脑卒中患者生存质量量表效度研究

目的：检验脑卒中患者生存质量疾病专表-脑卒中影响量表（SIS）应用于中国脑卒中患者的效度。方法：遵照SIS量表的发行机构MAPI推荐的程序及借鉴中山大学公共卫生学院统计学教研室译制经验编译SIS量表中文版，并使用此中文版对初次脑卒中发病后1个月的住院患者（180例）进行测量，运用相应的统计学方法进行效度分析。结果：SIS量表中文版的8个领域与FCA量表、SF-36量表的相关部分进行Pearson相关性分析，相关系数经统计学检验P〈0．05。结构效度中各公因子所包括的条目基本与原量表相同。结论：中文版SIS量表具有良好的效度，适用于脑卒中患者生存质量的评测。     

脑卒中照顾者照护结局量表中文版的信效度研究

[目的]检验脑卒中照顾者照护结局量表（BCOS）中文版的信度和效度。[方法]引进并翻译13（20S英文版,使用BCOS中文版对147位脑卒中主要照护者进行评估。[结果]BCOS总的Cronbaeh’s a系数为0．857,重测信度总的相关系数为0．878（P〈0．00]）。内容效度指数为0．968。经分析得到4个公因子,累积方差贡献率为64．180％。BCOS与脑卒中照顾者压力量表中文版呈负相关（r=-0．319,P〈0．01）,证实了其效标关联效度。[结论]BCOS中文版具有良好的信度和效度,可行性高,可用于脑卒中主要照顾者照顾负担的测评。     

Wolf运动功能测试量表的标准效度和评定者内部信度研究

目的：研究脑卒中偏瘫患者上肢运动的Wolf运动功能测试量表（WMFT）的标准效度和评定者内部信度研究。方法：22例脑卒中慢性期患者在2周内由同一测试者进行WMFT的检查，并与Fugl—Meyer评价量表上肢部分进行效度分析。结果：两次WMFT计时组内相关系数（ICC）为0．990，95％置信区间为0．977—0.996；两次WMFT动作质量分级组内相关系数（ICC）为0．988．95％置信区间为0.970—0．995。WM丌计时与WMFT动作质量分级相关系数为-0.971（P〈0．001）。WMFT计时与FMA上肢评分相关系数为-0．732（P〈0．001），WMFT动作质量分级与FMA评分相关系数为0．838（P〈0．001）。结论：WMFT具有好的重测信度和标准效度。     

中文版急性冠脉综合征反应指数量表信度及效度研究

目的：评价中文版急性冠脉综合征反应指数量表（C—ACSRI）的信度及效度。方法：采用翻译并修订的C—ACSRI对224例冠心病患者进行调查,并对结果进行信度、效度分析。结果：以Cronbach’s口系数检验总量表及态度、信念分量表的信度,Kuder—Rechardson 20（K-R20）系数检验知识分量表的信度,结果分别为0．81（总量表）、0．79（知识）、0．87（态度）、0．71（信念）。总量表的内容效度指数为0．93;分量表与总量表得分之间的相关系数为0．58～0．82,P〈0．01;主成分分析经方差最大正交旋转后,知识分量表抽取2个因子共解释总方差的31．6％,态度、信念分量表抽取3个因子共解释总方差的61．0％。结论：中文版急性冠脉综合征反应指数量表具有良好的信度及效度,可作为临床医务人员和研究人员进行筛查、测量的工具。     

心理干预对脑卒中患者预后及免疫功能的影响

目的研究心理干预对脑卒中患者预后及免疫功能影响的临床意义。方法将102名脑卒中患者随机分为对照组53例，干预组49例。两组患者均采用脑卒中后常规治疗和护理。干预组同时实施心理干预。在治疗前、治疗后1个月、治疗后6个月分别对两组患者进行生存质量量表（WHOQOL-BREF）、综合医院焦虑抑郁量表（HADS）、改良爱丁堡斯堪的那维亚卒中量表（MESSS）评定，同时对免疫球蛋白IgA、IgG、IgE、IgM、补体C3、C4及皮质醇进行测定。结果治疗前，除焦虑和抑郁评分干预组明显高于对照组（P〈0．05）外，其余指标两组无明显差异（P〉0．05）。1个月后，IgA水平干预组高于对照组（P〈0．05），余无明显差异（P〉0．05）。6个月后，IgA、IgE、C4、生存质量量表评分干预组明显高于对照组（P〈0．05），卒中量表评分干预组明显低于对照组（P〈0．05），余指标两组差异无显著性（P〉0．05）。结论心理干预对提高脑卒中患者的生存质量，改善预后有着积极的临床意义。     

