"五习惯"医患沟通评价量表的构建及信效度研究

背景 医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前，我国对医务人员医患沟通能力的评价研究较少，缺乏信效度良好的评估工具。 目的 构建"五习惯"医患沟通评价量表（5HCS），检验其信度和效度。 方法 2014年3月，采用Brislin翻译法在"四习惯"医患沟通评价体系（4HCS）的基础上，形成5HCS初稿；2014年4—6月，采用德尔菲法，使用问卷分两轮征求专家意见，根据专家意见修订条目后形成5HCS定稿；2018年3月，使用新构建的5HCS对127名住院医师的医患沟通能力进行评估，通过分析其评价数据，检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。 结果 正式版5HCS包含5个维度（"尊重示善，融洽关系""采集信息，引导观点""表达共情，建立信任""风险告知，知情同意""提供诊断，协商决策"），21个条目。量表的Cronbach's α系数为0.716，各维度与量表总分的r值为0.524~0.692，各条目的内容效度指数（I-CVI）≥0.81，量表总分的评价者间信度r值为0.912，组内相关系数（ICC）=0.912，标准关联效度以中文版医患沟通技能评价量表（SEGUE）为标准，两个量表总分之间的r值为0.377（P<0.01）。 结论 5HCS具有良好的信度和效度，可将其作为我国住院医师医患沟通能力测评工具加以推广应用。     

Computer-aided diagnosis tool for cervical cancer screening with weakly supervised localization and detection of abnormalities using adaptable and explainable classifier

While pap test is the most common diagnosis methods for cervical cancer, their results are highly dependent on the ability of the cytotechnicians to detect abnormal cells on the smears using brightfield microscopy. In this paper, we propose an explainable region classifier in whole slide images that could be used by cyto-pathologists to handle efficiently these big images (100,000x100,000 pixels). We create a dataset that simulates pap smears regions and uses a loss, we call classification under regression constraint, to train an efficient region classifier (about 66.8% accuracy on severity classification, 95.2% accuracy on normal/abnormal classification and 0.870 KAPPA score). We explain how we benefit from this loss to obtain a model focused on sensitivity and, then, we show that it can be used to perform weakly supervised localization (accuracy of 80.4%) of the cell that is mostly responsible for the malignancy of regions of whole slide images. We extend our method to perform a more general detection of abnormal cells (66.1% accuracy) and ensure that at least one abnormal cell will be detected if malignancy is present. Finally, we experiment our solution on a small real clinical slide dataset, highlighting the relevance of our proposed solution, adapting it to be as easily integrated in a pathology laboratory workflow as possible, and extending it to make a slide-level prediction.     

Measuring Psychological Inflexibility of Suicidal Thoughts: The Acceptance and Action Questionnaire for Suicidal Ideation (AAQ-SI)

Cognitive Therapy and Research - Despite interest in psychological inflexibility as a marker of suicide risk, no measure of psychological inflexibility specific to SI exists. The present study...