二项必选数字记忆测验在精神分裂症应用中的对比研究

目的了解在精神分裂症应用中,精神症状对二项必选数字记忆测验(BFDMT)结果的影响。方法选择住院的精神分裂症患者65例,正常对照组65名,进行二项必选数字记忆测验,精神分裂症患者进行阳性和阴性症状量表(PANSS)评定,PANSS评分≥60分,对两组测查结果进行比较。结果精神分裂症患者BFDMT测查总分、容易得分、困难得分均低于对照组(P0.05,P0.001);二项数字记忆测验得分的高低与PANSS评分之间无显著相关(P0.05)。结论精神症状对BFDMT测查结果存在影响。     

韦氏记忆测验、临床记忆量表在颅脑损伤后伤残鉴定的应用情况分析

目的:比较韦氏记忆测验和临床记忆量表在颅脑损伤患者的应用情况,探讨在该类患者的适用性.方法:对206例颅脑损伤恢复期患者作韦氏记忆测验、300例作临床记忆量表检测,并完成临床实际记忆损伤评估,对照分析结果.结果:①两个量表间记忆商数存在显著差异;②两个量表所得记忆商数都与临床实际评定存在较多不一致,韦氏记忆测验更明显.结论:①在正常或较轻的颅脑损伤后记忆损伤患者,两个量表有相似的检测结论,但在记忆损伤较严重的患者,临床记忆量表有更好的适用性;②不能仅依据测量工具的记忆商数,而要结合其它资料才能更准确地评估记忆功能状况.     

简易老年记忆测验的信效度分析

目的：对简易老年记忆测验的信度和效度进行检验。方法：采用分半相关法，复本法以及效标关联效度的同时效度和预测效度进行检验。结果：①信度检验：内部结构检验的分半相关系数较高（P〈0．001）。交叉重复测试显示两套测验基本等同（P〈0．001），再现性、稳定性良好；②效度检验：简易老年记忆测验与韦氏记忆测验量表有较高的相关性（P〈0．01）。18F-FDG脑代谢显像与简易老年记忆测验结果呈正相关关系（P〈0.05—0．01）． 结论：简易老年记忆测验的内部结构的稳定性，两套平行测验的一致性以及效标关联效度的有效性均基本符合设计的构思和要求。     

Alzheimer病与Parkinson病患者记忆损害的比较研究

目的：测查Alzheimer病、Parkinson病患者的记忆功能，了解这两种疾病病人记忆损伤的特征。方法：采用多维记忆评估量表中的12个分测验对30例原发性Parkinson病患者、30例临床诊断可能的Alzhdmer病患者及年龄、性别和教育程度与2个病人组相匹配的2个正常对照组进行外显记忆、内隐记忆及日常生活记忆等记忆功能的评定。结果：AD组在所有的分测验和记忆因子上均差于对照组；PD组在图画再认、数字广度、汉词回忆、图形再生、经历定向等分测验和记忆广度、再认记忆、自由回忆、日常记忆、外显记忆等记忆因子上均显著低于对照组：经以教育年限为协变量校正后发现。除自由组词、残图命名、数字广度、空间广度、汉词回忆、常识记忆、记忆广度、内隐记忆外，AD组在其余各分测验和记忆因子上均存显著差于PD病人组。结论：AD病人存在着广泛的记忆功能障碍：PD病人存在着工作记忆和策略记忆的障碍：两者的记忆功能障碍存在着明显的不同。     

难治性强迫症与非难治性强迫症认知功能比较研究

目的:比较难治性强迫症与非难治性强迫症认知功能差异。方法:采用韦氏记忆量表(WMS)、数字划销测验、威斯康星卡片分类测验(WCST)评估51例难治性强迫症和59例非难治性强迫症的记忆、注意、执行功能。结果:难治性强迫症的长时记忆较非难治性强迫症差,而两组其它记忆因子分及记商、数字划销测验、威斯康星卡片分类测验分差异无统计学意义。结论:难治性强迫症与非难治性强迫症认知功能无显著性差异。     

