轻度认知功能障碍患者评估量表的研究进展

背景 轻度认知功能障碍(mild cognitive impairment,MCI)是一种综合征,主要表现为患者认知减退程度超过了相应年龄及受教育程度的正常人群认知下降水平,但并未显著影响患者日常生活能力.MCI具有发展为痴呆的高度危险性.目的 对高危患者术前进行MCI正确评估,有助于围手术期“精准”麻醉的实施,即应用适当麻醉药物和方法,不加速甚至延缓MCI进程. 内容 对目前国内外常用MCI筛检量表进行综述. 趋向 蒙特利尔认知评估量表(montreal cognitiveassessment,MoCA)虽然在低教育年限患者的应用存在缺陷,但仍是较好的单一评估量表.同时,改良MoCA量表即蒙特利尔认知评估基础量表(montreal cognitive assessment-basic,MoCA-B)以及简明精神状态量表(mini-mental status examination,MMSE)与其他量表的联合使用,为MCI患者认知功能的正确评价提供了思路.     

养老机构老年人生活质量评估工具的应用分析

检索国内外常用的数据库,提取研究养老机构老年人生活质量的相关文献,共获取中文文献69篇,涉及12个生活质量评估量表;英文文献294篇,涉及40个生活质量评估量表。对在上述文献中应用次数≥10的生活质量评估工具进行评价,包括评估工具的主要内容、特点及应用情况,旨在为国内研究养老机构老年人生活质量提供参考。     

姑息护理常用核心量表简述

介绍护理姑息患者常用的核心量表,包括疼痛评估量表、压疮评估量表、疲劳评估量表、心理状况评估量表、日常生活能力评定量表和生命质量评定量表,旨在为临床顺利开展姑息护理提供依据,提高护理质量.     

四肢肌肉骨骼功能评定量表及其临床应用

随着骨科手术及护理技术的进步,对评价患者功能及健康状况的需求也日益增加.因此,临床医生为了解患者治疗后功能及日常生活能力恢复的水平,制做了各种的功能评价量表.常用的主要有针对整体健康状况的全身量表和针对各解剖部位功能的局部量表两大类.但是,有些整体健康量表对骨科患者缺乏特异性,而特定部位量表并不能反映患者的整体健康状况.因此,骨科医生如何选择适用于所有四肢创伤和疾患的量表来有效评估患者的整体功能状况成为一个焦点问题.     

垂体瘤患者生活质量测评工具的研究进展

总结在国内外垂体瘤患者生活质量相关研究中常用且性能较好的特异性评估工具,并对国外几种特异性量表的发展、适用人群、测评内容、信效度、应用状况进行介绍;为国内研究者完善垂体瘤患者生活质量评价体系,选择正确的测评工具提供参考。     

患者护理难度评价研究进展

介绍了患者护理难度的相关概念和影响因素,重点概括了患者护理难度常用评估工具的评估内容、优缺点等,以期为国内开展患者护理难度的研究提供参考.     

密歇根大学手概况问卷调查表在手外科的应用

目的探讨密歇根大学手概况问卷调查表(Michigan Hand Outcomes Questionnaire,MHQ)在手外科的应用效果并,为临床上使用该患者主观自评量表提供参考。方法查阅近年国内外MHQ应用的相关文献,总结分析MHQ在手外伤、周围神经卡压性疾病和关节炎等方面的应用。结果文献显示MHQ具有较好的信度、效度及敏感度,不但可以对手功能进行整体评估,而且可以利用某一子量表对某一方面进行单独评估。结论目前MHQ在国外已成为手外科常用的主观自评量表之一,但国内应用较少,相信随着对患者主观自评的重视,其研究和应用会越来越多。     

Braden-Q量表评估我国儿童压疮危险因素适用性研究

目的 探讨Braden-Q儿童压疮危险评估量表(下称Braden-Q量表)对国内ICU患儿压疮评估的预测效力.方法 采用儿童日常活动能力分类量表(POPC)、Braden-Q量表对133例ICU患儿进行评估.结果 POPC评分1～5(1.12±0.63)分;Braden-Q量表7个条目评分为2.10±0.89～3.84±0.43,压疮发生率为5.26%;Braden-Q量表临界值为13～16分时,灵敏度为0.15～0.23,特异度为0.96～0.98,阳性预测值为0.07～0.53,阴性预测值为0.86～0.99.结论 ICU患儿病情危重度不高,BrademQ量表临界值取15分时其灵敏度和特异度较好,Braden-Q量表对国内患儿压疮的预测效果不佳,其适用性尚需进一步扩大样本深入研究.     

护理信息能力评估工具研究进展

对国内外护理信息能力评估工具进行综述,分析国内评估工具存在的问题。提出护理信息能力评估工具均涉及计算机知识、技能和信息知识及技能、态度等,大部分量表有相应的护理信息能力标准作为量表编制基础,有明确的适用范围。建议国内学者制定护理信息能力评估量表时以相关理论框架作指导,力求内容全面,从而更好地衡量护生或护理人员的护理信息能力。     

迟发性睾丸功能减退筛查量表的研究与应用现状

随着迟发性睾丸功能减退(LOH)研究的深入,LOH筛查量表研究逐渐完善。常用筛查量表有AMS量表、ADAM问卷、MMAS问卷,量表的主要作用是筛查或者诊断LOH以及治疗效果的评估,目前研究主要集中在量表的应用、敏感性和特异性的验证、量表评价结果或者某些项目与血清激素水平之间的相关性、不同量表之间的比较等方面。本文综述筛查量表的研究、应用现状,并对其敏感性、特异性进行了总结。     

Measurement of health outcomes following tendon and nerve repair.

