Closed loop control of anaesthesia: an assessment of the bispectral index as the target of control

We investigated the performance of a closed-loop system for administration of general anaesthesia, using the bispectral index as a target for control. One hundred patients undergoing gynaecological or general surgery were studied. In 60 patients, anaesthesia was maintained by intravenous infusion of a propofol/alfentanil mixture. In 40, an isoflurane/nitrous oxide based technique was used. For each technique, patients were randomly allocated to receive either closed-loop or manually controlled administration of the relevant agents (propofol/alfentanil or isoflurane), with an intra-operative target bispectral index of 50 in all cases. Closed-loop and manually controlled administration of anaesthesia resulted in similar intra-operative conditions and initial recovery characteristics. During maintenance of anaesthesia, cardiovascular and electro-encephalographic variables did not differ between closed-loop and manual control groups and deviation of bispectral index from the target value was similar. Intra-operative concentrations of propofol, alfentanil and isoflurane were within normal clinical ranges. Episodes of light anaesthesia were more common in the closed-loop group for patients receiving propofol/alfentanil anaesthesia and in the manual group for patients receiving isoflurane/nitrous oxide anaesthesia. Convenience aside, the closed-loop system showed no clinical advantage over conventional, manually adjusted techniques of anaesthetic administration.     

栀子药材中三种有效成分HPLC定量分析结果不确定度的评定

采用HPLC方法同时测定栀子药材中栀子苷、绿原酸和藏红花素Ⅰ的含量,通过对测试方法流程进行分析,确定不确定度来源,结合含量测定方法验证数据,计算了不确定度分量、合成不确定度及扩展不确定度;结果表明,用HPLC方法定量分析栀子药材中栀子苷、绿原酸和藏红花素1的方法满足现代药物分析方法学的要求,且三者的扩展不确定度分别为0.1024,0.2254,0.1265.     

Validation of the repetitive behaviour questionnaire for use with children with autism spectrum disorder

The repetitive behaviour questionnaire (RBQ) (Turner, 1995) is one of the three most commonly used interview/questionnaire measures of repetitive behaviour (Honey et al., in preparation). Despite this there is a scarcity of information concerning its structure, reliability and validity. The psychometric properties of the RBQ were examined when used with children with an autism spectrum disorder, children of typical development and children with a learning disability. The questionnaire was found to examine two valid and reliable factors of repetitive behaviour and to have good levels of concurrent and construct validity. This novel study provides researchers and clinicians with information necessary to make decisions about the RBQ's utility and for the evaluation of conclusions drawn from existing research, which has used the RBQ.     

Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ)

ObjectiveThe Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients’ knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness.MethodsElective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n = 250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters.ResultsThe psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery.ConclusionThe adapted version of the PCSQ can be used for longitudinal analyses.Practice implicationsThe measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.     

口腔健康素养测量工具的构建及验证

目的: 构建口腔健康素养（Oral Health Literacy,OHL）测量工具,并对其进行信度和结构效度检验,为我国居民口腔健康素养评估提供科学工具。方法: 采用方便抽样方法,于2020年3月—4月选择山西省太原市小店区某社区的常住人口为调查对象,通过文献查阅、专家咨询和认知访谈,形成口腔健康素养测量工具。采用SPSS 22.0和AMOS 22.0软件包进行一般人口学特征描述、Spearman秩相关、项目分析、探索性因子分析、验证性因子分析信度和结构效度检验,同时计算Cronbach's α系数,对量表进行评价与验证。结果: 共发放问卷1 000份,回收有效问卷858份,通过项目分析和探索性因子分析,形成含基本技能、信息相关能力、口腔健康维持能力、个人特征、社会支持5个维度共90个条目的OHL量表。各条目分与所在维度分相关（r=0.250~0.744,P<0.001）,验证性因子分析结果显示,模型的整体适配指数可接受,其中χ²/df=2.785,RMSEA=0.057（95%CI：0.052~0.0762）,IFI=0.931,TLI=0.856,CFI=0.895,总量表的Cronbach α系数为0.899,各个维度的Cronbach α系数位于0.709~0.920之间。结论: 本研究构建的口腔健康素养测量工具具有良好的信度和结构效度,可供口腔工作者在预防、治疗、健康教育等工作中应用。     

Development of a lyophilized soybean paste certified reference material for the analysis of ochratoxin A