韦克斯勒记忆量表第四版中文版(成人版)的修订

目的:修订韦克斯勒记忆量表第四版(WMS-IV)中文版(成人版),并考察其效度和信度。方法:将全国16岁以上人口作为取样总体,以年龄、性别、教育程度为主要变量按比例分层取样,选取16~69岁有效样本1561人,应用WMS-IV中文版(成人版)对样本进行个别记忆测验。该量表包括5个基本分量表(逻辑记忆、词语配对、图形重置、视觉再现、空间叠加),用于导出5个指数分;还包含1个简明认知状况测验的可选分量表。同时施测韦氏成人智力量表第四版(WAIS-IV)中文版来检验效标效度。选取样本中95名被试间隔22天后重测WMS-IV中文版(成人版)。结果:验证性因子分析表明量表的二因素结构拟合较好(χ2/df=14.77/4,RM SEA=0.04,NFI=0.99,NNFI=0.99,RFI=0.99,AGFI=0.99,SRM R=0.02);各指数分与WAIS-IV中文版工作记忆指数的相关系数为0.50~0.64,各指数分及总记忆商与总智商的相关系数为0.61~0.73(均P<0.05)。各分量表得分、过程分、指数分及总记忆商的平均信度系数分别为0.79~0.93、0.67~0.86、0.93~0.97;分量表得分、指数分及总记忆商的重测信度分别为0.40~0.69、0.68~0.76、0.78;各再认分量表分类判定的一致性系数均>0.90;评分者一致性>0.95。结论:WM S-IV中文版(成人版)具有良好的效度和信度,可以在中国成人群体中进行应用。     

重复性成套神经心理状态测验的信度、效度分析

目的:对用于精神障碍患者认知功能测评的重复性成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)中文版的信度和效度作初步验证.方法:从北京市城乡方便取样,做横断面调查,451名健康人群完成RBANS测验,其中97人同时完成简易韦氏成人智力、韦氏记忆测验考察效标效度;41人间隔12周再次进行了RBANS测验.对获取的数据进行相关分析和因子分析.结果:反映内部一致性的Cronbach α系数在RBANS总量表为0.90,在即刻记忆、视觉广度、言语功能、注意、延迟记忆分量表分别为0.86,0.68,0.67,0.85,0.80.总量表的重测信度为0.90,5个分量表的重测信度分别为0.65,0.68,0.53,0.80,0.79(P均＜0.01).以简易韦氏成人智力、韦氏记忆测验为效标,结果除简易韦氏成人智力量表的言语得分与RBANS量表的视觉空间因子间相关性无统计学意义,RBANS与简易韦氏成人智力和韦氏记忆量表总分和各因子分均存在有统计学意义的正相关(r=0.21-0.59,P均＜0.01).验证性因素分析结果x2/df为4.13,相对拟合指数(CFI)为0.91,非范拟合指数(NNFI)为0.93,近似均方根误差(RMSEA)为0.079.12个分测验的完全标准化解(MI)分别为:0.80,0.74,0.61,0.38,0.61,0.90,0.66,0.60,0.81,0.60,0.81,0.73.结论:重复性成套神经心理状态测验是一个信效度比较好的认知功能评定工具.     

学习技能诊断测验的初步编制

目的:编制一套学习技能诊断测验,并检验其信效度。方法:以理论法编制了一套用于小学生的学习技能诊断测验,分低级(1-3年级)和高级(4-6年级)两个版本,每个版本含语文分量表和数学分量表,语文分量表由汉词拼音、汉词拼写和阅读理解三个分测验组成,数学分量表由数量概念、四则运算和数学推理三个分测验组成。用新编测验对近1000名小学生进行测查,重测样本95人,效标效度样本75人。结果:低级版的难度为0.49-0.78,高级版的难度为0.52-0.86之间;低级版的区分度为0.29-0.61,高级版的区分度为0.39-0.60。低级版重测信度为0.73-0.90,分半信度为0.66-0.95,α系数为0.70-0.97,高级版重测信度在0.73-0.89,分半信度为0.62-0.89,α系数为0.79-0.95。分测验之间的相关系数为0.36-0.97,分测验与总分的相关系数在0.71-0.95。分测验分数与华文认知能力量表智商的相关为0.55-0.81,与学校考试成绩的相关为0.19-0.74。结论:学习技能诊断测验的难度、区分度、信度和效度符合心理测量学的标准。     

强迫症患者认知功能与病期的关系

目的：探讨强迫症的认知功能障碍与病期的关系。方法：分别用韦氏记忆测验，数字划销测验和威斯康星卡片分类测验评估25例急性强迫症和36例慢性强迫症患者的记忆、注意和执行功能。结果：急性强迫症患者的记忆测验中记图和数字划销测验中第二阶段失误率显著性较慢性强迫症差，其余两组间记忆测验、划销测验和威斯康星卡片分类测验各量表分无显著性差异。结论：强迫症的认知功能与病期无明显相关。     

绘人测验与中国-韦氏儿童智力量表的比较研究

在临床工作中,儿童保健专业工作者常用绘人智能测验[1]来测试儿童的智力发展水平,因为它是一种能引起儿童兴趣的简便易行的智能测查方法。并且有研究报道它与标准化成套智力测验结果的一致性较高,但我们在临床工作中发现其结果似乎有差异,为此,我们采用中国-韦氏儿童智力量表(Ｃ-ＷＩＳＣ)进行测试,主要目的是比较二者之间的一致性,对绘人测验的效度进行再验证。1　材料与方法1.1　研究对象研究组为某中等城市一所普通小学一年级学生,随机抽取32名学生,年龄6岁1个月至6岁10个月,平均6岁8个月,其中女生16名,男生16名。1.2　方法智力量表采用…     

