The disability rating index: An instrument for the assessment of disability in clinical settings

The purpose of this study was to evaluate an instrument for assessment of physical disability, mainly intended for clinical settings, the Disability Rating Index (DRI). Healthy persons (n = 1092), both white and blue collar workers, and patients (n = 366) with different levels of physical capacity, were assessed. Most of the patients (n = 303) underwent rehabilitation programmes for neck/shoulder/low-back pain but some (n = 47) were arthritis patients waiting for hip or knee replacement surgery, or wheelchair patients with multiple sclerosis (n = 16). The reliability was investigated by test-retest studies, intra- and inter-rater and internal consistency studies. Five construct validity tests were carried out: a discrimination study; a converging validity test; a test for sensitivity to small alterations in health status; and two correlational validity tests. Correlation of the self-reported DRI to the actual performance in similar activities was carried out. Responsiveness was tested by correlation of the DRI before/after replacement surgery for arthritis. The test-retest correlations were 0.83–0.95 in the studies, including correlation of different versions. The intra- and inter-rater reproducibility was 0.98 and 0.99 respectively. The Kruskal-Wallis test in the discrimination study yielded p < 0.0001. More than 90% of the respondents completed the questionnaire correctly. Correlation of the DRI to the Functional Status Questionnaire was 0.46. The responsiveness was excellent, p = 0.0001. The DRI proved to be a robust, practical clinical and research instrument with good responsiveness and acceptability for assessment of disability caused by impairment of common motor functions.     

海南省消灭脊髓灰质炎开展强化免疫活动的效果评价

笔者根据海南省脊髓灰质炎历年的发病情况，以常规免疫和省内及全国强化免疫资料，对该省消灭脊髓效果进行了评价。结果表明：１９９３、１９９４年两年全国强化免疫活动日的效果显著，海南省从１９９４年以来无脊灰野毒感染病例发生。实验室资料也证实，全国强化免疫活动日，起到了阻断Ⅰ型野毒株循环的作用。     

心理训练对高特质焦虑新兵生理指标和考核成绩的影响

目的研究心理训练对高特质焦虑新兵考核时生理指标和成绩的影响。方法采用个人评价问卷（PEI）、状态．特质焦虑问卷（STAI）和简易应对方式问卷对参加考核的新兵实施团体测试。将被试者分为对照组、低特质焦虑组、高特质焦虑组和干预组，对干预组进行自我评价、潜能开发、团队精神强化、应对方式的心理训练。测试考核前后生理指标差值及考核成绩的变化。结果干预组新兵军事考核前后收缩压、舒张压和脉搏三项生理差值与考核成绩明显优于高特质焦虑组（P〈0．05）。结论系统的心理训练可有效改善新兵对应激情景的生理和心理反应，提高作业绩效。     

Psychological and clinical effects of renal biopsy performed using sedation

.A sedation regimen using sequential oral trinepazine, intravenous Pethco (pethidine, chlorpromazine and promethazine) and diazemuls was evaluated in children having native kidney (n = 17) and transplant kidney (n = 17) biopsies. Biopsy was successful in all cases, with no serious side effects. A self-reported scale of memory recall and pain perception showed the optimal time for biopsy to be between 30 and 90 min after the intravenous Pethco. The child’s level of distress was measured by a self-reported scale, a parent-reported scale and an observational scale for doctors and nurses; 45% of children rated themselves highly distressed prior to the procedure, their parents being the best assessors of this distress. Younger children and those undergoing native kidney biopsy had less understanding of the procedure. Children’s worries could be clearly categorised into procedural and outcome issues: those undergoing transplant biopsy were more worried about outcome, whereas those undergoing native kidney biopsy were more worried about the procedure. Received April 3, 1995; received in revised form and accepted April 17, 1996     

基于层次分析评价和模糊综合评价模型的临床医学课程思政实施效果评价

目的 探索基于层次分析评价和模糊综合评价模型的临床医学课程思政实施效果评价体系构建和应用。方法 利用Yaahp软件构建基于层次分析评价和模糊综合评价模型的临床医学课程思政实施效果评价体系。在西安交通大学第一附属医院185名学生的内科学课程中实施德医并举的课程思政清单式教学,并在课程结束时应用此评价体系得到定量的综合评价结果。结果 基于层次分析评价和模糊综合评价模型构建了临床医学课程思政实施效果评价体系,以德医双馨的育人目标为目标层,师德师风、课程设计、学生体会、发展评估为准则层,分13项方案层。利用此评价体系评价2020至2021学年第一学期内科学课程思政实施效果,结果显示德医并举的课程思政清单教学具有良好的育人效果,定量综合评价得分4.080分（1~5分）。结论 临床医学课程思政实施效果的评价可基于层次分析评价和模糊综合评价模型构建,具有科学、定量、综合和可改进等特点。     

