Power,effects, confidence,and significance: An investigation of statistical practices in nursing research

Objectives

To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported.

Design

Statistical review.

Data sources

Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors.

Review methods

Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified.

Results

The median power to detect small, medium, and large effect sizes was .40 (interquartile range [IQR] = .24–.71), .98 (IQR = .85–1.00), and 1.00 (IQR = 1.00–1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR = .26–.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal–Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers.

Conclusion

The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies.     

Congenital radial head dislocation with a progressive cubitus valgus: a case report

Congenital dislocation of the radial head is rare, although it is the most common congenital anomaly of the elbow. A concomitant progressive cubitus valgus of the elbow has not previously been described in literature. We describe a case of an 8-year-old girl with an unilateral congenital radial head dislocation with a progressive cubitus valgus of 35°, caused by a prematurely closing physis of the lateral humeral condyle. This might be caused by an increased pressure on the lateral physis by the anteriorly dislocated radial head. As no complaints or limitations were present, treatment was non-operative with clinical observation, with satisfactory results after a follow-up of 18 months. A concomitant progressive cubitus valgus can be present in patients with a congenital radial head dislocation. Non-operative treatment can provide satisfactory results.     

Reliability of Surface Electromyography in the Assessment of Paraspinal Muscle Fatigue: An Updated Systematic Review

Objective

The purpose of this study was to review the literature to determine whether surface electromyography (EMG) is a reliable tool to assess paraspinal muscle fatigue in healthy subjects and in patients with low back pain (LBP).

Methods

A literature search for the period of 2000 to 2012 was performed, using PubMed, ProQuest, Science Direct, EMBASE, OVID, CINAHL, and MEDLINE databases. Electromyography, reliability, median frequency, paraspinal muscle, endurance, low back pain, and muscle fatigue were used as keywords.

Results

The literature search yielded 178 studies using the above keywords. Twelve articles were selected according to the inclusion criteria of the study. In 7 of the 12 studies, the surface EMG was only applied in healthy subjects, and in 5 studies, the reliability of surface EMG was investigated in patients with LBP or a comparison with a control group. In all of these studies, median frequency was shown to be a reliable EMG parameter to assess paraspinal muscles fatigue. There was a wide variation among studies in terms of methodology, surface EMG parameters, electrode location, procedure, and homogeneity of the study population.

Conclusions

The results suggest that there seems to be a convincing body of evidence to support the merit of surface EMG in the assessment of paraspinal muscle fatigue in healthy subject and in patients with LBP.     

临床护士失禁性皮炎照护能力的研究进展

失禁性皮炎是由于大小便失禁导致的皮肤炎性反应与皮肤损伤,严重影响患者的生活质量,还会增加导尿管相关尿路感染等并发症发生的风险。故及早提供预防措施和正确处置,避免并发症的发生,尤为重要。目前临床护士失禁性皮炎照护能力较低,主要体现在对失禁性皮炎的评估、预防和护理能力以及与压力性损伤的鉴别能力。国内外对于提高护士失禁性皮炎照护能力的干预研究尚处于探索阶段,本文通过回顾整理临床护士失禁性皮炎的照护能力及其影响因素,以期为制订符合临床情境的干预方案提供依据。     

连续性肾脏替代治疗嵌入体外膜肺氧合管路连接方式的研究进展

体外膜肺氧合联合连续性肾脏替代治疗能有效改善和预防液体过负荷、清除炎症介质,提高危重患者的抢救成功率。该文介绍了连续性肾脏替代治疗嵌入体外膜肺氧合管路的不同连接方式的优缺点、护理操作及其风险,提出结合患者病情选择最佳连接模式,减少相关并发症的发生,为连续性肾脏替代治疗嵌入体外膜肺氧合患者的护理提供参考。     

基于Kano模型的失能老年人长期照护需求研究进展

该文综述Kano模型的发展以及基于此模型的失能老年人需求的研究进展,指出Kano模型在失能老年人长期照护需求方面存在的不足和发展方向,为未来建立科学化、多样化的失能老年人长期照护体系提供参考。     

概念图在证据转化与应用项目中的研究进展

如何识别利益相关者观点一直是证据转化与临床应用的重要议题,概念图为解决利益相关者相关研究问题提供了框架。该文介绍了概念图的概念、实施步骤及其在证据转化与应用项目中的应用方向,包括明确研究问题和需求,探索证据实施的障碍和促进因素,选择和剪裁实施策略,开发概念框架和测量工具等方面,总结了概念图的应用前景,以期促进概念图在国内证据转化研究中的应用。     

我国临床护理实践指南改编研究的范围综述

目的 探讨我国临床护理实践指南改编研究的内容、理论框架、改编过程、方法学质量及报告质量。 方法 系统检索PubMed、Cochrane Library、CINAHL、Embase、Scopus、Web of Science、中国知网、万方、维普、中国生物医学文献数据库、医脉通等数据库中以我国护理领域指南改编为主题的文献,检索时限为建库至2021年4月20日,由2名研究者独立筛选、提取数据,采用描述性分析对数据进行合成,采用临床指南研究与评价系统Ⅱ (appraisal of gui-delines for research and evaluationⅡ,AGREE Ⅱ) 工具和临床实践指南报告标准 (reporting items for practice guidelines in healthcare,RIGHT) 对指南的方法学质量和报告质量进行评价。 结果 共纳入23篇文献,16篇 (69.6%) 文献发表于近3年,仅7篇 (30.4%) 文献报告了基金支持。研究主题方面,15篇 (65.2%) 文献的主题为疾病及其症状的护理,仅12篇 (52.2%) 文献报告了改编过程中使用的方法,其中7篇 (30.4%) 文献采用指南改编方法 (guideline adaptation,ADAPTE) 。方法学质量评价结果显示,6个领域中平均得分>60%的领域包括范围和目的、参与人员、表达明晰性,得分最低的领域是编辑独立性。报告质量评价结果显示,7个领域中平均得分>4分的领域包括基本信息、背景、推荐意见,得分最低的领域是资金资助与利益冲突声明和管理。 结论 我国临床护理实践指南改编研究数量上呈现明显增加的趋势,但改编指南所依据的理论框架与改编指南方法学质量和报告质量欠佳。     

癌症患者社会疏离的概念分析

目的 分析并阐明癌症患者社会疏离的概念内涵。方法 系统检索万方数据库、中国期刊全文数据库、中国生物医学文献数据库、维普数据库、Pubmed、Web of Science、EBSCO、Embase、Proquest、Springer Link、Elsevier Science Direct、Wiley Online Library、Scopus数据库中与癌症患者社会疏离相关的研究,检索时限为1975年1月1日—2021年8月20日,依据纳入标准选取文献,应用Rodgers概念分析法对文献进行分析。结果 共纳入103篇文献,癌症患者社会疏离包括缺乏互动人员、自我隔离、孤独感、疏远感、无意义感5个概念属性;前因包括人口学、疾病与治疗、心理和社会因素;后果包括不良行为增加和生理机能下降等。结论 通过概念分析明确了癌症患者社会疏离的概念属性,研究者未来可结合癌症患者社会疏离的内涵,对癌症患者的社会疏离进行更为全面、深入的研究。