Construct Validity and Inter-Rater Reliability of a Tool Designed for Nurses

[Posted 17/Jan/2023]

AUDIENCE: Nursing

KEY FINDINGS: The surgical wound assessment tool was deemed to be acceptable, valid and reliable for monitoring the status of surgical wound healing. However, further modification and testing are needed to strengthen the tool and to determine the applicability of the tool in other populations.

BACKGROUND: Purpose of this study is to validate construct validity and inter-rater reliability of a surgical wound assessment tool. Wound assessment is central to appropriate wound management. However, limited standard surgical wound assessment tools are available to assist nurses in assessing and recording progress in the healing of surgical wounds.

DETAILS: A prospective observational study was utilised to test the validity and reliability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline was used. Convenience sampling was used to recruit 260 patients who underwent elective or emergency surgery at a hospital in Vietnam. Exploratory factor analysis was used to examine the construct validity of the surgical wound assessment tool. Inter-rater reliability was calculated using the intraclass correlation coefficient and Cohen's kappa to determine reliability of the overall scale and identified items. The results of the exploratory factor analysis supported a three-component structure of the surgical wound assessment tool. The intraclass correlation coefficient value of the overall scale was 0.79 (95% CI 0.67-0.89), p < .001, confirming excellent inter-rater reliability. Cohen's kappa value ranged from 0.5 to 1, demonstrating moderate to almost perfect level of agreement for individual items, except for one item on pain.

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Source: Do, H. T. T., Edwards, H., Finlayson, K. (2023). Surgical Wound Assessment Tool: Construct Validity and Inter-Rater Reliability of a Tool Designed for Nurses. Journal of Clinical Nursing. 2023; 32: 83-95. Published: January, 2023. DOI: 10.1111/jocn.16476.

[Posted 14/Oct/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: Aztreonam/avibactam retained substantial in vitro activity against Enterobacterales resistant to other advanced beta-lactam/beta-lactamase inhibitor combinations, including MBL-producing organisms. The findings are particularly relevant as NDM and other MBLs increasingly complicate the treatment of CRE infections. These results support the potential role of aztreonam/avibactam as a treatment option for selected infections caused by resistant Gram-negative bacteria. However, laboratory susceptibility findings do not establish clinical effectiveness in individual patients. Treatment decisions should incorporate susceptibility testing, infection site, patient factors, and applicable clinical guidance. Continued surveillance is also necessary to monitor emerging resistance.

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) are an increasing clinical concern because resistance to newer antibiotics, including ceftazidime/avibactam and meropenem/vaborbactam, limits treatment options for serious infections. Metallo-beta-lactamase (MBL)-producing organisms pose a particular challenge because these enzymes can inactivate many beta-lactam antibiotics. Aztreonam/avibactam combines aztreonam's stability against MBL-mediated hydrolysis with avibactam's inhibition of several other beta-lactamases. This study assessed its in vitro activity against resistant Enterobacterales collected from US medical centers.

DETAILS: Investigators analyzed 80,927 Enterobacterales isolates collected from 103 US medical centers between 2016 and 2024, with one isolate per patient. Antimicrobial susceptibility was evaluated using broth microdilution. The analysis focused on isolates that were not susceptible to ceftazidime/avibactam, meropenem/vaborbactam, or both, as well as carbapenem-resistant and MBL-producing isolates. Whole-genome sequencing was used to identify carbapenemase genes in resistant isolates. Among the collected isolates, 194 (0.24%) were not susceptible to ceftazidime/avibactam or meropenem/vaborbactam, 115 (0.14%) were not susceptible to both combinations, and 832 (1.0%) were carbapenem resistant.

Aztreonam/avibactam demonstrated activity against 91.9% of ceftazidime/avibactam-nonsusceptible isolates and 94.0% of meropenem/vaborbactam-nonsusceptible isolates. Activity was observed against 98.1% of CRE isolates and 98.4% of MBL-producing isolates. Cefiderocol was active against 78.8% of ceftazidime/avibactam-nonsusceptible isolates, 83.2% of meropenem/vaborbactam-nonsusceptible isolates, 94.7% of CRE isolates, and 82.1% of MBL producers. Genetic analysis identified carbapenemase genes in 159 (82.0%) of isolates nonsusceptible to ceftazidime/avibactam or meropenem/vaborbactam and in 683 (80.1%) of CRE isolates. New Delhi metallo-beta-lactamase (NDM) was the most common carbapenemase among the resistant isolates, identified in 114 (58.8%). Notably, MBL-producing organisms accounted for 36.1% (73/202) of CRE isolates collected during 2023–2024, highlighting the importance of continued resistance surveillance.

