客观结构化临床考试信度的Meta分析

目的对客观结构化临床考试(OSCE)的信度进行Meta分析,评价OSCE用于医学生临床能力评估考试的可靠性。方法计算机检索PubMed、ScienceDirect、CNKI、WanFang Data和VIP,收集采用OSCE评价医学生临床能力并使用Cronbach’sα系数进行OSCE信度测量的研究,检索时限均为1998年1月至2013年5月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料并评价方法学质量后,采用SPSS 17.0软件进行Meta分析。结果共纳入34个研究(53个Cronbach’sα系数),其中英文研究18个(28个Cronbach’sα系数),中文研究16个(25个Cronbach’sα系数)。Meta分析结果显示:OSCE的总Cronbach’sα系数为0.700[95%CI(0.660,0.737)],国外OSCE的Cronbach’sα系数为0.745[95%CI(0.696,0.790)],国内OSCE的Cronbach’sα系数为0.648[95%CI(0.584,0.705)]。国外OSCE的Cronbach’sα系数高于国内,两组差异有统计学意义。结论当前国内外OSCE的信度为0.7,OSCE用于国内外医学生临床能力评估考试均具有较好的可信度,但国外OSCE的可信性稍高于国内。     

迷你临床演练评估在护理教学中的研究进展

迷你临床演练评估(Mini-Clinical Evaluation Exercise,Mini-CEX)作为评估医护人员临床技能的一套兼具教学和评估的工具,目前在我国护理教学中开始尝试引入,本文主要阐述Mini-CEX在我国的发展现状、Mini-CEX在护理教学中的作用、应用中存在的问题以及相关建议,以期为Mini-CEX在以后护理教学中发挥更好的作用。     

迷你临床演练评估工具的改良及应用进展

<正>迷你临床演练评估工具(Mini Clinical Evaluation Exercise,mini-CEX)是美国内科医学会(American Board of Internal Medicine,ABM)发展并推荐的一种评价住院医师临床能力的测评工具~([1])。考评项目以医务人员6大核心能力为框架进行设计,由考核者直接观察被考核者在临床诊疗过程中的工作,包括医疗面谈、体格检查、人道专业、临床诊断、健康咨     

迷你临床演练评估在临床护理领域中的应用研究进展

介绍迷你临床演练评估(Mini-CEX)的发展现状、在临床护理领域中的应用情况、应用中存在的问题,为Mini-CEX更好地在临床护理领域应用提供参考。     

迷你临床演练评估在胃肠外科护理临床带教中的应用

目的在胃肠外科临床教学实践的带教、考核中引入迷你临床演练评估(mini clinical evaluation exercise,MiniCEX),观察其效果并探讨其用于临床教师带教考核的可行性。方法 2014年6月至2015年2月,便利抽样法选取在上海交通大学附属第一人民医院胃肠外科实习的全日制大专护生40名为研究对象。采用随机数字表法将其分为观察组和对照组,每组20名。观察组护生以Mini-CEX模式进行实习带教考核,对照组护生采用传统模式进行实习带教考核,两组护生均实习4周。根据Mini-CEX 7项内容,将外科临床护理2个考核项目(静脉输液和出院指导)的护理工作作为考核内容。共考核2次,分别是入科时和实习4周后。结果第1次考核,两组护生在静脉输液及出院指导考核成绩上的差异均无统计学意义(均P0.05),第2次考核,两组护生静脉输液及出院指导考核成绩均优于首次考核,差异均有统计学意义(均P0.01);且观察组护生的成绩均优于对照组,差异均有统计学意义(P0.05或P0.01)。结论将Mini-CEX应用于胃肠外科护理临床带教中,能提高护生的学习质量,值得推广。     

基于迷你临床演练评估的护理临床规范化带教方法

目的为了提高护理临床带教的规范化和科学性,帮助低年资护士在临床带教过程中自我学习。方法以文献综述和行动实践法在护理临床带教方法概述基础上阐述了迷你临床演练评估(Mini-Clinical Evaluation Exercise,Mini-CEX)护理临床带教方法及实施过程。结果 Mini-CEX护理临床带教方法具有科学诊断性与简便性、互动性等特点。结论 Mini-CEX护理临床带教方法适用于护理临床带教,可以拓展为基于工作场景综合带教方法。     

迷你临床演练评估在我国内地医学及护理学教育中应用的文献计量分析

目的 分析迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)在我国内地医学及护理学教育中的研究现状,为优化医学护理学教学评估工具、助力医学及护理学人才培养模式变革提供依据.方法 检索PubMed、Embase、万方、维普、中国知网及中国生物医学文献数据库的相关文献,...     

