SF-36量表用于事业单位员工健康测量的信度与效度评价

目的对SF-36量表用于事业单位工作人员健康测量的信度与效度进行评价,为事业单位工作人员健康测量工具的开发或选择提供依据。方法应用SF-36量表对整群抽取的东莞市5家事业单位的员工进行调查,采用SPSS和LISREL软件对SF-36量表的信度与效度进行分析。结果 SF-36量表的整体克朗巴哈系数以及PCS和MCS两个领域8个维度各自的克朗巴哈系数均在0.70以上,Spearman-Brown分半信度系数为0.767。量表结构效度的二阶验证性因子分析模型拟合指数RMSEA为0.071,NNFI为0.90,CFI为0.91,一阶因子载荷标准解以及二阶因子载荷标准解均大于0.30,t检验的P<0.05。结论 SF-36量表用于事业单位员工健康状况测量具有较好的信度与效度,可以作为事业单位工作人员健康测量的工具。     

工作内容量表(中文版)在医务人员中的验证

目的 开发中文版《工作内容量表》(job content questionnaire,JCQ)(1．5版)，考评它在临床医务人员中的使用情况。方法 将Robert Karasek编写的英文版JCQ泽成中文，并回泽。以云南省两家综合医院内科、外科、妇产科、急诊科的临床医护人员(320例)为样本，评定信度和效度，随机抽取24例在一周后进行重测，以评定重测信度。结果 中译本回译一致率95％，问卷有效回答率92．8％(297例)。JCQ含8个模块，共49个条目。8个模块的同质信度Cronbach'a系数的0．52-0．86，复测信度0．87-0．95；主成分因子分析提取8个因子，方差累积贡献率46．95％，进行方差最大正交旋转，8个因子的条目组成与JCQ量表中除不稳定工作因素(JI)以外的7个模块组成一致。Pearson相关检验证实问卷大部分条目的结构效度较好，但宏观工作自主度、JI两个模块的部分条目的相关性较低，考虑为不同的文化背景所致。结论 JCQ中文译本能够反映其理论基础中三个与职业紧张相关的维度。中文JCQ在效度、信度上符合心理测量学的要求，但部分条目仍须作进一步深入文化调试。     

中国成人心理健康量表的编制与其标准化

目前国内常用的成人心理健康评估工具之一为症状自评量表（SCL-90）。该量表的信度效度指标较好。但由于该量表是在西方化背景下开发，包含比较广泛的精神病症状学的内容。更适用于临床诊断和研究。鉴于目前缺乏针对我国普通成人所开发的心理健康量表的情况，作在多年调查研究的基础上编制了适用于我国成人的心理健康量表。并对该表的信度和效度进行检验，探索初步的常模资料，为国内成人心理健康研究提供更具针对性的有效评估工具。     

工作紧张测量量表(JSS)信度和结构效度分析

目的分析工作紧张测量量表(JSS)信度和结构效度。方法采用分层整群随机抽样的方法抽取中小学教师、医生、银行职员、环境保护工作者共991人作为样本,选用同质性信度和结构效度对JSS量表的信度和效度进行评价。结果JSS量表及其子项目α系数高于SPIELBERGER多次对JSS量表进行信度检验的结果,说明本次引进的JSS工具具有较好的信度,也即具有很好的同质性。利用结构方程模型(SEM)中的验证性因子分析对JSS进行结构效度的分析,整个模型拟和很好,所有条目在3个潜因子负荷大于0.4,3个项目在JSS的负荷超过0.80(P<0.01)。说明相应条目度量对应的潜在因子结构比较合理。结论JSS量表经过适当的修订,可以作为我国职业紧张定量评价工具。     

新型农村合作医疗满意度测评量表研究

目的为考核地方各级部门管理绩效提供明确的指标与有效测量工具。方法自行编制满意度测评量表,并用Cronbach’s alpha系数和因子分析对量表进行信度和效度检验。结果量表各向度、信度均属于中度或高度,总条目的Cronbach’s alpha系数为0.7348;因子分析表明调查量表包括6个领域,与专业理论大体一致;应用AMOS8.0软件对调查数据进行拟合,验证量表量的结构效度,分析结果显示拟合效果良好。结论该量表具有较好的信度和效度,可用做新型农村合作医疗满意度测量工具,应用于新型农村合作医疗的绩效评价研究。     

