护理研究中多要素评价指标赋权方法的应用进展

指标赋权作为指标体系构建中的重点及难点,是多要素综合评价的枢纽环节,指标权重确定的科学性、合理性、精确性直接决定评估结果的可靠性。本文对护理研究中常见的多要素评价指标主观赋权法、客观赋权法及综合集成赋权法进行系统梳理,深入探析指标权重具体确定方法、应用案例,分析总结其优缺点及适用范围,为后续科学选择指标权重确定方法提供参考依据,从而提高护理研究中多要素指标综合评价的精准性和客观性。     

应用层次分析法确定社区护士核心能力评价指标体系权重

目的 确立社区护士核心能力评价指标体系一、二级指标的权重系数,以建立社区护士核心能力评价指标体系.方法 在Delphi法的基础上,运用层次分析法建立结构模型、构造判断矩阵,计算确定指标权重并进行一致性检验.结果 确立了社区护士核心能力评价指标体系6个一级指标和22个二级指标的权重系数.结论 权重的确定进一步完善了社区护士核心能力评价指标体系,为社区护士的培训、考核提供客观可量化的依据.     

育龄妇女使用五种宫内节育器临床效果分析

目的观察5种宫内节育器（IUD）的临床使用效果。方法回顾性分析药铜165型、元宫220型、宫铜、TCu220型、母体乐共5种IUD的5年临床随访观察效果。结果5年的随访结果表明，元宫220型的续用率最高（P〈0.05），为97．23％；放置含消炎痛IUD（药铜165型、TCu220型、元宫220型）中月经量的增多较不含消炎痛IuD（宫铜、母体乐）少（P〈0.05）；置器后3个月腰部、下腹部疼痛以宫铜、母体乐、TCu220型较明显，但5组间差异无统计学意义（P〉0.05）。结论元宫220型IUD不良反应小，续用率高，避孕效果好。     

Delphi和AHP法在医院护理综合评价中的应用

为克服个体决策者知识的不完备性,本文提出利用多领域的专家知识实现评价系统中指标体系的确定.采用Delphi法和AHP法对半结构化的评价问题进行定量分析.结合医院护理综合评价系统中的影响因子(指标)及其权重的确定实例给出了医院护理综合评价指标体系及模型的建立方法.     

主管护师综合评价指标体系研究

目的构建科学、实用的主管护师综合评价指标体系。方法采用文献查阅和专家访谈设计指标体系,运用Delph法进行指标的筛选与评价标准的确立,层次分析法用于指标权重的确定,相关性分析和因子分析法检验指标体系的信度与效度。结果本研究构建的主管护师综合评价指标体系包括4项一级指标、12项二级指标和46项三级指标,确定了各级指标的权重,确认了指标体系良好的信度和效度。结论主管护师综合评价指标体系具有科学性、合理性和可操作性,可作为主管护师综合评价、绩效考核、聘任及晋升的有效决策工具和评价依据。     

临床护理专家认证评价指标体系权重的研究

[目的]确立临床护理专家评价体系各级指标的权重系数,以建立临床护理专家综合评价指标体系。[方法]采用Delphi法对34名专家进行问卷调查,利用层次分析法建立层次结构模型,构造判断矩阵,通过计算确定指标权重并检验其逻辑一致性。[结果]Delphi法和层次分析法联合应用确定临床护理专家综合评价体系4类共计55项指标的权重系数,各级指标权重均满足逻辑一致性要求,具有科学性和客观性。[结论]利用该体系对护理人员进行综合评价,结合定性与定量指标,为公正、客观、准确地对临床护理专家进行评价提供了统一标准。     

临床护理专家认证评价指标体系权重的研究

[目的] 确立临床护理专家评价体系各级指标的权重系数，以建立临床护理专家综合评价指标体系。[方法] 采用Delphi法对34名专家进行问卷调查，利用层次分析法建立层次结构模型，构造判断矩阵，通过计算确定指标权重并检验其逻辑一致性，[结果] Delphi法和层次分析法联合应用确定临床护理专家综合评价体系4类共计55项指标的权重系数，各级指标权重均满足逻辑一致性要求，具有科学性和客观性。[结论]利用该体系对护理人员进行综合评价，结合定性与定量指标，为公正、客观、准确地对临床护理专家进行评价提供了统一标准。     

