循证医学中常用统计指标的介绍

本文集中介绍了循证医学中的常用统计指标,如RRR(相对危险度减少率,relative risk reduetion)、ARR(绝对危险度减少率,absolute risk reduction)、NNT(需要处理的病人数,number needed to treat)等的意义和用途,以供循证医学研究者参考.     

可信区间的用途和意义

本文介绍了可信区间的用途和意义,并集中举例说明了常用统计指标,如RRR(relative risk reduction,相对危险度减少率)、ARR(absolute risk reduction,绝对危险度减少率)、NNT(number needed to treat,需要处理的病人数)等的可信区间计算方法,以供循证医学研究者参考.     

循证医学中常用统计指标的介绍

本集中介绍了循证医学中的常用统计指标，如RRR（相对危险度减少率,relative risk reduction)、ARR（绝对危险度减少率，absolute risk reduction)、NNT（需要处理的病人数，number needed to treat)等人的意义和用途，以供循证医学研究参考。     

可信区间的用途和意义

本介绍了可信区间的用途和意义，并集中举例说明了常用统计指标，如RRR（relative risk reduction,相对危险率减少率）、ARR（absolute risk reduction,绝对危险度减少率）、NNT（number needed tgo treat,需要处理的病人数）等的可信区间计算方法，以供循证医学研究参考。     

中药足浴对胃癌术后睡眠障碍病人疗效的循证医学评价

[目的]用循证医学方法评价中药足浴对胃癌术后睡眠障碍病人的疗效.[方法]选取2011年9月-2012年9月住院行胃癌手术后睡眠障碍病人80例,按随机数字表分为两组各40例,观察组采用中药足浴法;对照组采用外观颜色、温度相同的纯水足浴液足浴,每次30 min,每日1次,5次为1个观察周期.观察两组足浴后的总有效率、足浴前后睡眠积分情况及循证医学评价.[结果]两组总有效率、睡眠积分比较差异有统计学意义（P＜0.01）;比值比（OR）为0.15,OR95％置信区间（CI）为0.05～4.30;相对危险度（RR）为0.14,RR95％ CI为0.04～0.42;相对危险度降低率（RRR）为86％,RRR95％ CI为58％～96％;绝对危险度降低率（ARR）为47.5％,ARR95％ CI为31.8％～63.2％;需要治疗的病例数（NNT）为2（例）,NNT95％ CI为2（例）～3（例）.[结论]中药足浴能使胃癌术后病人睡眠改善,有利于机体康复;且有循证医学评价指标支持.     

循证医学中统计指标的正确应用

循证医学实践包括提供证据(创造证据)和证据的应用,提供证据的研究人员(doer)应能正确选用有关的统计方法,证据的应用者(user)应能认识某研究证据中所使用的统计方法,以此推断其结果的可靠性。因此,理解有关的统计方法,对循证医学的研究者和应用者均是重要的内容。介绍循证医学中的常用统计指标,如OR(比值比,oddsratio)、RR(相对危险度,relativerisk)、RRR(相对危险度减少率,rela-tiveriskreduction)、ARR(绝对危险度减少率,absoluteriskreduction)、NNT(需要处理的患者数,numberneededtotreat)等的意义和用途,并着重介绍了这些指标的可信区间计算方法、用途和意义,可以供循证医学研究者参考。     

循证医学中统计指标的正确应用

循证医学实践包括提供证据（创造证据）和证据的应用，提供证据的研究人员（doer)应能正确选用有关的统计方法，证据的应用者（user)应能认识某研究证据中所使用的统计方法，以此推断其结果的可靠性。因此，理解有关的统计方法，对循证医学的研究者和应用者均是重要的内容。介绍循证医学中的常用统计指标，如OR（比值法，odds ratio)、RR（相对危险度，relative risk)、RRR(相对危险度减少率，relative risk reduction)、ARR（绝对危险度减少率，absolute risk reduction)、NNT（需要处理的患者数，number needed to treat)等的意义和用途，并着重介绍了这些指标的可信区间计算方法、用途和意义，可以供循证医学研究者参考。     