脑卒中4种评定量表的效度、信度及可操作性检验

目的：比较4种脑卒中评定量表的效度、信度和可操作性。方法：103例脑卒中患者同时接受改良爱丁堡－斯堪的那维亚脑卒中评分量表（MESSS）、美国国立卫生研究所脑卒中评分量表（NIHSS）、欧洲脑卒中评分量表（ESS）和加拿大神经功能评分量表（CNS）评分，评分值与Barthel指数（BI）进行相关分析，与不同结局（死亡／生存）进行Logistic回归分析。另外对20例脑卒中患者进行评定，测定各量表的平均评分时间以及评分者间一致性。结果：量表与BI的相关系数分别为：MESSS－0．804－-0．815、CNS0．694－0．696，NIHSS和ESS 0．721－0．793，MESSS与BI的相关系数高于CNS（P＜0．05）。Logistic回归分析表明4种量表均对死亡有充分的预测能力；CNS的评分者间一致性最好，MESSS次之，NIHSS和ESS的一致性最差；评定所需时间为CNS最短，NESSS较长，NIHSS和ESS最长。结论：NESSS具有最高的效率，较好的信度和可操作性。故在没有更理想的量表供选择的情况下，推荐选用MESSS。     

骨质疏松症自我效能量表的信度与效度测定

守的分析翻译和修订的骨质疏松症自我效能量表的信度和效度。方法用翻译和修订的骨质疏松症自我效能量表调查29l例社区中老年人,并按年龄和学历分层随机抽取其中65例进行重测。结果内部一致性信度α系数0．90～0．94,重测Pearson。相关系数0.63～0.82（P〈0.001）,配对￡检验P〉0．05。结论骨质疏松症自我效能量表的信度与效度良好,项目设置适用于骨质疏松症目我效能的评价。     

Wolf运动功能量表的因子分析及信度和效度研究

目的探讨Wolf运动功能量表（WMFT）评定脑卒中患者上肢运动功能的信度、效度及内郎一致性，同时进行因子分析。方法采用WMFT对22例脑卒中患者进行评定，同时测定作业时间。12例患者瘫痪侧上肢进行WMFT作业活动时，由检查者对其摄像，用于信度检验。进行WMFT评定的同一周内用简易上肢功能评定量表（STEF）再次评估患者上肢功能。结果检查者内及检查者间的功能评分平均值信度分别为0．96和0．93，作业时间中位数的信度均为0．99。WMFT功能评分的内部一致性很高，Cronbach’s α值为0．96。根据原始因子的特征值，提取2个特征值大于1的因子，第1个主因子与上肢近端功能有关，第2个主因子与手指功能有关。WMFT功能评分平均值及作业时间中位数均与STEF明显相关（分别为r=0．75，P〈0．001；r=0．73，P〈0．01）。结论WMFT具有较高的信度、效度及内部一致性，通过因子分析可将其作业活动分为3组。WMFT项目可能过多，删除部分项目能否仍保持WMFT较高的效度和信度有待进一步研究。     

SF-36量表在重症急性胰腺炎患者中的应用

目的 探讨中文版36条目简明健康调查量表（36-items short form health survey，SF-36）在重症急性胰腺炎（severe acute pancretitiS，SAP）患者术后的生存质量（quality of life，QOL）评价中的可行性。方法 采用中文版SF-36量表对62例SAP患者术后的QOL进行评价，并测定其信度和效度。结果 SF-36量表的复测信度达0．82～0．94，8个维度的内部一致性信度为0．66-0．92；各条目与所属维度的相关系数范围为0．64—0．96，集合效度和区分效度的成功率均达到了100％；因子分析中产生的两个主因子，分别代表心理健康和生理健康，共解释了64．7％的总方差；SAP患者的QOL总分在82．2—141．2之间，第二条目与总分之间的相关系数为0．422。结论SF-36量表用于SAP患者术后的QOL评价具有较好的信度和效度；同时发现SAP患者出院后的整体生存质量较好。     

完美主义自我呈现量表在中国大学生群体中的修订

目的在中国大学生群体中修订完美主义自我呈现量表,得到完美主义自我呈现量表的中文修订版。方法通过对1208名大学生进行完美主义自我呈现量表中文翻译版和多维度完美主义量表中文版的测量,对完美主义自我呈现量表中文修订版进行探索性因素分析、验证性因素分析和信效度检验。结果完美主义自我呈现量表中文修订版包含20个题目,3个因素,可解释总变异的59．821％;各因素内部一致性信度为0．721-0.817,分半信度为0．707—0．816,重测信度为0．768-0.842,总量表的内部一致性信度为0．851,分半信度为0．828,重测信度为0．880;3个因素间的相关系数均达到显著性水平（P〈0．01）,各维度与总分之间的相关也非常显著（P〈0.01）;多维度完美主义量表中文版总分及担心错误、个人标准、父母期望、行动疑虑因子分与完美主义自我呈现量表中文修订版总分及各因子分呈显著正相关（P〈0.01）,条理性因子分与呈现完美形象因子分呈显著正相关（P〈0.01）。结论完美主义自我呈现量表中文修订版具有较好的信效度,可以作为国内完美主义研究的一个有效工具,也可以作为临床心理研究和咨询实践的辅助工具。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.