TCu380A与其它常用宫内节育器效果比较的系统评价

目的系统评价TCu380A与其它常用宫内节育器(IUD)的有效性。方法计算机检索CBMdisc(1979～2005)、万方(1994～2005)、CNKI (1994～2005)、CMCC(1994～2005)、CMAC(1994～2005)和EMbase (1974～2004)、MEDLINE(1974～2004)、世界卫生组织生殖医学图书馆(WHO／RHL 2004～2005)、Cochrane图书馆(2004年第4期)、SCI(1985～2005)、POPLINE(1966～2003),并手检9种相关杂志。纳入TCu380A与其它常用IUD比较的随机对照试验(RCT)和临床对照试验(CCT),质量评价后进行Meta分析。结果共纳入15篇已发表研究,合计20 417例妇女。Meta分析结果显示,与TCu380A比较:①TCu220C累积脱落率较低,随访6个月及5年时差异有统计学意义[OR 0．36,95％CI(0．18,0．70);OR 0．44,95％CI(0．31,0．62)];累积妊娠率较高,随访10年时差异有统计学意义[OR 1．22(1．04,1．43)];累积因症取出率较低,随访6个月时差异有统计学意义[OR 0．59,95％CI(0．36, 0．97)]。②MLCu375累积脱落率较高,随访1年时差异有统计学意义[OR 2．17,95％CI(1．29,3．67)];累积妊娠率较高,随访1年和2年时其差异均有统计学意义[OR 1．66,95％CI(1．13,2．43);OR 1．26,95％CI(1．00, 1．58)]。③宫铜300累积脱落率较低,随访5年时差异有统计学意义[OR 0．38, 95％CI(0．27,0．56)]。④活性γ380累积因症取出率较低,随访1年时差异有统计学意义[OR 0．31,95％CI(0．14,0．70)]。结论与TCu380A比较,TCu220C长期使用(10年)的避孕效果略逊于TCu380A,但仍是一种性能优良的IUD;MLCu375临床综合效能与TCu380A类似;宫铜300具有低脱落率的特性;活性γ380能有效降低副反应发生率。但该结论还需开展多中心长随访时间的RCT加以证实。     

护理操作技术难度评价指标体系的构建

目的 建立一套较为科学、量化可比的护理操作技术难度评价指标体系.方法 在初步拟定的指标体系基础上,采用德尔菲(Delphi)技术通过3轮专家咨询确立指标体系;运用层次分析法(AHP)确定一级指标的权重、专家评定法确定二级指标的权重.结果 构建了一个包括5项一级指标、11项二级指标的护理操作技术难度评价指标体系.结论 3轮咨询结果 具有可靠性,所构建的指标体系能从多个维度体现护理操作技术难度的特征,可对护理操作技术难度作出较为公正、客观的评价.     

护理职业风险评价指标体系权重的确立及分析

目的 确立护理职业风险评价指标体系权重,为科室护理绩效分配中的护理职业风险模块做参数.方法 采用专家评议法与层次分析法相结合确定指标权重,并将其应用于15个科室中260名护士的护理职业风险程度评价,对其信效度进行分析.结果 确立护理职业风险评价指标体系权重,问卷整体及各部分的克朗巴赫系数分别为0.950、0.892、0.802、0.837、0.912、0.888.效标关联效度结果显示,原评价指标体系与确立了权重后的评价指标体系测得的科室护理职业风险分数与专家评分均具有显著的强相关性(P均<0.01),但是确立了权重后的评分与专家评分的相关系数(0.932)比原评价指标体系(0.892)大,差异有统计学意义(P<0.05).结论 确立的护理职业风险评价指标体系权重具有科学性、合理性、准确性,切合临床实际,可对护理职业风险进行评价.     

Imaging of intrauterine contraceptive devices.

OBJECTIVE: Intrauterine contraceptive devices (IUDs) are reemerging as common methods of birth control in the United States. Imaging, especially sonography, has an important role in their evaluation. This review illustrates the normal and abnormal imaging appearances of IUDs. METHODS: We describe and illustrate the appearance of different types of IUDs on different imaging modalities as well as radiologically relevant complications associated with IUDs. RESULTS: On sonography, the IUD should be visualized as centrally located within the endometrial cavity, with the crossbar (if present) in the fundal portion of the endometrial cavity. Some older patients have IUDs in place that are no longer commonly used, such as the Lippes Loop (Ortho Pharmaceutical, Raritan, NJ) and Saf-T-Coil (Julius Schmid Laboratories, Little Falls, NJ), which have a pathognomonic appearance. Newer IUDs, such as the early version of the Mirena IUD (Leiras Oy, Turku, Finland), may be difficult to visualize on sonography. Patients from China frequently have a ring-shaped IUD. Sonography is important in assessing the complications of IUDs, including a low position, associated infection, myometrial migration, uterine perforation, intrauterine or extrauterine pregnancy associated with the IUD, and retention and fragmentation of the IUD. If an IUD is known to be present but not visualized sonographically, plain radiography is helpful in assessing the location. Computed tomography and magnetic resonance imaging are not typically used to assess IUDs, but the appearances of IUDs should be recognized with these modalities. CONCLUSIONS: Imaging, specifically sonography, has a crucial role in the evaluation and management of IUDs and associated complications.     