与循证医学相关的名词及其解释

·Absolute risk（AR）：净危险性（事件发生率） 在一定期间，某个个体发生某种结局事件的概率。用公式表达为： 净危险性=试验组或对照组发生的事件（有利事件或不良事件）数/该组人数 净危险性取值0至1。与一般用法不同的是，这里“危险性”一词可以指不良事件（如心肌梗死），或指期盼的事件（如治愈）。 ·Absolute risk reduction(ARR)：净危险性减少 这是一种评价治疗效果的指标。某项试验中试验组与对照组之间危险性的净差异。当对照组的危险性超过了试验组的危险性时，用此指标。计算方法为对照组危险性（ARC）减去试验组危险性（ART），即ARR=ARC－ART。例1，有3项关于加强胰岛素治疗以减少视网膜病变恶化的随机化分组的临床试验，合并这3项试验的结果显示，试验组的视网膜病变恶化率为13％（ART），对照组为38％（ARC），其ARR=38％－13％=25％。该项指标并不说明两组危险性的下降比例，此时需用相对危险性减少（RRR）这个指标。 ·Absolute risk increase（ARI）：净危险性增加 某项试验中试验组与对照组之间危险性的净差异。当试验组的危险性超过了对照组的危险性时，用此指标。计算方法为试验组危险性减去对照组危险性，即ARI=ART－ARC。例2，有3项关于加强胰岛素治疗以减少视网膜病变恶化的随机化分组的临床试验，合并分析结果显示，试验组的有症状的低血糖发生率为57％（ART），对照组为23％（ABC），其ARI=57％－23％=34％。该项指标并不说明两组之间危险性的增加比例，此时需用相对危险性增加（RRI）这个指标。 ·Relative risk（RR）：相对危险性 与另一组相比，一组中更可能发生（RR大于1）某事件或较少可能发生（RR小于1）某事件的倍数。如果事件罕见，相对危险性与比数比（OR）相似，它等于各组的净危险性之比。计算公式为RR=ART/ARC=1－RRR。上例中，RR=13％/38％=0.342，说明加强胰岛素治疗有保护作用。 ·Relative risk reduction（RRR）:相对危险性减少 这也是一种评价治疗效果的指标。某试验中，试验组与对照组之间危险性（不良结局率）减少比例。它等于相对危险性的互补值（1－RR）。计算公式为RRR=（ARC－ART）/ARC=1－RR，上例中，RR为0.342，RRR=（38％－13％）/38％=0.658，也就是说治疗组某种不良结局的相对危险性较对照组减少65.8％。在一定范围的净危险性内，RRR是恒定的。但在净危险性较高的人群中ARR较高、需要治疗的人数（NNT）较低。例如，根据年龄和其它危险因素估计，如不治疗某人的脑卒中净危险性为25％，治疗后降至20％，ARR=25％－20％=5％或0.05；RRR=（25％－20％）/20％=25％或0.25；NNT=1/0.05=20。而一名不治疗的个体发生脑卒中的净危险性为2.5％，治疗后降至2％，ARR=2.5％－2％=0.5％或0.005；RRR=（2.5％－2％）/2％=25％或0.25；NNT=1/0.005=200。     

系统化健康宣教对家属知晓计划免疫的作用

目的:探讨系统化健康宣教对提高患儿家属计划免疫知识知晓程度的作用。方法:将90名家属随机分为宣教组和对照组(各45名)。对前者进行系统化健康宣教及后者给予常规宣教后,经问卷调查评分比较其效果。结果:宣教组计划免疫知识得分比对照组高(t=9.911,P=0.000);宣教组非常知晓、比较知晓、基本知晓和不知晓率比对照组相应率高(χ2=51.213,P=0.000);临床意义分析:RR=0<1,RRR=1>0,ARR=0.311 1>0,NNT=3.214 4。结论:系统化健康宣教可提高病儿家属计划免疫知识的知晓,对实施计划免疫及预防传染病意义深远。     

基于学生视角护理硕士专业学位课程现状与意向分析

[目的]了解护理专业学位研究生课程设置现状,探讨其对课程设置的意向,为完善课程建设提供依据。[方法]采用自设问卷对213名护理硕士研究生进行调查,了解课程现状并分析其对课程的内在需求,采用t检验、χ2检验、主成分分析等统计方法进行分析。[结果]专业学位与科学学位研究生在课程安排、课程设置、授课内容、授课方法、考核时间、授课形式上比较差异皆无统计学意义(P0.05)。专业学位研究生选择专业技术课的得分高于科学学位研究生,而选择科研基础课的得分低于科学学位研究生(P0.05)。[结论]专业学位研究生视角下期望开设的课程与科学学位研究生的需求不一样,应根据专业学位研究生的需求和培养目标进行课程改革。     