外科学总论多媒体辅助教学思考

自2003年起连续3年在我校本科临床医学系教学中应用自行设计制作的“外科学总论多媒体教学视听课件”授课,同学们普遍认为多媒体辅助教学方式新颖生动,内容直观清晰,记忆深刻持久,能够最大程度地激发同学们互动学习的兴趣,培养主动思考处理临床问题的能力;仅应用初期因为对多媒体授课与传统授课的有机结合掌握不当而使部分习惯于传统方式教学的同学觉得难以适应。因此如果教师应用恰切,计算机多媒体技术作为临床辅助教学手段可以在很大程度上改善教学方法、提高教学质量。     

Departing from PowerPoint Default Mode: Applying Mayer’s Multimedia Principles for Enhanced Learning of Parasitology

Purpose: PowerPoint (PPT™) presentation has become an integral part of day-to-day teaching in medicine. Most often, PPT™ is used in its default mode which in fact, is known to cause boredom and ineffective learning. Research has shown improved short-term memory by applying multimedia principles for designing and delivering lectures. However, such evidence in medical education is scarce. Therefore, we attempted to evaluate the effect of multimedia principles on enhanced learning of parasitology. Methodology: Second-year medical students received a series of lectures, half of the lectures used traditionally designed PPT™ and the rest used slides designed by Mayer’s multimedia principles. Students answered pre and post-tests at the end of each lecture (test-I) and an essay test after six months (test-II) which assessed their short and long term knowledge retention respectively. Students’ feedback on quality and content of lectures were collected. Results: Statistically significant difference was found between post test scores of traditional and modified lectures (P = 0.019) indicating, improved short-term memory after modified lectures. Similarly, students scored better in test II on the contents learnt through modified lectures indicating, enhanced comprehension and improved long-term memory (P < 0.001). Many students appreciated learning through multimedia designed PPT™ and suggested for their continued use. Conclusions: It is time to depart from default PPT™ and adopt multimedia principles to enhance comprehension and improve short and long term knowledge retention. Further, medical educators may be trained and encouraged to apply multimedia principles for designing and delivering effective lectures.     

An artificial neural net and error backpropagation to reconstruct single photon emission computerized tomography data

At present, algorithms used in nuclear medicine to reconstruct single photon emission computerized tomography (SPECT) data are usually based on one of two principles: filtered backprojection and iterative methods. In this paper a different algorithm, applying an artificial neural network (multilayer perception) and error backpropagation as training method are used to reconstruct transaxial slices from SPECT data. The algorithm was implemented on an Elscint XPERT workstation (i486, 50 MHz), used as a routine digital image processing tool in our departments. Reconstruction time for a 64 x 64 matrix is approximately 45 s/transaxial slice. The algorithm has been validated by a mathematical model and tested on heart and Jaszczak phantoms. Phantom studies and very first clinical results ((111)In octreotide SPECT, 99mTc MDP bone SPECT) show in comparison with filtered backprojection an enhancement in image quality.     

川芎嗪改善宫颈微循环治疗宫颈糜烂

川芎嗪改善宫颈微循环治疗宫颈糜烂艾旭＊郭萍＊张俊霞子宫颈糜烂与宫颈癌的发生有关，故对其治疗广受重视。我们采用活血化瘀的方法改善宫颈局部微循环，并佐以消炎的药物治疗宫颈糜烂取得较满意的效果。１资料与方法临床资料：９０例患者为妇科门诊病人，生育年龄。有生...     

Computerized analysis of video fluorescein imaging (VFI) of the skin.

Video fluorescein imaging (VFI) is a new technique to continuously follow the development of fluorescence in the skin, i.e. blood inflow and perfusion, after intravenous injection of sodium fluorescein. The method is supplementary to other microcirculatory techniques for evaluation of peripheral arterial occlusive disease, particularly in critical ischaemia. In the present article we describe a totally computerized digital imaging processing system for evaluation and present results from a comparison between the evaluations of the appearance and development of the fluorescence in the sole of the foot using the computerized and the previously used manual techniques. With the computerized system the images are stored and correlated with the start of the injection. Regions of interest are then marked and a mean value of fluorescence intensity is calculated for each image. Using this computerized system the time required for evaluation has been shortened to about 10 min. The results of the comparison between the manual and computerized evaluations of appearance times showed that a significant correlation existed in all examined parts of the feet between the two techniques. The methods gave approximately the same results in regions with fluorescence appearance times between 20 and 50 s. With longer appearance times than approximately 50 s a systematic difference between the two techniques seemed to exist. In this interval shorter appearance times were measured with the computerized technique than with the manual technique. However, the clinical information with regard to prognosis would be relatively unchanged when the new computerized assessment technique and a new cut-off level for the appearance time are used. Also, regarding the development of fluorescence after the appearance time, expressed by the slope, a significant correlation was found between the manual and the computerized evaluation.     