The intrauterine contraceptive device

Nonmedicated polyethylene IUDs and medicated copper-releasing or progestogen releasing IUDs are highly effective in preventing pregnancy. Several mechanisms of action forthe antifertility effect of the different IUDs have been postulated, such as alteration of sperm migration, ovum transport, and fertilization orthe prevention of implantation due to morphological and biochemical changes in the endometrium induced by the device. All IUDs stimulate a foreign body reaction in the endometrium which may be further enhanced by the release of copper or influenced by the release of progestogens.Similarly to other methods of contraception, the IUD is associated with side effects; the incidence of pelvic inflammatory disease appears to be higher in the first three months or so following insertion and an increased risk of ectopic pregnancy is predominantly associated with the progesterone-releasing IUD. However, the major reason for poor acceptance of the IUD as a contraceptive method is a disturbance of the menstrual bleeding pattern. Consequently research efforts in recent years have been directed towards the development of IUDs with reduced side effects, particularly bleeding complications.     

Migration of an intrauterine contraceptive device to the ovary

We present the case of a 37-year-old woman with a history of 2 consecutive insertions of intrauterine contraceptive devices (IUDs) 3 years before she was referred to us for sonographic evaluation of lower abdominal pain. The first of the IUDs was presumed to have been expelled spontaneously, and 3 months after insertion of the second device, the patient had begun experiencing lower abdominal pain. Medical treatment with antibiotics and spasmolytics had been unsuccessful. We performed transvaginal sonography, which revealed the presence of an IUD in the uterus and a 2-cm linear metallic echogenic area in the left ovary, believed to represent another IUD. Anteroposterior radiography confirmed that there were 2 IUDs in the pelvis, and CT demonstrated 1 IUD in the uterus and another in the left ovary. The patient underwent laparoscopic removal of the ovarian IUD and was discharged in good condition. To our knowledge, this is the first report of migration of an IUD to the ovary detected on transvaginal sonography. We recommend consideration of this possibility during evaluation of women with unexplained chronic pelvic pain.     

Early sonographic diagnosis of intrauterine device migration to the adnexa

Uterine perforation is an uncommon complication of intrauterine devices (IUDs). Perforating IUDs can migrate to various locations but paradoxically are rarely found in ovaries or broad ligament. We describe an unusual case of a 23‐year‐old woman 1‐month postpartum with an IUD translocation to the right adnexa. The IUD was inserted only 1 week prior to presentation, and she experienced pain on insertion. After visualization by ultrasound, the IUD was laparoscopically removed. We suggest early use of ultrasound in cases of potential IUD migration, particularly in high‐risk patients and when IUD insertion causes pain. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

IUDs: current perspectives

Intrauterine devices (IUDs) have been under much adverse media publicity and many product liability lawsuits have been filed since the mid-1970s, when reports of the association of the Dalkon Shield with septic abortion and pelvic inflammatory disease (PID) surfaced. Yet, worldwide, it is estimated that 70 million women are using IUDs (50 million in China). In Scandinavia they are the most popular form of contraception. An international meeting on the current status of IUDs in New York in 1992 concluded that the IUD is a safe and excellent method of contraception for many women. The newest devices, such as Copper TCu380A and the Multiload Cu375, are the most effective. The risk of PID compared with women using no contraception is elevated by a factor of 7.02 only within the first 20 days after IUD insertion. In Norway, where around 40% of women use IUDs, there has been no increase in subfertility rates compared with the US and UK. A large WHO multicenter study in 1989 found that IUD users were 50% less likely to experience ectopic pregnancy than women using no contraception (90% with Copper TCu 380A). The risk of spontaneous abortion is more than doubled and the risks of preterm delivery increased 10-13% with an IUD in situ; therefore, IUDs should be removed as soon as pregnancy is confirmed. If uterine perforation by the device is suspected, it should be located by ultrasound or x-ray and promptly removed. After contraceptive counselling, even experienced general practitioners can insert IUDs at any time during the menstrual cycle, after induced abortion, or complete spontaneous abortion. Heavy menstrual loss or dysmenorrhea are the most common reasons for removing IUDs. Partial or complete IUD expulsion by uterine contractions is most likely during the first 3 months after insertion. Infection should be suspected in any user who develops pelvic pain.     

The shadow of the intrauterine device.