彩色多普勒超声对感染性休克患者急性肾损伤的预测价值

背景 感染性休克患者存在肾脏血液灌注异常,严重时可诱发急性肾损伤(AKI),严重威胁患者生命安全;彩色多普勒超声(CDU)可用于评估肾脏血流变化,但有关其在感染性休克患者AKI评估中价值的研究较少。目的 通过CDU评价感染性休克患者AKI的发生情况及其血流动力学改变。方法 选取2019年6月至2021年7月徐州市中心医院收治的105例确诊为感染性休克的患者并纳入感染组,选取同期健康体检者58例并纳入对照组,收集受试者一般资料。采用CDU检查受试者肾脏血流动力学指标[肾动脉管腔内径(D)、收缩期血流峰值速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)、搏动指数(PI)],比较感染组与对照组的一般资料及肾脏血流动力学指标。根据感染组患者入院72 h内发生AKI与否将其分为AKI组及非AKI组,比较AKI组与非AKI组肾脏血流动力学指标。应用受试者工作特征(ROC)曲线分析肾脏血流动力学指标对感染性休克患者发生AKI的预测价值。应用单因素分析及多因素Logistic回归分析探讨感染性休克患者发生AKI的影响因素。以AKI由轻到重的程度将患者分为AKIⅠ组、AKIⅡ组、AKIⅢ组,比较...     

小儿遗尿症指南和专家共识质量评价

背景 小儿遗尿症是儿科常见病之一,有效的小儿遗尿症诊疗指南有助于症状的规范化控制和缓解,而制定高质量的临床实践指南是提高小儿遗尿症诊疗水平的重要方式。目的 基于AGREEⅡ和RIGHT工具,评价2010年以来国内外发布的小儿遗尿症指南和专家共识的质量,以期为临床实践及后续指南的制订提供参考。方法 检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed(补充检索医脉通、世界卫生组织以及英国国家临床示范研究所等数据库)2010-01-01至2022-01-31公开发表的小儿遗尿症相关的诊疗指南和专家共识。采用AGREEⅡ和RIGHT工具评价纳入文献的方法学和报告质量。根据AGREE Ⅱ工具评价结果,将各指南/共识推荐等级评定为“推荐(A级)”“更新后推荐(B级)”和“不推荐(C级)”。使用组内相关系数(ICC)进行一致性评价。结果 纳入8部指南和5部专家共识。共形成推荐意见185条,其中44条为诊断评估方面的意见,140条为治疗方面的推荐意见,1条为随访推荐意见。AGREEⅡ工具评价结果显示,范围和目的、参与人员、严谨性、清晰性、应用性和独立性6个领域的总得分(报...     

Personal relationships with an intelligent interactive telephone health behavior advisor system: a multimethod study using surveys and ethnographic interviews

The burgeoning of consumer health informatics and virtual health care can help people improve their health. However, little is known about individuals' reactions to such systems. We conducted an evaluation of the telephone-linked care (TLC) system, a computer-based telecommunications system, that functions as an at home monitor, educator, and counselor for patients with chronic health conditions. Our multimethod assessment of individuals' reactions to using TLC included both quantitative and qualitative methods. Ethnographic in-depth open-ended interviews indicated more subtle and surprising reactions to TLC than the overall positive responses from surveys: individuals formed personal relationships with this technology. This relationship formation suggests that TLC designers may have been successful in their attempts to emulate a conversation with a human being. Our study adds to evidence that technology can serve as a projective device for peoples' values and psychological issues. Both designers and users project values and goals onto computer-based technologies and take on different identities through it. Different groups of users, therefore, may see the same technology differently. People also form relationships with technologies, as they did with TLC. These findings, as well as implications for system design and health outcomes, need to be explored in additional studies.     

Model building on the basis of Dutch cervical cancer screening data

A mass screening programme for cervical cancer is in progress in three pilot regions in The Netherlands. All women living in these regions aged 35-53 are invited to undergo screening at three-year intervals. The MISCAN simulation model was developed for the analysis and optimization of screening programmes. In this paper the model-based approach to evaluation is first outlined and then illustrated by analysing data from the first two screening rounds in the pilot regions. This analysis resulted in a rather restricted range of data-compatible assumptions for the mean duration of preclinical disease (14-19 yr) and the frequency of spontaneous regression of preinvasive lesions (45-65%), as well as a rather wide sensitivity range for the Pap smear (50-90%). These preliminary findings are compared with those of a previous MISCAN analysis of cervical cancer screening in British Columbia. On the basis of an assumed 18-yr duration, 50% regression and 70% sensitivity, a number of screening policies relating to the same age ranges but with different intervals are compared. Both the analysis and the policy comparisons are preliminary, but the findings are nevertheless reasonable and consistent with those of previous studies. A more complete MISCAN-based analysis of the Dutch screening programme and subsequent optimization of screening policies will be possible when further results become available and a cost-effectiveness analysis procedure has been incorporated into the MISCAN programme.     

无症状性脑梗死患者的心理功能测评

随着高敏度的脑成像技术如ＣＴ、ＭＲＩ在临床的广泛应用 ,发现了许多临床上无明显症状、体征或症状、体征与既往卒中史不相关的梗死灶 ,称之为无症状性脑梗死 (ａｓｙｍｐｔｏｍａｔｉｃｉｎｆａｒｃｔ)或静止性脑梗死(ｓｉｌｅｎｔｃｅｒｅｂｒａｌｉｎｆａｒｃｔｉｏｎ ,ＳＣＩ)。虽然这些病人经传统的神经系统检查未发现明显的异常 ,但有学者认为他们存在明显的认知功能障碍、精细运动障碍及情感障碍等。本文对 38例ＳＣＩ及 30例对照组进行了认知功能、记忆、精细运动、感知觉及情感等方面的评价 ,有利于ＳＣＩ以及血管性痴呆的早期防…