运用标准差指数和变异系数指数评价实验室内不同血细胞分析仪检测结果的一致性

目的探索运用标准差指数(standard deviation index, SDI)和变异系数指数(coefficient of variation radio, CVR)对比分析同一实验室内不同血细胞分析仪检测WBC、RBC、血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,HCT)和血小板(platelets,PLT)计数项目的室内质量控制比对检测结果的一致性,及其评价方法的新模式。 方法分析2014年5月1日至5月31日期间,宁夏医科大学总医院医学实验中心不同型号的5台血细胞分析仪检测WBC(流式细胞计数法)、RBC (鞘流DC检测法)、Hb(十二烷基硫酸钠血红蛋白检测法)、HCT(脉冲高度检测法)和PLT(鞘流DC检测法) 5项血常规项目三个水平的室内质量控制数据,计算出75组均值( )、标准差(standard deviation,SD)、及变异系数(coefficient of varation, CV),以及各项目的SDI、CVR等;同时评价分析不同血细胞分析仪检测各项目的日间精密度分布及比对分析检测结果正确度的一致性。 结果根据5台血细胞分析仪2014年5月,连续31 d中,检测WBC、RBC、Hb、HCT、PLT项目1~3的三个水平共465个质控数据。5个项目各水平的SDI和CVR分别为-1.37~1.84和0.72~1.46、-3.35~2.59和0.83~1.21、-3.28~3.57和0.40~1.67、-2.79~1.88和0.53~1.61、-1.25~1.21和0.52~1.59。其中,RBC和HGB 3个水平室内质控结果SDI>2的数量最多,分别为5个和7个;HCT有1个SDI>2;WBC和PLT的SDI<2。WBC、RBC、Hb、HCT、PLT的SDI指标不合格率分别为0、33.33%、46.67%、6.67%、0。每台仪器检测5个项目CVR与所有实验室仪器CVR相比均<2。 结论运用SDI和CVR综合评价实验室内不同血细胞分析仪检测同一WBC、RBC、Hb、HCT、PLT项目结果的正确度和精密度的室内质量控制的可比性较好,可作为实验室内不同血细胞分析仪检测相同项目结果一致性评价的实验室内质量控制新模式。     

服务蓝图及过程能力指数在医院服务质量评价中的应用

目的对医院内部服务质量进行量化测算,以便于医院实施服务质量的控制与管理。方法利用服务蓝图技术确定内部服务评价的主客体关联图。根据SERVQUAL服务质量评价量表,设计服务流程中各环节服务质量评价指标体系,通过专家赋权法给出各职能部门相对整体服务质量绩效重要性权重,并对各部门评价结果加权综合,借鉴工业产品质量控制中过程能力指数,提出医院服务过程能力指数的概念,从而得到服务部门过程能力指数。结果应用此方法对某大型三级甲等医院CT服务质量进行定量评价,得到CT业务服务过程能力值为3．6490分。结论用医院服务质量过程能力指数,动态、连续地监测内部服务质量变动情况,有利于医院服务质量的提升。     

Bland-Altman分析在临床测量方法一致性评价中的应用

在放射医学、超声医学、实验室医学等临床医学活动中,经常会遇到评价两种或多种检测、测量方法结果一致性(agreement)的问题。一般情况下,其中一种方法是目前广泛应用的或被称为“金标准”的方法,而另一种方法则是更先进、更便于应用、更经济、无创或微创的方法。通过对两种测量方法进行一致性评价可以回答“这两种方法能否互相替代”这样的问题。本文通过实例介绍用于评价测量结果为连续资料的两种测量方法一致性的Bland-Altman分析。原理和方法Bland-Altman分析最初是由Bland J M和AltmanDG于1986年提出的〔2〕。它的基本思想是计算出…     