2～6岁儿童看护者养育行为量表的编制及其信度效度分析

编制2～6岁儿童看护者养育行为量表, 并对量表的信效度进行验证。招募1 350名2～6岁儿童看护者, 采用条目区分度分析和探索性因子分析对量表结构、维度、条目进行分析, 采用同质信度、折半信度、重测信度对量表信度进行分析, 采用内容效度、结构效度对量表效度进行分析。结果显示, 量表共包含7个维度, 45个条目。同质信度分析显示, 总量表的Cronbach′s α系数为0.945;折半系数为0.899;重测信度分析显示, 两次测试相关系数分别为:0.893(总分), 0.854(社交), 0.832(语言), 0.871(大运动), 0.893(精细动作), 0.862(认知), 0.832(自理), 0.872(感觉)。2轮德尔菲专家咨询法对内容效度检验显示, 项目评分的kendall系数为0.813(P<0.01);结构效度分析显示, 本量表各维度与总量表、各维度之间均相关, 各维度平均方差提取值均大于该维度与其他维度的相关系数。整体而言, 本量表信度、效度良好, 可以作为2～6岁儿童看护者养育行为的评价和指导工具。     

居民就医障碍量表编制及信效度分析*

目的：开发居民就医障碍量表并验证其信效度，以期认识我国居民就医需求现状，缓解居民就医难题，为改革医疗卫生服务提供理论支持与实证工具。方法：通过文献研究法、半结构化访谈法及专家咨询法等形成量表初稿；采用分层多阶段抽样法开展调研并进行信效度检验分析，对量表进行验证。结果：经分析得到与理论相一致的量表框架结构，共包含 6 个维度及 31 个条目。各因子与总得分的相关系数在 0.783~0.888 （P＜0.01），Cronbach’s α系数及折半信度分别为 0.974 和 0.915。结论：就医障碍量表信效度良好，可提供多维度测量需方视角下就医障碍的工具，具有理论及实践价值。     

学习障碍筛查量表的修订与评价

目的 对国外“学习障碍筛查量表（ＰＲＳ）”进行了翻译和修订，旨在为我国学习障碍儿童的筛查提供了简便的工具。方法 对原量表进行了翻译修改，并对不同版本作了项目检验，以整群抽样方式测评了１０４７名小学生，其后进行了信度和效度检验。结果 该量表各项目得分呈常态，与原量表结构相符，其信度和效度在可接受范围内，因素分析后从量表中抽出三个主要因素，即言语因素、操作因素和社会适应因素，其权重项目数同于原版量表。     

慢性病患者生命质量测定量表体系——系统性红斑狼疮量表的研制及信度与效度分析

目的研制慢性病患者生命质量测定量表体系中的系统性红斑狼疮量表QLICD—SLE（V2．0），并对它的信度、效度进行分析。方法通过对143名系统性红斑狼疮病人的测量来考评该量表的信度和效度。结果系统性红斑狼疮量表QLICD—SLE（V2．0），由29个条目的共性模块（QLmD—GM）和19个条目的特异模块构成。各领域及总量表的Cronbach＇s α系数、分半信度和重测信度分别为：生理功能领域：0．74，0．83，0．74；心理功能领域：0．87，0．91，0．81；社会功能领域：0．75，0．79，0．72；特异模块领域：0．84，0．86，0．88；总量表：0．69，0．96，0．67。量表各条目和本领域得分的相关系数除GPS10、SLE14、SLE17这3个条目外都在0．60以上，且明显大于各条目和其他领域的相关系数。特异模块、共性模块因子分析结构均与理论构想一致。量表各领域与效标各领域显著相关。结论QLICD—SLE（V2．0）具有较好的信度、效度和临床可行性。     

三维工作疲劳量表的中文版修订

目的 翻译并修订三维工作疲劳量表(3D-WFI),并检验其在中国文化背景下的效度和信度。方法 对国内330制造业企业员工进行3D-WFI中文版初测(回收有效问卷314份),通过项目分析及探索性因子分析确定正式量表。选取810名制造业企业员工正式施测(回收有效问卷754份),进行验证性因子分析和内部一致性信度检验;同时选取工作倦怠普适量表(MBIGS)作为校标探究工作倦怠与工作疲劳的相关性。1个月后,选取其中270人检验重测信度。结果 3D-WFI中文版包含18个条目,分为躯体疲劳、精神疲劳以及情绪疲劳3个维度;验证性因子分析表明量表具有良好的结构效度(χ2=107.10,df=32,RMSEA=0.08,NFI=0.90,CFI=0.91,GFI=0.90,PGFI=0.52)。量表总的内部一致性系数为0.92,重测信度为0.82;付出、回报以及过度投入3个分量表的内部一致性系数分别为0.91、0.89、0.87,重测信度为别为0.58、0.79、0.81。结论 修订后的三维工作疲劳量表在选取的制造业企业员工样本中有良好的测量学指标,在测量我国制造业企业员工工作疲劳方面具有一定参考意义,未来的研究应扩大取样范围,多地区、多行业抽取样本,以期在更大范围内验证并推广三维工作疲劳量表的适用性。     