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Source: Sader, H. S., Papp-Wallace, K. M., Kimbrough, J. H., et al. Antimicrobial activity of aztreonam/avibactam and molecular characterization of Enterobacterales not susceptible to ceftazidime/avibactam and/or meropenem/vaborbactam from US medical centres (2016-2024). Journal of Antimicrobial Chemotherapy. 2026; 81(10). Published: October, 2026. DOI: 10.1093/jac/dkag308.

[Posted 13/Oct/2026]

AUDIENCE: Emergency Medicine, Geriatrics, Internal Medicine

KEY FINDINGS: This study suggests that frailty may provide clinically relevant information when assessing hospitalization needs in older adults presenting to the emergency department. The association was most apparent in patients assigned lower triage urgency categories, although the formal analysis did not confirm a statistically significant difference across categories.

Incorporating frailty assessment into geriatric emergency care may help clinicians consider functional vulnerability alongside acute illness severity. However, the findings are based on a single-center retrospective study and do not establish that frailty itself causes hospitalization. Further prospective, multicenter research is needed to clarify how frailty, social circumstances, clinical decision-making, and healthcare-system factors influence disposition.

BACKGROUND: Emergency department (ED) triage systems prioritize patients according to the urgency of their acute medical conditions. However, among older adults, frailty may also influence the need for hospitalization, even when patients have similar triage-assessed urgency. Understanding the relationship between frailty and hospital admission may help clinicians improve geriatric assessment and disposition decisions in emergency care.

DETAILS: This single-center retrospective cohort study was conducted at an urban tertiary hospital in Japan. Investigators analyzed emergency department visits by patients aged 65 years or older between November 2025 and March 2026. Frailty was defined as a score of 5 or higher on the Clinical Frailty Scale (CFS). Triage urgency was classified using the Japan Triage and Acuity Scale (JTAS). The primary outcome was hospitalization at the study hospital or transfer to another acute-care hospital. The investigators used mixed-effects logistic regression, adjusting for age, sex, mode of arrival, injury- or poisoning-related visits, living arrangements, and long-term care needs certification. The analysis also examined whether the association between frailty and hospitalization differed across triage categories.

The study included 3,127 emergency department visits, of which 1,526 resulted in hospitalization. Among patients in JTAS category 2, frailty was not significantly associated with hospitalization (adjusted odds ratio [OR], 1.00; 95% CI, 0.65–1.55). In category 3, frailty was associated with higher odds of hospitalization (OR, 1.54; 95% CI, 1.19–1.99). In the combined JTAS categories 4 and 5, the adjusted odds of hospitalization were approximately twice as high among frail patients (OR, 2.01; 95% CI, 1.13–3.58). The association between frailty and hospitalization appeared stronger in the lower-acuity categories. However, the overall interaction between frailty and triage category was not statistically significant (P = 0.091), so the study did not establish that the association differed across triage levels.

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Source: Hata, N., Nagae, M., and Umegaki, H. Frailty and Hospitalization After Emergency Department Evaluation Within Triage Categories in Older Patients: A Retrospective Cohort Study. Academic Emergency Medicine. 2026; 33(10). Published: August 22, 2026. DOI: 10.1111/acem.70419.

[Posted 5/Oct/2026]

AUDIENCE: Family Medicine, Endocrinology, Primary Care

KEY FINDINGS: Among adults older than 50 years initiating levothyroxine, an initial dose exceeding 1.0 μg/kg per day was associated with higher long-term risks of cardiovascular events, bone outcomes, and all-cause mortality compared with lower initial dosing. The findings support careful consideration of initial dose and subsequent titration in older patients. However, the observational design does not establish that higher dosing directly caused these outcomes, and prospective studies are needed to validate the findings.