基于医疗质量指数及专科能力指数的科室医疗质量评价

目的 探索建立多维度的医院高质量发展评价体系,评价深圳某医院各住院科室医疗质量,为医院质量管理工作、选择重点学科、高质量发展科室评选提供参考依据。方法 选择TOPSIS法及加权综合指数法计算医疗质量指数、专科能力指数,对医院46个住院科室2022年1月1日—12月31日50 845份病案数据进行医疗质量综合评价。采用Spearman相关分析对医疗质量指数和DRG能力指数、专科能力指数和DRG能力指数评价结果分别进行相关性分析。结果 医疗质量指数、专科能力指数合计排名前10科室有8个科室为重点学科,有7个为手术科室,有8个为西院区科室,重点学科排名优于非重点学科,手术科室排名优于非手术科室,西院区科室排名优于东院区;医疗质量指数与DRG能力指数评价结果相关分析检验,r=0.594,P<0.05;专科能力指数和DRG能力指数评价结果相关分析检验,r=0.575,P<0.05。结论 用医疗质量指数、专科能力指数进行综合评价能科学、客观、全面地反映临床科室的医疗质量,为医院高质量发展评价提供数据依据。     

CODMn指数测量不确定度评定

随着对外开放力度的加大,特别是加入WTO后,对实验室特别是第三方实验室检测能力的要求越来越高,实验室间的竞争愈趋激烈,实验室的国家认可工作更显其重要性。而实验室国家认可中不确定度的评定是一个不可忽视的内容。我们试图对水中CODMn指数测量不确定度评定进行初步探讨,数学模型采用分项替代法简化成便于运算的数学形式进行了尝试。     

工作能力指数量表的评价研究

目的 评价工作能力指数(work ability index,WAI)量表的内在结构及其条目合理性。方法 采用“工作能力指数”量表,对不同行业6429名在职职工进行工作能力测试,剔除不合格或项目不全者,最终纳入统计分析的对象为4354名。同时,按系统抽样原则从工作能力测试对象中袖取10％进行功能能力(包括脑力能力、肌肉骨铬功能)测定,剔除测试项目不全者,有530名纳为统计分析对象。采用因子分析、相关分析和列联表x^2检验等方法进行WAI量表评价。结果 WAI量表7个条目(W1—W7)分别由4个公因子支配(条目W1、W2由公因子F1支配,条目W3、W4由公因子F3支配,条目W5由公因子F4支配,条目W6、W7由公因子F2支配),累计贡献率为79．80％,条目W1—W7的公因子方差均高于0.60。除少数测试指标外,脑体功能能力主、客观指标问均具有相关关系(P＜0.05),体力功能分级、脑力功能分级与工作能力分级的一致率分别为60．19％和61．89％,分级之间相关关系具有统计学意义(P＜0．01)。结论 工作能力是多种因素的综合体现,WAI量表的部分条目应作修订。     

定量测量结果的一致性评价及Bland-Altman法的应用

目的 探讨Bland-Altman法在定量测量结果的一致性评价方面的应用.方法 采用Bland-Altman作图法对定量测量结果的一致性问题进行分析评价,针对不同的数据情况分别采用原始数据和经过对数转换以后的数据进行作图分析,以适应不同数据条件的要求,计算差值均数的一致性界限,并与专业要求的容许误差进行比较,最终做出推断结论.结果 Bland-Altman图法将一致性界限的定量分析与散点图分布的定性描述相结合,可以对定量测量数据的一致性进行较为准确的评价.结论Bland-Altman图法是定量数据一致性评价的理想方法.     

医学生学日大脑工作能力指数评价

大学生在校期间的主要任务是学习科学文化知识。学习以大脑活动为主,以建立条件反射为基础,因此学习的生理负荷主要落在高级神经系统,特别是第二信号系统。为了更合理地组织安排教学,提高教学质量,使学生以最小的神经细胞损耗达到最佳的学习效果,我们对学日大脑工作能力（AYP）指数进行了评价。1对象与方法1．1对象抽取佳大医学院基础医学课学生120名。1．2方法剂量作业试验法（技字法）。采用安菲莫夫首创的试验表。为了分析学日中医学生的学习能力变化规律,每日测试6次,每次测试时间为2分钟,分别于上午第1节课前（A）、第1节课…     

健康不公平性的测量:基尼系数和集中指数简介

微观经济学常用基尼系数与洛仑兹曲线来表示社会经济公平性，本文介绍基尼系数与洛仑兹曲线在健康公平性方面的理论、方法与应用情况。     

探讨B超监测羊水指数的临床价值

妊娠晚期应用B超测量羊水指数,进而监测胎儿高危程度,对其分娩的处理及对围产儿预后的估价均有重要意义.羊水过少与胎儿生长发育及胎盘功能状态均有密切的关系.现将我院监测结果报告如下.     