Precautionary approaches to the appraisal of risk: a case study of a genetically modified crop

There are strong scientific reasons for holding the broader scope of precautionary approaches to be more consistent with the scientific foundations of rational choice and probability theory than are conventional narrow risk-assessment techniques. The imperatives both of science and precaution can be seen to pull in the same direction. The regulatory appraisal of risk should become more systematic and broader in scope. In particular, a set of criteria can be developed concerning the need for greater humility, completeness, transparency, and participation in regulatory appraisal, with specific attention to the comparison of different options (including mixtures of options), the consideration of benefits and justifications, and the systematic "mapping" of the ways in which different framing assumptions lead to different pictures of performance. A case study of a pilot exercise applying a multi-criteria mapping method to the regulatory appraisal of a genetically modified crop is reported. The results are more complete than orthodox risk assessment, in that they embody consideration of an unlimited array of issues and include consideration of a wide range of different strategic alternatives to the use of GM technologies. It is concluded that conventional regulatory appraisal might be adapted to better address the imperatives of both science and precaution.     

数字化医院大型医疗设备绩效评价方式的改进研究

目的：数字化医院是通过宽带网络把数字化医疗设备、数字化医学影像系统和数字化医疗信息系统等全部临床作业过程纳入到数字化网络中,通过大型医疗设备的绩效评估监控管理设备的使用。方法：对大型医疗设备进行有效的绩效评估,可以促进其资源配置的优化、精准科学的管理,合理良性的应用,使大型医疗设备充分有效地应用到临床诊疗中。结果：基础数据的搜集,是大型医疗设备绩效评估的基础。基础数据的即时有效、真实准确以及规范科学可以增强大型医疗设备综合绩效管理评估的可操作性与科学性。结论：本研究通过设定大型医疗设备使用的基础数据采集规则,从而提高了大型医疗设备统计中基础数据的时效性、准确性和规范性。     

基于手术分类编码的四级手术目录分析与思考

目的2019年三级公立医院绩效考核将"出院患者四级手术比例"纳入考核,方法基于ICD-9-CM-3手术分类对《三级公立医院绩效考核四级手术目录》(2019年版)进行分析,以期对编码工作、医院管理和四级手术目录修订方面提供参考和建议。结果四级手术目录共2038条,涉及16个章节、576个分类。其中212个分类下仅部分编码为四级手术,仅"00"码为四级手术、仅"00"码为非四级手术、该分类下的四级手术条目含义清晰准确和该分类下存在包含含义的四级手术扩展码4种情况。结论编码人员应与时俱进地提高编码水平、医院应使用信息化手段把关手术填写质量提高四级手术填报率、国家主管部门应及时更新和维护四级手术目录,才能使公立医院绩效考核中四级手术的考核更加科学合理。     

对科室科研产出周期性考核办法的探讨

创建科研型肿瘤专科医院是北京大学肿瘤医院的发展宗旨之一,为充分调动科研人员的积极性,医院制定了以五年为一个考核周期的科研产出考核方案,同时设立年终科研优秀奖作为补充.办法实施以来,科研产出有明显提高,利用考核办法能及时掌握科室科研进展,并且考核周期、鼓励合作、采用可操作的考核指标、动态调整目标值等设计理念合理,后续拟通过分梯队设立考核指标改进方案,以期达到鼓励后进、激励先进,最终提高科研实力的目的.     

Plant secondary metabolites: antiparasitic effects and their role in ruminant production systems

The purported antiparasitic properties of plant secondary metabolites (PSM) have been the cause of controversy amongst the scientific community. Despite long-standing knowledge of the prophylactic and therapeutic properties of PSM-rich extracts, which comes mainly from ethnoveterinary sources, the scientific evidence of the antiparasitic effects of PSM is inconsistent. In the first part of the present paper the causes of this controversy are addressed, and the evidence available on the antiparasitic effects of PSM is critically examined. The focus is on examples of the antiparasitic activity of PSM against helminth nematodes. The conclusion is that PSM can have antiparasitic properties, which depend on their structure, level of ingestion and availability within the gastrointestinal tract of the animal. The second part is an appraisal of the potential role of PSM for parasite control in ruminant production systems. Despite their antiparasitic properties, PSM consumption does not necessarily have positive consequences in parasitised herbivores, as excessive consumption of PSM can adversely affect herbivore fitness and survival, through their anti-nutritional properties. For this reason it is suggested that the antiparasitic properties of PSM should be assessed at the same time as their anti-nutritional effects. The same measure, e.g. the performance of parasitised hosts, should be used when assessing these properties. The assessment of the costs and benefits suggests that parasitised herbivores can benefit from the long-term consumption of PSM only if the antiparasitic benefits outweigh the anti-nutritional costs of PSM. In addition, it is proposed that parasitised animals might be able to benefit from PSM consumption even if their performance is impaired, as long as the latter is a short-term compromise that leads to long-term benefits.     

