基于零缺陷管理理论构建肝胆外科加速康复评价指标体系

目的构建适用于肝胆外科的加速康复评价指标体系,为加速康复外科实施效果提供评价工具。方法在零缺陷管理理论基础上,通过文献查阅、德尔菲专家咨询法构建肝胆外科加速康复评价指标体系。结果 2轮问卷回收率均为100%,专家权威系数分别为0.920、0.919。经过2轮专家咨询,最终构建的肝胆外科加速康复评价指标体系包括3个一级指标,8个二级指标,39个三级指标;指标重要性评分均4分,变异系数0～0.166;并确定各级指标权重。结论肝胆外科加速康复评价指标体系构建合理,有较好的可信度,经验证后可作为肝胆外科加速康复质量评价工具。     

Functional Abilities of an International Post-Stroke Population: Standard Assessment of Global Everyday Activities (SAGEA) Scale

Background and ObjectivesFunction is an important outcome after stroke; traditional assessments may not capture functional deficits important to patients. We examined the validity of the Standard Assessment of Global Everyday Activities (SAGEA), a patient-reported outcome that assesses activities important to patients and for use in international clinical trials.MethodsThe NAVIGATE-ESUS trial evaluated rivaroxaban compared to aspirin in preventing recurrent stroke in 7213 participants. The Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the SAGEA were collected at entry. Chi square tests were used to compare proportions and Spearman rank correlations were used to compare between measures. SAGEA was compared to the Modified Frailty Index (MFI) and the occurrence of infarct to examine criterion validityResultsParticipants were 67 years, 2/3 were male, and at baseline 30% had no disability and 58% had slight disability according to mRS scores. SAGEA was weakly correlated with the mRS (r=0.37), the NIHSS (r=0.29) and the MFI (r=0.30). Of the 2154 with an mRS score of 0, 61% reported difficulty on the SAGEA. The largest discrepancies between SAGEA and other measures were because of cognitive functional deficits detected by the SAGEA that were not identified on other assessments. A larger number of MRI identified infarcts (acute and covert) were associated with a higher SAGEA score (p=0.007).ConclusionsThe SAGEA is a simple, globally applicable measure of cognitive and functional abilities that identifies issues that other commonly used assessments of disability and function do not capture.