综合培训法在迷你临床演练评估同质化评分培训中的应用

目的:运用综合培训法对护理教学督导进行迷你临床演练评估的同质化评分培训,提高评分的准确性与一致性。方法:采用整群抽样法对医院77名教学督导进行误差培训法、绩效维度培训法、参照系培训法3种方法的综合培训,并在培训前后对评分的准确性和一致性进行测评。运用χ²检验、肯德尔和谐系数对培训前后的评分准确率和评分一致性程度进行检验。结果:培训后研究对象各维度评分准确率均有所提高,标准差减小,评分曲线与标准分更加一致,肯德尔和谐系数由0.298提高到0.427。结论:对护理教学督导开展迷你临床演练评估法的评分同质化培训,提高评分准确性和一致性,是保证该教学方法科学开展的必要前提。误差培训法、绩效维度培训法、参照系培训法3种方法的综合培训可以提高教学督导迷你临床演练评分的准确性与一致性。     

Mini-CEX在临床护士培训考核中应用效果的Meta分析

目的:系统评价迷你临床演练评量(Mini-clinical Evaluation Exercise, Mini-CEX)在临床护士培训考核中的应用效果。方法:通过检索中国知网、维普、万方、PubMed、EMbase、the Cochrane Library、Web of Science等数据库,纳入临床护士培训中应用Mini-CEX方法的随机对照试验(RCT)的文献,检索年限从建库至2022年5月,对纳入文献进行质量评价并从中提取数据,使用RevMan 5.4软件进行Meta分析。结果:共纳入12篇文献,研究对象1 045人,其中,试验组521人,对照组524人。Meta分析结果显示,试验组护士理论成绩、操作成绩、考核合格率、培训满意度以及核心能力均高于对照组,差异有统计学意义(P<0.05)。结论:现有证据表明,Mini-CEX培训能提高护士培训的考核成绩,并在护士核心能力、健康宣教方面发挥作用。     

Assessing the Validity of a Multidisciplinary Mini-Clinical Evaluation Exercise

Construct: The purpose of this study was to provide validity evidence for the mini-clinical evaluation exercise (mini-CEX) as an assessment tool for clinical skills in the workplace. Background: Previous research has demonstrated validity evidence for the mini-CEX, but most studies were carried out in internal medicine or single disciplines, therefore limiting generalizability of the findings. If the mini-CEX is to be used in multidisciplinary contexts, then validity evidence should be gathered in similar settings. The purpose of this study was to gather further validity evidence for the mini-CEX but in a broader context. Specifically we sought to explore the effects of discipline and rater type on mini-CEX scores, internal structure, and the relationship between mini-CEXs and OSCEs in a multidisciplinary context. Approach: During clerkship, medical students completed eight different rotations (family medicine, internal medicine, surgery, psychiatry, pediatrics, emergency, anesthesiology and obstetrics and gynecology). During each rotation, mini-CEX forms and a written examination were completed. Two multidisciplinary OSCEs (in Clerkship Year 3 and start of Year 4) assessed clinical skills. The reliability of the mini-CEX was assessed using Generalizability analyses. To assess the influence of discipline and rater type, mean scores were analyzed using a factorial analysis of variance. The total mini-CEX score was correlated to scores from the students' respective OSCEs and corresponding written exams. Results: Eighty-two students met inclusion criteria for a total of 781 ratings (average of 9.82 mini-CEX forms per student). There was a significant effect of discipline (p < .001, = .16), and faculty provided lower scores than nonfaculty raters (7.12 vs. 7.41; p = .002, = .02). The g-coefficient was .53 when discipline was included as a facet and .23 when rater type was a facet. There were low, but statistically significant correlations between the mini-CEX and scores for the 4th-year OSCE Total Score and the OSCE communication scores, r(80) = .40, p < .001 and r(80) = .29, p = .009. The mini-CEX was not correlated with the written examination scores for any of the disciplines. Conclusions: Our results provide conflicting findings for validity evidence for the mini-CEX. Mini-CEX ratings were correlated to multidisciplinary OSCEs but not written examinations, supporting the validity argument. However, reliability of the mini-CEX was low to moderate, and error accounted for the greatest amount of variability in scores. There was variation in scores due to discipline and resident raters gave higher scores than faculty. These results should be considered when considering the use of the mini-CEX in different contexts.     

Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise

ObjectiveA network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity.Data SourcesMEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021.Study SelectionRandomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included.Data ExtractionThe data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence.Data SynthesisA total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between ?0.74 and ?1.24). In the NMA, combined exercise (?1.51; 95% confidence interval [CI], ?2.01 to ?1.01) and resistance training (?1.15; 95% CI, ?1.81 to ?0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively.ConclusionsExercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.     

运动对预防老年人跌倒效果的网状Meta分析

目的 系统评价运动对预防老年人跌倒的疗效.方法 检索1980年至2020年7月Web of Science、PubMed、Cochrane Library、中国知网数据库有关运动对预防老年人跌倒的随机对照试验,采用Review Manager 5.3对纳入文献进行质量评价,应用R-Studio和Addis 1.16.6...     

运动疗法对周围神经病变干预效果的Meta分析

目的通过Meta分析探讨运动疗法在周围神经病变中的应用效果。方法检索中外数据库,按照纳入与排除标准筛选周围神经病变患者进行运动疗法的随机对照试验研究,提取资料并评价文献的研究质量。采用RevMan 5.3软件完成Meta分析。结果共纳入8篇随机对照试验,包括414例患者。Meta分析结果证实,运动疗法能够降低PN的发生率(Z=3.19,P0.05),缩短患者"起立-行走"计时试验的时长(Z=2.73,P0.05),提高神经传导速率(Z=9.54,P0.01),延长患者的单腿站立时长(Z=6.24,P0.01),使患者Berg平衡量表(Z=2.60,P0.05)以及FRT得分增加(Z=3.27,P0.05)。结论运动疗法对于周围神经病变的预防及缓解是安全有效的,建议临床推广使用。     

弹性抗阻运动对慢性阻塞性肺疾病康复疗效的Meta分析

目的 系统评价弹性抗阻运动(弹力带/弹力管)对慢性阻塞性肺疾病(COPD)患者康复疗效的影响。方法 检索Cochrane Library、PubMed、Web of Science、中国知网、维普、万方和生物医学文献数据库中关于弹性抗阻运动治疗COPD患者的临床随机对照试验,检索时限自建库至2020年9月。最后纳入文献11篇,其中英文9篇,中文2篇,共485例患者。采用Cochrane风险偏倚评估工具及物理治疗证据数据库量表进行质量评价,采用RevMan 5.2软件进行分析。这一系统评价在PROSPERO(CRD42020208659)上登记。结果 弹性抗阻运动组与传统抗阻运动组(如举重训练机、体重训练) 6 min步行试验距离(6WMD) (MD = 1.19, 95%CI -7.02~9.39, P = 0.78)、COPD患者自我评估测试(CAT) (MD = -0.43, 95%CI -2.42~1.57, P = 0.68)和肌力(MD = 0.23, 95%CI -1.06~1.52, P = 0.73)无显著性差异,两组间异质性不高。弹性抗阻运动组与非抗阻运动组6MWD (MD = 18.30, 95%CI -8.92~45.52, P = 0.19)和CAT (MD = -0.59, 95%CI -3.78~2.60, P = 0.72)无显著性差异,研究间异质性较高。结论 弹性抗阻运动也许是一种潜在的替代传统抗阻训练的方法,但弹性抗阻运动对运动耐力、生活质量、肺功能的影响尚不明确。     

八段锦对稳定期慢性阻塞性肺疾病患者肺康复影响Meta分析

目的 评价八段锦对稳定期慢性阻塞性肺疾病患者肺功能、运动耐量的影响.方法 通过检索中国知网全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、中国科技期刊数据库(VIP)等中文数据库,PubMed、Springer、Cochrane图书馆等英文数据库,获取已公开发表并符合评价标准的有关八段锦对稳定期慢性阻塞性肺疾病患者肺康复影响的随机对照试验,经文献质量评价后,采用RevMan5.0进行Meta分析.结果 共纳入9篇随机对照试验研究.八段锦干预后,干预组肺功能各指标中第1秒用力肺活量、第1秒用力肺活量占预计值百分比、用力肺活量高于对照组,差异均有统计学意义(P<0.05),第1秒钟用力肺活量占用力肺活量的比值水平与对照组比较,差异无统计学意义(P>0.05);八段锦干预后,干预组6 min步行距离高于对照组,差异有统计学意义(P<0.05).结论 八段锦可改善稳定期慢性阻塞性肺疾病患者肺功能,提高患者运动耐量.     