Concept Analysis of Adherence in the Context of Cardiovascular Risk Reduction

TOPIC. Cardiovascular disease is the number one cause of death in the United States. Examination of the concept of adherence is essential to provide informed patient‐centered care to prevent the development and progression of this largely preventable disease. OBJECTIVE. The purpose of this concept analysis is to explore and clarify the concept of adherence. This analysis will provide a framework for those seeking a better understanding of patient decision‐making, reduction of relapse to unhealthy behaviors, and increased long‐term adherence to cardiovascular health recommendations. Reviews of major theories related to health behavior are reviewed in the second part of the article and are linked to the concept of adherence. METHOD. Following a review of the literature, Morse's guidelines were utilized to present a concept analysis of adherence and the related terms concordance and compliance from the disciplines of nursing, health psychology, ethics, pharmacy, and medicine. RESULTS. Adherence is dependent on the collaborative relationship between patient and healthcare provider. Adherence is influenced by the meaning of health, heart disease, and sense of personal risk as well as socioeconomic status, decision support, motivation, and desire for change, self‐efficacy, and sources of credible health information. Attributes of successful adherence include alignment of patient behavior and health recommendations, mastery of new health knowledge and behavior, continued collaborative relationships between the patient and healthcare provider, and ability to meet outcome targets. CONCLUSION. Adherence is defined as persistence in the practice and maintenance of desired health behaviors and is the result of active participation and agreement. Adherence is dependent on the development of a concordant relationship and its measurement should be specific utilizing the correct tools. Special attention should be paid to shared decision‐making between patient and healthcare provider.     

The Food and Drug Administration Risk Evaluation and Mitigation Strategy

ABSTRACT

The Food and Drug Administration Amendments Act of 2007 extended the agency's regulatory authority over drug products that have been shown to place patients at risk. This Act authorizes the FDA to require pharmaceutical manufacturers and distributors to ensure that the safety of their products continue to outweigh the risks. This article discusses in more detail the proposed elements of an acceptable Risk Evaluation and Mitigation Strategy (REMS) for any drug product, including extended-release opioid analgesics.     

Factors Influencing Safer Sexual Behaviors in Heterosexual Late Adolescent and Young Adult Collegiate Males

An exploratory study examined variables characterized as predisposing to the practice of safe sexual behaviors. A sample of 227 male subjects from a state-supported university in southeastern New England returned questionnaires anonymously that contained demographic questions and instruments to measure the study variables. After removing two variables for low internal consistency reliabilities, the remaining five were entered simultaneously into a multiple regression equation. The variables captured 2 1 % of the variance. The direction and magnitude of the statistically significant standardized beta weights are as follows: attitude toward condoms, .41; internal health locus of control, .22; and self-esteem, -.16. These attitudes and characteristics can be incorporated into interventions to reduce sexual exposure to HIV.     

Outcome Expectancies and Risk-Taking Behavior

One explanation for risk-taking behavior despite warnings about the dangers is that anticipated positive consequences outweigh possible negative outcomes. In a five-part investigation, a new questionnaire was developed to assess outcome expectancies for the potential consequences of involvement in a variety of risky activities. Conceptual and methodological limitations of previously available questionnaires were addressed and content, construct, and criterion validity were demonstrated. The new questionnaire measures respondents' beliefs about the consequences of 30 risky activities, as well as their expected and actual involvement in those activities. Consistent with a large body of alcohol expectancy research, beliefs about potential benefits were found to be more reliably associated with risk-taking than were beliefs about potential negative consequences. Implications for cognitive approaches to harm reduction are discussed.     

临床防治性研究结果的评价方法

伴随着临床医学由传统的经验医学 向遵循语气的循 医学的转变,寻求科学的最好临床证据成为越来越多医务工作者关注的焦点,疾病的有效防治成为临床医学研究的最大热点。因此,探索客观,真实,有效的防治性研究结果,并用于临床医疗实 于实践循证医学有着十分重要的意义。     

The process of changing health risk behaviors: an Oregon rural clinic experience

PURPOSE: A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change. DATA SOURCES: Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader. CONCLUSIONS: Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors. IMPLICATIONS FOR PRACTICE: NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer-mentoring program.