A certified reference material (CRM) [²KRISS CRM # 108-10-018] for the analysis of ochratoxin A (OTA) in doenjang (fermented soybean paste and popular food in Korea) was produced to ensure the reliability of analytical results in testing laboratories. A home-made doenjang was chosen as a raw material after testing its OTA level. The raw material was freeze-dried, pulverized, sieved and homogenized. An isotope-dilution-liquid chromatography/tandem mass spectrometric method (ID-LC/MS/MS) which was previously developed and validated in this laboratory was used as a higher-order reference method for characterization, homogeneity studies, and short-term stability studies. The CRM had good between-bottle homogeneity with 0.56% relative standard deviation among 10 selected units. The stability of the CRM at −70 °C (the storage condition in our laboratory) and at −20 °C (the possible storage temperature at user sites) were tested for up to 8 months. No change in the OTA content was observed within the measurement uncertainty. The stability of the CRM at room temperature (for regular use and transportation) was also tested and confirmed. The certified value was (49.50 ± 1.17) μg/kg, where the expanded uncertainty was in the confidence level of 95%.     

Reliability of Auditory Function Tests in Severely Hearing-Impaired and Deaf Subjects

The test-retest variability of a series of auditory functions has been investigated in a group of severely hearing-impaired and deaf subjects (64 ears, median Fletcher index: 80 dB) and in a group of 10 controls with normal hearing. An adaptive forced-choice procedure was used for both groups. The functions were: tone audiogram, difference limen for intensity, difference limen for frequency, modulation transfer function and critical ratio. In spite of sometimes strongly deviating function values within the hearing-impaired group, the test-retest variability of the two groups was found to be of the same order of magnitude, except for the tone audiogram where the variability in the hearing-impaired group was twice that for the control group.

Nous avons examiné la variabilité des mesures répétées de quelques fonctions auditives dans un groupe de sujets ayant des troubles auditifs importants (64 oreilles; médiane de l'index de Fletcher 80 dB). Par comparaison nous avons aussi examiné un groupe de 10 sujets ayant une audition normale. Dans les deux groupes nous avons utilisé une procédure adaptive et de choix forcé. Nous avons examiné les seuils auditifs, les seuils différentiels d'intensité et de fréquence, la fonction de transfert de modulation et le rapport critique. Malgré les anomalies majeures du groupe des malentendants, la variabilité des mesures dans les deux groupes est équivalente, à l'exception de la variabilité des seuils auditifs qui est deux fois plus grande chez les malentendants.     

Psychometric properties of the Neck OutcOme Score,Neck Disability Index,and Short Form–36 were evaluated in patients with neck pain

ObjectiveTo assess reliability, construct validity, responsiveness, and interpretability for Neck OutcOme Score (NOOS), Neck Disability Index (NDI), and Short Form–36 (SF-36) in neck pain patients.Study Design and SettingInternal consistency was assessed by Cronbach alpha. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC), and measurement error was estimated from the standard error of measurement. Responsiveness was assessed as standardized response mean (SRM) and interpretability from the minimal important difference (MID). Construct validity was tested correlating subscale scores from NOOS and SF-36 and NDI items.ResultsAt baseline, 196 neck pain patients were included. Cronbach α was adequate for most NOOS subscales, NDI, and SF-36 with few exceptions. Good to excellent reliability was found for NOOS subscales (ICC 0.88–0.95), for NDI, and for SF-36 with few exceptions. For NOOS, minimal detectable changes varied between 1.1 and 1.9, and construct validity was supported. SRMs were higher for NOOS subscales (0.19–0.42), compared to SF-36 and NDI. MID values varied between 15.0 and 24.1 for NOOS subscales.ConclusionsIn conclusion, the NOOS is a reliable, valid, and responsive measure of self-reported disability in neck pain patients, performing at least as well or better than the commonly used SF-36 and NDI.     

Bacteremia in the Spinal Cord Injury Population

Abstract

Positive blood cultures were found in 41 patients on the Spinal Cord Injury Service at the Milwaukee VAMC during the period of July, 1980 to December, 1985 giving an incidence of bacteremia of 1.3%. Mortality rate was 17%. Most common pathogens were E. Coli, Proteus mirabilis, Serratia marcescens and Staphylococcus aureus. A review of 29 available charts revealed genitourinary and respiratory tracts as the most common sources of infection (72.4% and 10.3% respectively). Other sources of infection were skin, postoperative, intravenous catheter site and cellulitis. Initial febrile response was seen in 93.1% of patients with 48.1% having temperature greater than 38.3°C. Hypotension (blood pressure less than 90/50 mm Hg) was noted in five out of the 29 (17.1%) patients. Clinical diagnosis of disseminated intravascular coagulation was made in two out of the 29 (6.9%) patients. Underlying risk factors were poor nutrition, respirator dependency, indwelling Foley catheters and manipulative procedures. Incidence and mortality rates are similar to the non-SCI population as reported elsewhere. The risk factors are different; therefore preventive management is extremely important.