不同运动干预方式对老年人肌少症改善效果的Meta分析

目的 评价单一和多种运动干预对老年人肌少症的改善效果。方法 计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普和万方7个数据库,收集从建库至2021年7月发表的关于探讨单一与多种运动对老年人肌少症改善效果的随机对照研究。由两名研究人员进行文献检索与筛选,并独立对纳入文献进行质量评价。采用RevMan 5.3软件进行Meta分析。结果 最终纳入15篇文献,共816例患者。与空白对照组相比,单一运动(MD = -0.05, 95%CI -0.14~0.04, P > 0.05)和多种运动(MD = 0.15, 95%CI -0.01~0.31, P > 0.05)对骨骼肌质量指数的效果不显著;单一运动(MD = 2.06, 95%CI 0.25~3.87, P < 0.05)和多种运动(MD = 2.36,95%CI 1.10~3.63, P < 0.001)能改善最大握力;多种运动能显著改善膝关节伸展肌力(SMD = 0.49, 95%CI 0.26~0.73, P < 0.001)和步速(SMD = 0.24, 95%CI 0.19~0.29, P < 0.001)。结论 单一运动能改善肌少症老年人的最大握力,多种运动能改善最大握力、膝关节伸展肌力和步速。     

Isometric Exercise Training for Blood Pressure Management: A Systematic Review and Meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis quantifying the effects of isometric resistance training on the change in systolic blood pressure(SBP), diastolic blood pressure (DBP), and mean arterial pressure in subclinical populations and to examine whether the magnitude of change in SBP and DBP was different with respect to blood pressure classification.Patients and MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials lasting 4 or more weeks that investigated the effects of isometric exercise on blood pressure in healthy adults (aged ≥18 years) and were published in a peer-reviewed journal. PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for trials reported between January 1, 1966, and July 31, 2013. We included 9 randomized trials, 6 of which studied normotensive participants and 3 that studied hypertensive patients, that included a total of 223 participants (127 who underwent exercise training and 96 controls).ResultsThe following reductions were observed after isometric exercise training: SBP—mean difference (MD), −6.77 mm Hg (95% CI, −7.93 to −5.62 mm Hg; P<.001); DBP—MD, −3.96 mm Hg (95% CI, −4.80 to −3.12 mm Hg; P<.001); and mean arterial pressure—MD, −3.94 mm Hg (95% CI, −4.73 to −3.16 mm Hg; P<.001). A slight reduction in resting heart rate was also observed (MD, −0.79 beats/min; 95% CI, −1.23 to −0.36 beats/min; P=.003).ConclusionIsometric resistance training lowers SBP, DBP, and mean arterial pressure. The magnitude of effect is larger than that previously reported in dynamic aerobic or resistance training. Our data suggest that this form of training has the potential to produce significant and clinically meaningful blood pressure reductions and could serve as an adjunctive exercise modality.     

Effectiveness of Home-Based Exercise for Nonspecific Shoulder Pain: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness of home-based exercise to treat nonspecific shoulder pain (NSSP).Data SourcesMEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Controlled Register of Trials, and Physiotherapy Evidence Database were searched from inception to January 2022.Study SelectionIndependent reviewers selected randomized controlled trials that compared the effects of home-based exercise alone with no treatment or other conservative treatments in individuals with nonsurgical painful shoulder disorders. The primary outcomes were shoulder pain intensity and function, and the secondary outcome was shoulder range of motion (ROM).Data ExtractionTwo reviewers independently conducted data extraction. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and the overall quality of the evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation approach.Data SynthesisTwelve studies were included in the review, and 10 studies were included in the meta-analysis. Low to moderate quality of evidence indicated that home-based exercise alone and other conservative treatments showed equal improvements in pain intensity reduction (mean difference [MD], 0.27; 95% confidence interval [CI], ?0.12 to 0.65; I²=30%), function (standardized mean difference [SMD], 0.12; 95% CI, ?0.14 to 0.38; I²=16%), flexion ROM (MD, 4.61; 95% CI, ?1.16 to 10.38; I²=54%), and abduction ROM (MD, 3.74; 95% CI, ?12.44 to 19.93; I²=82%). Very low quality of evidence indicated that home-based exercise alone was more effective than no treatment for pain intensity reduction (MD, ?1.47; 95% CI, ?2.33 to -0.61) and function improvement (SMD, ?0.81; 95% CI, ?1.31 to -0.31; large effect).ConclusionsHome-based exercise alone may be equally effective as other conservative treatments and superior to no treatment for the treatment of NSSP. To draw firmer conclusions, further research is required to validate these findings.