The World Health Organization's model of health suggests that tendon and nerve injury outcomes can be assessed in terms of impairment, activity limitations, and participation restrictions. A tendon injury results in impairment of motion and strength of affected digits. Literature on outcome of tendon surgery has focused on active motion. Recently developed devices can be used to measure strength impairments associated with individual digits after tendon injury, although the importance of either grip or digital strength measures as indicators of post-tendon recovery has not been fully delineated. Published impairment rating scales have expressed outcome based on regained total active motion of relevant joints. These scales also tend to classify outcomes on a subjective four-point scale ranging from poor to excellent. Subjective ratings have not been validated, vary across scales, and inhibit meaningful comparisons by diluting information. Nerve injuries result in an impairment of motion, strength, sensibility, and sympathetic nerve function. Development of quantitative measures of sensibility continues to evolve, although all current methods have some limitations. Two-point discrimination was once a mainstay of assessment, but current evidence suggests it is less valid and responsive than other quantitative sensory testing. Cold sensitivity is common and can be measured through rewarming responses or by self-report. A comprehensive impairment rating scale for nerve injury with subscales addressing sensory, motor, and pain/discomfort domains has been developed. Use of this validated instrument will facilitate more meaningful comparisons across centers and studies. Recent literature on treatment outcomes has focused on impairment measures with minimal attention to activity limitations and participation restrictions. Validation of appropriate scales and inclusion of both impairment and disability measures in future clinical studies is required to fully understand health outcomes after tendon and nerve injury.     

Spontaneous recovery of hindlimb movement in completely spinal cord transected mice: a comparison of assessment methods and conditions

STUDY DESIGN: To compare results obtained with a variety of locomotor rating scales in Th9/10 spinal cord transected (Tx) mice. OBJECTIVES: To assess spontaneous recovery with a variety of rating scales to find the most sensitive methods for assessing recovery levels in Tx mice and differences associated with gender and condition. SETTING: Laval University Medical Center, Neuroscience Unit & Laval University, Department of Anatomy and Physiology, Quebec City, Quebec, Canada. METHODS: Scales including the Basso, Beattie and Bresnahan (BBB), the Basso Mouse Score (BMS), the Antri, Orsal and Barthe (AOB), the Motor Function Score (MFS) and the Averaged Combined Score (ACOS) were used to assess, in open-field and treadmill conditions, spontaneous locomotor recovery in male and female Tx mice. RESULTS: The ACOS scale revealed a progressive increase of spontaneous recovery during 5-weeks post-Tx. The other methods detected a progressive increase for the first 2-3 weeks post-Tx without any significant progress in weeks 4 and 5. Generally, scores obtained with each method were nonsignificantly different between males and females or between open-field and treadmill conditions. CONCLUSION: These results further confirm the existence of a limited but significant increase of locomotor function recovery, occurring without intervention, in Tx animals. Although each method could detect small levels of recovery, the ACOS method was discriminative enough to detect progressive changes up to 5 weeks post-Tx. In conclusion, the ACOS rating scale was the most discriminative method for assessing the spontaneous return of hindlimb movements found in Tx mice, both in open-field and treadmill conditions.     

Management and methodological approaches for the assessment of emotional states in anesthesiology

In anaesthesiology emotional states are of great importance. Reduction of anxiety and sedation in the preoperative preparation as well as stress reduction and the process of recovery are a challenge for anaesthetists as perioperative physicians. As emotions have different dimensions of manifestation like experience, expression, behaviour and somatic indicators, all these are needed to describe emotions sufficiently. In a multidimensional approach for the measure of emotional states, the different dimensions, their relationships and interactions are taken into account. The methodological approaches to registration of emotions in the anaesthesiological context are heterogeneous. In this summary the possibilities are differentiated by the source of information. Self-rating by the patient, rating by the observer, expression and behaviour and somatic indicators are taken into consideration. Analysis of the methods for the assessment of emotional states in anaesthesiological setting leads to the following recommendations: The most sensitive source of information is the patient. The rating scale used should be multidimensional and it should take specific as well as unspecific emotional aspects into account. As there are enough rating scales thoroughly developed and up to the demands of the classical test-theory, no ad hoc developed scales should be used. The rating of the emotional state should be supplemented by a rating of the physical state. The rating by the observer can be a valuable addition. The agreement between observers and the reliability of the method must be guaranteed. At presence there is no alternative in clinical practice to simple autonomic parameters such as blood pressure and heart rate as somatic indicators of emotion. Still it is important to consider the normal values for the individual patient. It is necessary to develop and to evaluate simple methods to register characteristics of expression in clinical context.     

Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale

Introduction

Laparoscopic common bile duct exploration (LCBDE) is an effective, single-stage treatment for choledocholithiasis. However, LCBDE requires specific cognitive and technical skills, is infrequently performed by residents, and currently lacks suitable training and assessment modalities outside of the operating room. To address this gap in training, a simulator model for transcystic and transcholedochal LCBDE was developed and evaluated.

Methods

A procedure algorithm incorporating essential cognitive and technical steps of LCBDE was developed, along with a physical model to allow performance of a simulated procedure. Modified Objective Structured Assessment of Technical Skills (OSATS) rating scales were developed to assess performance on the model. Construct validity was assessed by comparing the performance of novices (residents and surgeons without LCBDE experience) versus experienced subjects (surgeons with previous LCBDE experience). Concurrent validity was assessed by comparing scores from the LCBDE scales to those from the standard OSATS scale. Internal consistency and interrater reliability were assessed by comparing performance scores assigned by three independent raters.

Results

Sixteen novices and five experienced subjects performed simulated procedures, with novices scoring lower than experienced subjects on both transcystic (20?±?3 vs. 33?±?2 [possible score range, 0–45], p?p?Conclusions The LCBDE simulator is a low-cost yet realistic physical model that allows performance and evaluation of technical skills required for LCBDE. The LCBDE rating scales show evidence of construct validity, concurrent validity, internal consistency, and interrater reliability. Use of the LCBDE model and associated rating scales allows procedure-specific feedback for trainees and could be used to improve current training.     

What we talk about when we talk about trauma: Content overlap and heterogeneity in the assessment of trauma exposure

The accurate definition and assessment of trauma exposure is the foundation for replicable studies of mental health problems following trauma exposure. However, scales developed to assess trauma exposure might vary widely in terms of item content; overlap; and specifications of trauma intensity, frequency, duration, and timing. We compared eight frequently used self-report measures of trauma exposure to address content overlap and measurement heterogeneity. Combined, these measures assess 44 disparate exposures. Mean overlap across scales was moderate (M = 0.41, range: 0.25–0.48 across scales). Pairwise overlap between scales ranged from .19 to .59. We found 18 exposures (40.9%) that were included in one scale and three exposures (6.8%) that were included in all eight scales. Four of the included scales assess trauma frequency, five assess intensity or perceived danger, two assess duration, and four assess timing. The implications of measurement heterogeneity for clinical research as well as for comparability and replication of trauma-related research are discussed.     

Comparison of trauma assessment scores and their use in prediction of infection and death.

Current trauma assessment scores do not include an assessment of immune competence and have not been designed to predict late death from or risk of infection. We have compared the use of the Outcome Predictive Score (OPS) with other standard scales to predict clinical outcome after trauma. The OPS combines the Injury Severity Score (ISS) corrected for age (%LD50), degree of bacterial contamination, and monocyte HLA-DR antigen expression on hospital admission. The OPS was compared to the ISS, %LD50, Revised Trauma Score (RTS), Combined Trauma Score-ISS (TRISS), and Anatomical Index (AI). Sixty-one seriously ill patients were studied. Patient outcome was defined as uneventful recovery (n = 18), major infection (n = 27), and death (13 of 16 deaths resulted from infection). The assessment scores were compared for their use in prediction of these outcomes, as well as their ability to distinguish patients with good outcome from those patients who developed major infection or died, and to differentiate survival from death. Only the OPS was able to significantly segregate all five outcome groups (p less than 0.05). Although the age-adjusted ISS distinguished between survival and death (p less than 0.05), only OPS consistently distinguished between good outcome and sepsis/death (p less than 0.05), and therefore best identified the patients who developed infection. AI, RTS, and TRISS had little predictive value.     

Observations on nerves evaluation methods for efficiency analysis of the operative treatment in upper extremity compressive neuropathies.

Authors present the evaluation scales for nerve efficiency for functional recovery after operative treatment of compressive neuropathies in the upper limb. The methodology consists of both subjective and objective evaluation. Presented methods are non invasive and may be performed in every medical examination room.     

BBB评分评估脊髓损伤大鼠后肢运动功能的探讨

目的：探讨大鼠脊髓损伤后和修复中如何评估人鼠后肢运动的BBB评分。方法：对4组大鼠分别行T10脊髓背侧半切断(A组)、T10脊髓全切断(B组)、T10脊髓节段全切除(C组)、T10以下脊髓全切除(D组)，制成不同损伤程度的大鼠脊髓损伤模型，对所有动物的后肢运动功能进行BBB评分和脊髓组织学观察。结果：A组大鼠BBB评分存损伤后5崩达到20分或21分，B组和C组大鼠存术后2周以后BBB评分维持在8分．D组大鼠BBB评分维持在0。B组和C组大鼠脊髓顺行追踪显示脊髓损伤区和尾侧无追踪剂分布．连续矢状冰冻切片抗神经丝(NF)染色未见连续NF通过损伤区，结论：大鼠脊髓损伤模型的后肢运动功能BBB评分如果在8分以下，就需要慎重评价，这种运动有可能完全是或包括有自发的后肢运动。