Agreement between Two Methods of Dietary Data Collection in Male Adolescent Academy-Level Soccer Players

Collecting accurate and reliable nutritional data from adolescent populations is challenging, with current methods providing significant under-reporting. Therefore, the aim of the study was to determine the accuracy of a combined dietary data collection method (self-reported weighed food diary, supplemented with a 24-h recall) when compared to researcher observed energy intake in male adolescent soccer players. Twelve Academy players from an English Football League club participated in the study. Players attended a 12 h period in the laboratory (08:00 h–20:00 h), during which food and drink items were available and were consumed ad libitum. Food was also provided to consume at home between 20:00 h and 08:00 h the following morning under free-living conditions. To calculate the participant reported energy intake, food and drink items were weighed and recorded in a food diary by each participant, which was supplemented with information provided through a 24-h recall interview the following morning. Linear regression, limits of agreement (LOA) and typical error (coefficient of variation; CV) were used to quantify agreement between observer and participant reported 24-h energy intake. Difference between methods was assessed using a paired samples t-test. Participants systematically under-reported energy intake in comparison to that observed (p < 0.01) but the magnitude of this bias was small and consistent (mean bias = −88 kcal·day⁻¹, 95% CI for bias = −146 to −29 kcal·day⁻¹). For random error, the 95% LOA between methods ranged between −1.11 to 0.37 MJ·day⁻¹ (−256 to 88 kcal·day⁻¹). The standard error of the estimate was low, with a typical error between measurements of 3.1%. These data suggest that the combined dietary data collection method could be used interchangeably with the gold standard observed food intake technique in the population studied providing that appropriate adjustment is made for the systematic under-reporting common to such methods.     

两种方法测定消毒剂中二氧化氯含量的比较

目的 比较二氧化氯消毒剂的两种含量测定方法，为二氧化氯含量测定方法的标准化提供参考。方法 采用丙二酸-碘量法和五步碘量法。结果 两种试验方法测定的结果差别很大，pH值越低，两种方法测定的结果越接近。且方法的精密度也不同，两种方法的相对标准偏差分别为0．09996％～0.2503％和0．7336％～14．80％。结论 作为消毒剂中二氧化氯含量测定的标准方法，这两种方法都还有待于进一步完善。?     

Assessing Measurement Properties of Two Single-item General Health Measures

Background: Multi-item health status measures can be lengthy, expensive, and burdensome to collect. Single-item measures may be an alternative. We compared measurement properties of two single-item, general self-rated health (GSRH) questions to assess how well they captured information in a validated, multi-item instrument. Methods: We administered a general health survey (SF-12V) that included “standard” and “comparative” forms of a GSRH. We repeated the survey two weeks later to the same 75 medically stable outpatients to test for GSRH reproducibility, reliability, and validity using SF-12V Physical Functioning and Emotional Health subscales as a reference. Results: At each survey administration, the two GSRH questions demonstrated good alternate forms reliability (first administration: r=0.74, p<0.001; second administration: r=0.74, p<0.001) and good reproducibility (“standard”: ICC 0.69; “comparative”: ICC 0.85). Both GSRH items correlated with physical functioning (“standard”: r=0.66; “comparative”: r=0.56) and emotional health measures (“standard”: r=0.65; “comparative”: r=0.59). Mean subscale measures associated with responses in each GSRH category were significantly different (ANOVA, p<0.001), indicating strong discriminant scale performance. Conclusions: Our single-item, GSRH questions demonstrated good reproducibility, reliability, and strong concurrent and discriminant scale performance with an established health status measure.     

Assessing the Process of Clinical Problem Solving

This article describes a technique for the assessment of medical performances based on the sequence of questions (tactic) that physicians may ask in order to diagnose, treat or follow up a patient. The technique considers changes in the amount of information requested depending on: a) levels of medical experience, b) medical specialties, c) cultural environment, and d) individual diagnostic performance evaluated using different norms. The change in the information value (bits) of a given question depending on its ordinal placement in the tactic is discussed. The obtained results show that surgeons and clinicians request similar information but organize the diagnostic process differently, suggesting the possibility of applying the technique for early detection of specific vocations. The importance of the variable order is of crucial interest throughout all the described results. The obtained findings may serve to train medical students. This revised version was published online in July 2006 with corrections to the Cover Date.     