以国家公立医院绩效考核为抓手推进医联体建设

目的通过分析国家公立医院绩效考核结果,探索精准推进医联体建设的方向。 方法以上海市某医联体内部A、B、C 三家医院为例,分析国家三级公立医院绩效考核反馈的2018年相关数据。结果A医院需关注与单病种相关的费用及病死率,提高门诊患者满意度和医务人员满意度;B医院需进一步加强胸痛中心和卒中中心相关疾病的单病种管理,提高住院医师首次参加医师资格考试通过率,医疗信息化建设水平,以及门诊患者满意度;C医院需进一步提升开展疑难手术的能力和医务人员科研能力。结论通过建立医联体医院信息互联互通,以国家公立医院绩效考核为抓手,可以精准推进医联体建设。     

A comparison of clinical practice guideline appraisal instruments

OBJECTIVE: To identify and compare clinical practice guideline appraisal instruments. METHODS: Appraisal instruments, defined as instruments intended to be used for guideline evaluation, were identified by searching MEDLINE (1966-99) using the Medical Subject Heading (MeSH) practice guidelines, reviewing bibliographies of the retrieved articles, and contacting authors of guideline appraisal instruments. Two reviewers independently examined the questions/statements from all the instruments and thematically grouped them. The 44 groupings were collapsed into 10 guideline attributes. Using the items, two reviewers independently undertook a content analysis of the instruments. RESULTS: Fifteen instruments were identified, and two were excluded because they were not focused on evaluation. All instruments were developed after 1992 and contained 8 to 142 questions/statements. Of the 44 items used for the content analysis, the number of items covered by each instrument ranged from 6 to 34. Only the instrument by Cluzeau and colleagues included at least one item for each of the 10 attributes, and it addressed 28 of the 44 items. This instrument and that of Shaneyfelt et al. are the only instruments that have so far been validated. CONCLUSIONS: A comprehensive, concise, and valid instrument could help users systematically judge the quality and utility of clinical practice guidelines. The current instruments vary widely in length and comprehensiveness. There is insufficient evidence to support the exclusive use of any one instrument, although the Cluzeau instrument has received the greatest evaluation. More research is required on the reliability and validity of existing guideline appraisal instruments before any one instrument can become widely adopted.     

贵州省乡镇卫生院骨干医师收入现状及其对工作满意度的影响

目的 了解贵州省乡镇卫生院骨干医师的收入现状,分析其收入对工作满意度的影响,为合理调整收入分配制度以提高乡镇卫生院骨干医师的工作满意度提供科学依据。方法 对贵州省2015年乡镇卫生院骨干医师培训项目的800名学员进行问卷调查,共收回790份有效问卷。描述乡镇骨干医师的收入现状,采用单因素和多重线性回归分析收入及相关因素与工作满意度的关系。结果 贵州省乡镇卫生院骨干医师的平均月收入为3 592元,期望月收入平均值为6149元。不同性别、年龄、工龄、职称、职务、学历的骨干医师收入存在统计学差异(P<0.05);多重线性回归结果显示,收入满意度、绩效考核制度实施情况和职务与工作满意度有统计学关联(P<0.05)。结论 贵州省乡镇卫生院骨干医师的收入水平偏低,收入满意度是激励骨干医师的重要杠杆,建议通过制定科学合理的绩效考核制度,不断提高收入满意度和水平,从而提高乡镇卫生院骨干医师的工作满意度和队伍稳定性。     

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments

ABSTRACT: BACKGROUND: Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. METHODS: To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. RESULTS: The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. CONCLUSIONS: The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test.     

护士绩效考核现况分析

通过文献回顾的方法对国内外护士绩效考核研究现状进行综述,得出目前护士绩效考核研究中存在的主要问题——考核指标体系的设计与现行的责任制整体护理模式不匹配,关键指标不能反映岗位管理、分层使用、责任护士包干患者及分级护理等诸多因素;工作量考核要么指标太复杂统计难度大,要么指标单一或者不全面代表性差;重考核轻沟通,回馈机制不完善等。为进一步构建科学合理的护士绩效考核指标体系及绩效工资分配方案提供依据。