决策疲劳量表的汉化及其应用于ICU患者家属的信度效度评价

目的引进并翻译决策疲劳量表,并应用于ICU患者家属以检验中文版量表的信度和效度。方法对决策疲劳量表进行翻译、回译和跨文化调适,形成中文版决策疲劳量表。采用便利抽样法选取191例ICU患者家属进行调查。结果中文版决策疲劳量表包含9个条目,各条目和总量表得分显著相关(r=0.436~0.682,P<0.05);量表条目内容效度为0.800~1.000,量表总内容效度为0.950;决策疲劳量表与医院焦虑、抑郁情绪维度、疲劳量表得分的相关系数为(r=0.677~0.784,P<0.05);验证性因子分析显示各项拟合指数均达标;量表总Cronbachα系数为0.854,重测信度为0.863。职业进行分组,比较ICU患者家属中文版决策疲乏量表的得分。结果显示,ICU患者的入住ICU天数、ICU患者家属性别不同,其ICU患者家属决策疲乏得分比较,差异均有统计学意义(P<0.001)。结论中文版决策疲劳量表条目简洁,具有较好的信度和效度,可有效评估ICU患者家属决策疲劳状况。     

健康调查简表在糖尿病足患者生活质量评价中的适用性研究

目的:研究健康调查简表在糖尿病足患者的生活质量评价中的适用性。方法:采用健康调查简表对239例糖尿病足患者进行调研,对测量结果进行可行性、信度、效度、天花板效应和地板效应、反应度分析。结果:1可行性分析:量表完成时间为16.9±3.2min,完成率为100%;2信度分析:Cronbach'sα系数均高于0.80;组内相关系数均高于0.6;折半信度均高于0.8;3效度分析:因子分析所产生的2个主成分可解释总变异的69.03%,最大方差旋转后产生2个公共因子与量表的理论假设基本一致;量表各维度的Pearson相关系数均高于0.6;4天花板效应和地板效应:RP、PF 2个维度地板效应显著,分别为28.76%、33.69%;5反应度:各维度评分治疗后显著提高(P0.05)。结论:健康调查简表可较好的反应糖尿病足患者的生活质量,但个别条目需进一步完善。     

炎症性肠病痛苦量表的汉化及信效度检验

目的 对炎症性肠病痛苦量表进行汉化,并检验中文版量表的信效度。方法 按照Brislin翻译模型将英文版炎症性肠病痛苦量表翻译成中文,并进行文化调试。采用便利抽样法,选取2022年2月—6月在厦门市某三级甲等医院消化内科就诊或住院的178例炎症性肠病患者进行调查,检验中文版量表的信效度。结果 中文版炎症性肠病痛苦量表共1个维度,28个条目,量表总的Cronbach’s α系数为0.978,重测信度为0.68(95%CI为0.42～0.84);量表水平的内容效度指数为0.964,条目水平的内容效度指数为0.800～1.000。该量表得分与医院焦虑抑郁量表中焦虑、抑郁分量表得分均呈正相关（r=0.712,P<0.001;r=0.601,P<0.001）。结论 中文版炎症性肠病痛苦量表具有良好的信效度,可用于评估炎症性肠病患者的疾病痛苦水平。     

儿童自我报告结局测量信息系统的已知组别效度分析

目的检验儿童自我报告结局测量信息系统八大简表的可行性及已知组别效度。方法 2012年5-9月,采用便利抽样法选取上海市和成都市4所儿童医院8～17周岁的232名儿童和青少年癌症患者为研究对象,应用一般资料调查表、儿童自我报告结局测量信息系统八大简表对其进行调查,通过问卷有效回收率及回答有效性来分析其可行性,采用t/U检验来检验治疗期组和无进展生存期组的组间差异。结果本次调查共发放问卷247份,回收有效问卷232份,有效回收率为93.93%。治疗期组与无进展生存期组儿童的抑郁症状、愤怒、疲劳、疼痛影响、同伴关系、身体功能-移动性、身体功能-上肢功能七大简表测评结果的差异有统计学意义(P<0.05或P<0.01),儿童焦虑简表的测评结果差异无统计学意义(P>0.05)。结论儿童自我报告结局测量信息系统简表具有良好的可行性,大部分简表具有良好的已知组别效度,可进行该系统简表的其他测评,进而为儿童癌症患者提供可比、精确的健康相关测评工具。     

化疗所致周围神经病变评估工具的汉化及信效度检测

目的引进和翻译国外化疗所致周围神经病变评估工具,并验证其在我国癌症患者化疗所致周围神经病变评估中的信效度。方法经过翻译、回译和文化调适确定中文版问卷,便利抽样260例癌症患者进行问卷试调查。通过高低分组比较、条目与总分的相关、天花板效应和地板效应来进行量表的项目分析,并检验问卷的信效度。结果项目分析未有条目删除,各条目区分度较好,各条目与总分之间的相关系数为0.32~0.70(P0.01);除了化疗所致周围神经病变对日常生活活动的影响存在轻微地板效应外,其余分量表和总量表都不存在地板效应和天花板效应。总量表及分量表的Cronbach’sα系数为0.89~0.94,重测信度为0.89~0.93。在患者症状体验部分,提取出2个公因子,累积方差贡献率为53.61%;在对日常生活影响部分,提取出2个公因子,累积方差贡献率为57.46%。验证性因子分析发现各分量表模型的适配度良好。同时量表具有较好的区分效度和效标关联效度。结论中文版化疗所致周围神经病变评估工具具有良好的信效度,适用于评估中国癌症患者化疗所致周围神经病变。     