BACKGROUND: Levothyroxine is commonly prescribed for hypothyroidism, but determining an appropriate initial dose in older adults remains challenging. Both insufficient and excessive thyroid hormone replacement may adversely affect cardiovascular health, bone integrity, and survival. This study used an emulated target trial approach to evaluate the association between initial weight-based levothyroxine dosing and long-term clinical outcomes in adults older than 50 years.

DETAILS: This observational study used data from The Health Improvement Network, a UK primary care database, covering January 1, 2006, through December 31, 2021. Eligible participants were adults older than 50 years with diagnosed hypothyroidism, at least one recorded thyroid-stimulating hormone (TSH) measurement exceeding 4.0 mU/L, and a new levothyroxine prescription during the study period. The investigators compared patients initiating levothyroxine at more than 1.0 μg/kg per day with those receiving 1.0 μg/kg per day or less. Dosing was assessed using both total bodyweight and lean bodyweight. Participants were followed for up to 10 years for cardiovascular events, bone outcomes, and all-cause mortality. Inverse probability of treatment weighting was used to adjust for baseline confounders, and weighted Cox proportional hazards models were applied to estimate outcome associations.

A total of 19,027 records were eligible, including 14,296 women (75%) and 4,731 men (25%). The cardiovascular analysis included 15,463 adults, the bone health analysis included 14,947, and all 19,027 participants were included in the mortality analysis. Unweighted event rates were higher among patients initiating levothyroxine at more than 1.0 μg/kg per day than among those receiving lower doses. Cardiovascular events occurred in 20% versus 18%, bone outcomes in 13% versus 9%, and all-cause mortality in 18% versus 17%, respectively. Higher initial dosing was associated with increased risk of cardiovascular events (adjusted hazard ratio [HR], 1.18; 95% CI, 1.08-1.29), bone outcomes (HR, 1.29; 95% CI, 1.16-1.43), and all-cause mortality (HR, 1.17; 95% CI, 1.09-1.25).

Using total bodyweight-based dosing, the weighted 10-year absolute risk differences between the higher- and lower-dose groups were 1.3% (95% CI, 0.3-3.0) for cardiovascular events, 3.0% (95% CI, 1.6-4.5) for bone outcomes, and 3.4% (95% CI, 1.7-5.1) for all-cause mortality. Similar associations were observed in analyses using lean bodyweight-based dosing.

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Source: Holley, M., Wilkes, S., Moss, E. D., et al. Weight-based levothyroxine dosing and long-term cardiovascular, bone, and mortality outcomes in older adults: an emulated target trial using UK primary care data. The Lancet Primary Care. 2026; 2(8): 100194. Published: August, 2026. DOI: 10.1016/j.lanprc.2026.100194.

[Posted 30/Sep/2026]

AUDIENCE: Gastroenterology, Oncology, Internal Medicine

KEY FINDINGS: In this international randomized trial conducted at specialized Lynch syndrome surveillance centres, adding AI-assisted detection to high-definition white-light colonoscopy did not significantly increase adenoma detection. Although the CADx system demonstrated good sensitivity and specificity for lesion differentiation, it did not clearly provide an advantage over expert optical diagnosis in this specialist setting. The findings indicate that the benefit of AI-assisted colonoscopy may depend on the expertise and clinical setting in which it is deployed.

BACKGROUND: Individuals with Lynch syndrome undergo regular colonoscopic surveillance because of their increased risk of colorectal cancer. Artificial intelligence (AI)-based computer-aided detection (CADe) has improved adenoma detection in average-risk colorectal cancer screening, but evidence in Lynch syndrome surveillance has been limited. The CADLY2 trial evaluated whether AI-assisted colonoscopy could improve adenoma detection and whether computer-aided optical diagnosis (CADx) could accurately differentiate neoplastic from non-neoplastic colorectal lesions.

DETAILS: This international, multicentre, open-label, randomized controlled trial was conducted at nine specialized hereditary cancer surveillance centres in Belgium, Germany, the Netherlands, and Spain. Adults aged 18 years or older with genetically confirmed Lynch syndrome undergoing surveillance colonoscopy were randomly assigned to high-definition white-light (HD-WL) colonoscopy alone or HD-WL colonoscopy assisted by the CAD EYE AI system. CADe was used during withdrawal to identify lesions, while CADx was used after lesion detection to assist with optical differentiation. The primary outcome was adenoma detection rate, defined as the proportion of patients with at least one histopathologically confirmed adenoma.