The ecological validity of traditional memory evaluation in relation with controlled memory processes and routinization

The neuropsychological evaluation of memory by traditional tests raises questions about their ecological validity, as the results on these tests often have little relation to the memory complaints. In an attempt to explain this lack of relationship, the present study had two objectives: (1) explore the ecological superiority of the Process Dissociation Procedure (PDP) over traditional memory tests and (2) explore the effects of routinization on the relationship between memory complaints and memory tests. Thirty-three participants aged 55-86 years were given the PDP (memory evaluation), two questionnaires evaluating daily memory complaints (QAM and CDS) and a questionnaire evaluating routinization (EPR). The results indicate that the PDP, with its measure of controlled processes, is more ecological than traditional memory tests for elderly people. As well, the participants' lifestyle (routinized versus non-routinized) influenced their results on memory tests. The results are discussed in relation to neuropsychological evaluation and rehabilitation.     

First-Last Names and the Grocery List Selective Reminding Test: two computerized measures of everyday verbal learning.

Data are presented on two computerized tests of everyday verbal learning: Paired associate learning of First-Last Names (FLN), and the Grocery List Selective Reminding Test (GLSRT). MANOVA and multiple regression analyses demonstrated that performance on FLN and GLSRT was most strongly related to age, with significant secondary associations found for gender, with females performing better than males. Additional factor analysis of FLN and GLSRT supported the construct validity of these measures by demonstrating significant associations of performance with traditional newopsychological measures of memory and related functions, including the Paired Associate Learning and Logical Memory subtests from the Wechsler Memory Scale, the Benton Visual Retention Test, and WAIS Digit Symbol.     

Recollection memory deficits in patients with major depressive disorder predicted by past depressions but not current mood state or treatment status

BACKGROUND: Neuropsychological studies have suggested that memory systems reliant on medial temporal lobe structures are impaired in patients with depression. There is less data regarding whether this impairment is specific to recollection memory systems, and whether clinical features predict impairment. This study sought to address these issues. METHOD: A computerized process-dissociation memory task was utilized to dissociate recollection and habit memory in 40 patients with past or current major depression and 40 age, sex and IQ matched non-psychiatric control subjects. The Cognitive Failures Questionnaire was used to assess patients' perceptions of day-to-day memory failures. RESULTS: Patients had impaired recollection memory (t = 4.7, P < 0.001), but no impairment in habit memory when compared to controls. Recollection memory performance was not predicted by indices of current mood state, but was predicted by self-assessments of impairment (beta = -0.33; P = 0.008) and past number of depressions (beta = -0.41; P = 0.001). There was no evidence that standard therapy with antidepressant medication either improved or worsened memory performance. CONCLUSIONS: The results confirm that patients with multiple past depressions have reduced function on recollection memory tasks, but not on habit memory performance. The memory deficits were independent of current mood state but related to past course of illness and significant enough that patients detected impairment in day-to-day memory function.     

Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides.

Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the "traditional medical history" describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary-Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.     

Computerized,interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice

BACKGROUND: Cognitive-behavioural therapy (CBT) brings about significant clinical improvement in anxiety and depression, but therapists are in short supply. We report the first phase of a randomized controlled trial of an interactive multimedia program of cognitive-behavioural techniques, Beating the Blues (BtB), in the treatment of patients in general practice with anxiety, depression or mixed anxiety/depression. METHOD: One hundred and sixty-seven adults suffering from anxiety and/or depression and not receiving any form of psychological treatment or counselling were randomly allocated to receive, with or without medication, BtB or treatment as usual (TAU). Measures were taken on five occasions: prior to treatment, 2 months later, and at 1, 3 and 6 months follow-up using the Beck Depression Inventory, Beck Anxiety Inventory and Work and Social Adjustment Scale. RESULTS: Patients who received BtB showed significantly greater improvement in depression and anxiety compared to TAU by the end of treatment (2 months) and to 6 months follow-up. Symptom reduction was paralleled by improvement in work and social adjustment. There were no interactions of BtB with concomitant pharmacotherapy or duration of illness, but evidence, on the Beck Anxiety Inventory only, of interaction with primary care practice. Importantly, there was no interaction between the effects of BtB and baseline severity of depression, from which we conclude that the effects of the computer program are independent of starting level of depression. CONCLUSIONS: These results demonstrate that computerized interactive multimedia cognitive-behavioural techniques under minimal clinical supervision can bring about improvements in depression and anxiety, as well as in work and social adjustment, with and without pharmacotherapy and in patients with pre-treatment illness of durations greater or less than 6 months. Thus, our results indicate that wider dissemination of cognitive-behavioural techniques is possible for patients suffering from anxiety and/or depression.