乳腺癌患者心理弹性量表的汉化及信效度检验

目的翻译乳腺癌患者心理弹性量表并检验其信效度。方法遵循Brislin模型对量表进行翻译,经过两轮德尔菲专家咨询形成最终量表。用中文版乳腺癌患者心理弹性量表对200名乳腺癌患者进行测试,以检验其信度和效度。结果中文版乳腺癌患者心理弹性量表经过因子分析最大方差正交旋转法,共提取2个因子、16个条目,累计贡献率为73.666%。量表共有个体保护(11个条目)和社会保护(5个条目)2个维度。总量表Cronbach’sα系数为0.948,个体保护维度Cronbach’sα系数0.931,社会保护维度Cronbach’sα系数0.943;总量表的折半信度为0.918;重测信度为0.905。量表各条目I-CVI为0.858～1.00,总量表S-CVI/Ave为0.947。结论中文版乳腺癌患者心理弹性量表的信度、效度良好,可作为衡量我国乳腺癌患者心理弹性的有效量表。     

乳腺癌患者心理社会适应问卷的研制

目的 研制科学、实用、有较好信度和效度的乳腺癌患者心理社会适应问卷.方法 通过大量文献回顾和对10例乳腺癌患者的半结构式访谈及对4位专家的咨询,形成初始化问卷,并通过对228例乳腺癌术后患者的调查,对问卷进行条目分析和信效度检验.结果 乳腺癌患者心理社会适应问卷共有44个条目,包括焦虑/抑郁、自尊和自我接纳、态度、归属感、自我控制和自我效能感5个维度.该问卷具有较好的内容效度,主成分分析提取出5个因子,累积贡献率54.578％,绝大多数条目在相应因子上的负荷达到0.4以上,结构与理论构想基本一致;参照于焦虑自评量表、一般自我效能感量表和自我接纳问卷的效标关联效度分别为-0.757、0.505、0.691.问卷的Cronbach's α系数为0.945,重测信度为0.961.结论 乳腺癌患者心理社会适应问卷具有较好的信度和效度,能客观、有效地评估乳腺癌患者的心理社会适应状况,具有较高的实用性和推广价值.     

孕妇产前检查焦虑量表的汉化及信效度研究

[目的]对孕妇产前检查焦虑量表(PDPAS)进行汉化,并检验其信效度。[方法]通过翻译、回译、跨文化调试和预实验,形成中文版PDPAS量表,并对兰州市某三级甲等医院等待做超声检查248名孕妇进行问卷调查,评价量表的信度和效度。[结果]中文版PDPAS量表包括对检查的焦虑和对结果的焦虑2个维度,共11个条目。量表条目水平的内容效度指数(I-CVI)为0.8～1.0,平均量表水平的内容效度指数(S-CVI)/Ave为0.96。探索性因子分析共提取2个公因子,累积方差贡献率为65.06%,校标效度为0.587。量表总的Cronbach'sα系数为0.911,重测信度为0.899。[结论]中文版PDPAS量表信效度较好,可用于我国孕妇产前检查焦虑水平的测量。     

中文版认知融合问卷在乳腺癌人群中的信效度研究

目的在乳腺癌人群中应用中文版认知融合问卷(CFQ)并检测其信效度,为未来研究的开展提供科学依据。方法用中文版认知融合问卷(CFQ)对110例乳腺癌确诊患者进行调查,对测量数据进行信度和效度分析。结果中文版认知融合问卷(CFQ)总量表的Cronbach'sα系数为0.898;重测信度系数为0.986,差异有统计学意义(P0.01);Pearson相关分析结果显示各条目和量表的总得分相关系数(r)在0.618～0.809之间,差异均有统计学意义(P0.01);高分组与低分组得分差异有统计学意义(t=16.394,P0.01),具有良好的鉴别效度。结论中文版认知融合问卷(CFQ)在乳腺癌人群中的信效度较好,可用于评估乳腺癌患者认知融合水平。     

中文版化疗脱发困扰量表应用于乳腺癌患者的信效度评价

目的 对化疗脱发困扰量表翻译及跨文化调适,并在乳腺癌患者中检验其信效度.方法 将英文版翻译为中文,采用方便抽样法选取160例接受化疗的乳腺癌患者进行问卷调查,采用SPSS 20.0和AMOS 17.0测定量表的信度及效度.结果中文版化疗脱发困扰量表包含17个条目,探索性因子分析提取4个公因子,累计方差贡献率为56.108％.验证性因子分析所得模型拟合度良好.量表的Cronbachα系数为0.864;Guttman分半信度为0.775;重测信度为0.931.结论 中文版化疗脱发困扰量表具有较好的信效度,适用于评估中国乳腺癌患者的化疗脱发困扰程度.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.