两种宫腔填塞方法在产后出血中的临床应用效果分析

目的：探讨采用不同的宫腔填塞止血方法治疗阴道分娩产后出血的临床效果。方法：回顾分析2007年6月-2012年6月在本院阴道分娩后2h内,出现宫缩乏力性产后出血患者50例,分为研究组（腔水囊填塞＋阴道纱条填塞组）和对照组（宫腔填纱组）各25例,观察两组手术操作时间、止血时间、止血显效时间、填塞物留置体内时间、产褥病率、填塞失败率、子宫切除例数等。结果：研究组的填塞物置入时间、填塞物留置时间、止血显效时间明显缩短,止血有效率明显提高,与对照组比较差异有统计学意义（P〈0.05）,研究组的填塞失败率明显低于对照组（P〈0.05）,两组子宫切除率及产褥病率差异无统计学意义（P〉0.05）。结论：宫腔水囊填塞＋阴道填纱治疗产后出血方法取材方便,操作简单,疗效肯定,比较适用于基层医院阴道分娩产后早期子宫收缩乏力所致的产后出血者。     

Assessing the Co-occurring Capability of Mental Health Treatment Programs: the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index

The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index was developed to assess the capability of mental health programs to provide substance abuse and co-occurring treatment services. The DDCMHT is an objective scale rated following a site visit that includes semi-structured interviews with staff at all levels, review of program documents and client charts, and ethnographic observation of the milieu and setting. Using data from 67 mental health programs across six states, this study found that the DDCMHT had excellent total score reliability, variable subscale reliability, high inter-rater reliability (n?=?18), and moderate construct validity (n?=?22). Results also suggest that many mental health programs are at a relatively low level of capability for the delivery of care to individuals with co-occurring disorders. Results from this important new benchmark measure, the DDCMHT, can be used with programs in implementation planning and with treatment systems, states, or national organizations to guide policy change.     

N-Nitroso Compounds: Assessing Agreement between Food Frequency Questionnaires and 7-Day Food Records

BackgroundN-nitroso compounds are recognized as important dietary carcinogens. Accurate assessment of N-nitroso intake is fundamental to advancing research regarding its role with cancer. Previous studies have not used a quantitative database to estimate the intake of these compounds in a US population.ObjectiveTo address this gap, a database of N-nitroso values was developed in conjunction with an existing food frequency questionnaire (FFQ). In this article we report on the relative validity of the FFQ instrument modified to estimate intake of N-nitroso compounds.DesignIntake estimates of 23 N-nitroso compounds from the FFQ were compared with those from 7-day food records in a cross-sectional study conducted from January 2005 through June 2006.SubjectsA sample of 98 healthy adult subjects (aged 50.42±12.84 years) completed an FFQ and then recorded foods and beverages consumed on 7-day food records.ResultsCrude and energy-adjusted N-nitroso compounds intakes were significantly higher in the FFQ than the 7-day food records (P<0.001). Spearman correlations for crude and energy-adjusted N-nitroso intakes ranged from 0.004 to 0.48. By tertiles of N-nitiroso compounds, there was moderate agreement (κ>0.30) for five compounds. Higher estimates of N-nitroso compounds by FFQ was explained by a greater proportion of subjects who reported eating foods high in N-nitroso compounds on FFQ than reported on 7-day food records.ConclusionThe modified FFQ with N-nitroso values is a useful tool for assessing N-nitroso intakes relative to a group, and captures all food items with N-nitroso compounds, including those foods with high concentrations and eaten sporadically.     

两种方法修复牙列缺损的临床研究

目的：比较两种方法用于修复后牙游离缺失伴残根残冠的修复效果。方法：选择38例后牙游离缺失伴残根残冠的患者,按随机数字表法将其分为两组,分别采用冠外栓道式精密附着体义齿（n=17）和卡环固位活动义齿修复（n=21）,5年后对修复效果进行评价。结果：冠外栓道式精密附着体义齿组出现1例崩瓷,无冠桩松动脱落、根折、桩折、牙周炎和根尖周炎,无活动部分破损,成功率为94．1％;卡环固位活动义齿组出现8例失败,成功率为61．9％,两组成功率比较差异有统计学意义（P〈0．05）。结论：对于后牙游离缺失伴残根残冠的牙列缺损病例,选用冠外栓道式精密附着体义齿修复的临床效果较好,值得临床推广使用。