Between May 9, 2023, and October 30, 2025, 757 patients were randomly assigned to HD-WL colonoscopy (377) or AI-assisted colonoscopy (380). The primary analysis included 733 patients: 369 in the HD-WL group and 364 in the AI-assisted group. Adenoma detection occurred in 30.9% of patients undergoing HD-WL colonoscopy compared with 33.8% receiving AI-assisted colonoscopy. The odds ratio was 1.14 (95% CI, 0.83-1.57; P=0.41), indicating no statistically significant improvement in adenoma detection with CADe. In the lesion-level analysis, CADx differentiated neoplastic from non-neoplastic lesions with a sensitivity of 85.9% (95% CI, 82.0-89.1) and specificity of 91.4% (95% CI, 89.4-93.0). Three adverse events occurred in the AI-assisted group, including two mild post-polypectomy bleeding events and one serious pulmonary embolism or deep venous thrombosis considered unrelated to the procedure. No adverse events were reported in the HD-WL group.

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Source: Hüneburg, R., van Bokhorst, Q. N. E., Pellisé, M., et al. Artificial intelligence-assisted detection and optical differentiation of colorectal lesions in Lynch syndrome surveillance (CADLY2): a multicentre, open-label, randomised controlled superiority trial. The Lancet Gastroenterology & Hepatology. 2026; 11(10): 875-886. Published: October, 2026. DOI: 10.1016/S2468-1253(26)00163-9.

[Posted 29/Sep/2026]

AUDIENCE: Internal Medicine, Sports Medicine, Family Medicine

KEY FINDINGS: In young adults with persistent knee symptoms after ACL reconstruction, a 4-month supervised exercise and education program produced greater short-term improvements in knee pain, symptoms, function, and quality of life than minimal education and self-directed exercise. The treatment difference diminished by 12 months, and no difference in cartilage thickness was observed, providing trial evidence that the supervised exercise program did not result in detectable adverse changes in this structural measure over the study period. The findings support the potential value of structured rehabilitation for patients who continue to experience knee problems after the usual postoperative rehabilitation period.

BACKGROUND: Persistent pain, functional limitations, and reduced quality of life can continue in young adults after anterior cruciate ligament reconstruction (ACLR), increasing concern about early post-traumatic knee osteoarthritis. The SUPER-Knee randomized clinical trial evaluated whether a structured, physiotherapist-supervised exercise and education program could improve knee symptoms and function in young adults with ongoing problems after ACLR, while also examining whether exercise affected knee cartilage.

DETAILS: The randomized clinical trial enrolled 184 adults aged 18 to 40 years who remained symptomatic 9 to 36 months after ACL reconstruction. Participants were randomly assigned to either a 4-month individualized program of twice-weekly, physiotherapist-supervised strengthening and neuromuscular exercise with education or a minimal-intervention group receiving a one-time education session and advice for self-directed exercise. The primary outcome was change in the Knee injury and Osteoarthritis Outcome Score (KOOS4), which incorporates pain, symptoms, function in sports and recreational activities, and knee-related quality of life. Secondary outcomes included patient-perceived recovery, thigh muscle strength, and MRI measures of cartilage.

Of the 184 participants, 92 were assigned to each group; 178 participants (97%) completed the 4-month assessment and 174 (95%) completed the 12-month assessment. At 4 months, KOOS4 scores improved by 14.1 points in the supervised exercise group compared with 9.3 points in the minimal-intervention group, corresponding to an adjusted between-group difference of 4.8 points (95% CI, 1.4 to 8.2). The difference was smaller at 12 months, with an adjusted between-group difference of 1.4 points (95% CI, -2.0 to 4.8). Participants receiving supervised exercise also had greater improvements in thigh muscle strength and were more likely to report that their knee had improved. The odds of reporting improvement were 5.2 times higher at 4 months (95% CI, 2.7 to 10.0) and 2.5 times higher at 12 months (95% CI, 1.3 to 4.9). MRI assessment showed no between-group difference in cartilage thickness.

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Source: Culvenor, A. G., Bruder, A. M., West, T., et al. XXExercise Therapy and Education for Young Adults With Persistent Knee Problems After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. Annals of Internal Medicine. Published: September 29, 2026. DOI: 10.7326/ANNALS-26-02460.