settings (Havens & Johnston, 2004; International Council of Nurses [ICN], 2007). Positive practice environments promote quality nursing care and better patient outcomes. However, in South America, there are no instruments to measure the nursing practice environment in a hospital setting. The purpose of this research was to examine the validity and reliability of a Spanish translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI; Lake, 2002) in the Colombian clinical context. An instrument validation study using expert panel review, content validity indexing techniques, and a factor analysis of survey responses from 144 nurses was used. The scale-level content validity evaluation achieved high levels of acceptability, with values above 0.90. Construct validity results suggest that the instrument consists of 5 factors as prescribed by original instrument. The overall internal consistency value was a Cronbach's alpha level of 0.89. This is the first instrument to measure the work environment of nursing practice in South America, now validated in the Colombian context.

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Objective: The objective of this study is to evaluate the content validity of the Iberian Spanish version of the questionnaire The Practice Environment Scale of the Nursing Work Index (PES-NWI) by using the Content Validity Indexing (CVI). Methods: A descriptive cross-sectional observational study was conducted. The Spanish version of the questionnaire was translated from the American English instrument through forward and back translation processes. Experts evaluated the translated items through content validity indexing. Once the assessments were completed, CVI indicators were calculated: number of agreements, item Content Validity Index and overall content validity and modified kappa coefficient of the instrument. Results: The overall content validity of the instrument was 0.82. The average modified kappa coefficient of the items was 0.80, with a rating of 'excellent'. Only 4 of the items were rated as weak or poor. Conclusions: The study demonstrates that the content validity of the Spanish version of the PES-NWI is acceptable. Some results indicate that some items have cross-cultural applicability challenges that need to be addressed in future research studies. Use of the instrument in other Spanish language speaking countries should be taken with caution since some words may not reflect the language of the healthcare systems there.

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