OBJECTIVE: An intrauterine device (IUD) is a highly effective and prevalent form of birth control with a low failure rate. It is not without complications, including irregular bleeding and pelvic pain, perforation, expulsion, and pregnancy. Investigation of the symptomatic patient and routine follow-up of asymptomatic women with IUDs include transvaginal ultrasonography to rule out IUD malposition and other complications. Three-dimensional ultrasonography (3DUS) has been shown to have added value in imaging the pelvic organs, including the uterus. However, even with 3DUS, the operator may encounter difficulty in imaging the IUD in its entirety, because of variability in both echogenicity and exact location. METHODS: More than 30 women undergoing IUD placement evaluation, including routine examinations and cases of suspected pregnancy, irregular bleeding, infection, and pelvic pain, were evaluated with 3DUS and volume contrast imaging in the C plane (VCI-C), which visualized acoustic shadows of the IUDs, facilitating identification of the intrauterine position and type of the device. RESULTS: Four examples are presented from women undergoing evaluation of IUD placement in whom 2-dimensional ultrasonography failed to visualize the device satisfactorily. Volume contrast imaging in the C plane allowed visualization of the acoustic shadows of the IUDs, thereby providing more exact imaging of the type of device as well as aiding in locating the IUD. In a woman with irregular bleeding, a bicornuate uterus with pregnancy in 1 horn and a bowed T-type IUD in the contralateral horn were diagnosed with VCI-C. CONCLUSIONS: We conclude from these shadow images that VCI-C is a useful modality in cases of difficult visualization of the IUD; VCI-C visualization of the acoustic shadow of the IUD may provide an adjunctive approach.     

Update on IUDs

The SUD is the most effective mechanical contraceptive method available at this time. When inserted correctly, IUDs are 95-99% effective. More than 3 million women in the United States and over 15 million women worldwide are IUD users. Women who are using or are considering using IUDs need comprehensive medical care and adequate health instruction. In this discussion attention is directed to how IUDs work and the various types of IUDs, factors to consider when selecting an IUD and timing for insertion, and complications and risks. The 2 basic categories of IUDs are nonmedicated and medicated. The most important factor to consider when selecting an IUD is the competence of the nurse or physician who inserts it and their familiarity with the IUD selected. The time to insert an IUD is near the end of a woman's normal menstrual period, for this helps assure that she is not pregnant and masks any bleeding associated with insertion. There are 3 particularly serious complications or potential risks from using an IUD: perforation of the uterus; infection, and ectopic pregnancy. A women who is considering IUD use should be informed of the probability of increased menstrual bleeding and cramping, the occurrence of intermenstrual spotting, and dyspareunia for some. Although the pregnancy rate with IUDs is very low, the potential IUD user needs to understand what is likely to happen if she becomes pregnant with an IUD. Spontaneous abortion with the IUD in situ is about 50%.     

超声对四种常见宫内节育器异常和避孕失败的临床分析

目的 应用超声检查探讨和比较四种常见宫内节育器(IUD)异常及其对避孕效果的影响。方法 对已放置IUD的1741名育龄妇女(金属单环834例、宫形环215例、TCu环498例、MLCu环194例)进行超声检查,其结果按环型分组作对比分析。结果 活性IUD(TCu环、MLCu环)移位发生率高于惰性IUD,(金属单环、宫形环),P<0.05;而活性IUD带器妊娠发生率明显低于惰性IUD,P<0.05。IUD移位的三个异常环位(斜置、低置、宫颈内置)、带器妊娠人数的比较无明显差异(P>0.05)。结论 移位是IUD异常中最常见和导致避孕失败的主要原因。活性含铜IUD的避孕效果是明显的。超声诊断能够准确地测出IUD在宫腔的位置,发现IUD异常情况,是研究IUD有价值的检测方法。     

Assessment of olefin-based IUD tail strings.

The "tail string" that extends from a contraceptive intrauterine device (IUD) into the vagina is an illustrative case in materials engineering design. The strings must satisfy certain criteria for strength and other properties in order to fulfill the function of providing a means of insuring that the IUD has not been ejected, and eventually of helping remove the IUD. This must be done without contributing to an additional risk of unwanted medical side effects beyond those that may be inherent in any such device. Oriented monofilament olefins appear to satisfy these criteria, and have been used successfully in several IUD designs. This article describes a study of two such monofilaments taken from new IUDs, showing how the material's processing, structure, and properties lead to effective performance as tail strings. Several types of used IUDs were also studied, to insure that nothing occurred during use that would alter the conclusions drawn from the study of new strings.     

Sonographic Appearances of Chinese Intrauterine Devices

Objective. The purpose of this presentation is to familiarize physicians about the different types of intrauterine devices (IUDs) used in China. Methods. The characteristic features and the sonographic appearances of the different types of IUDs commonly used in China are described. Results. The stainless steel ring is the most commonly used IUD in China. However, various different types of copper‐bearing IUDs are gaining popularity. Most Chinese IUDs do not have an attached thread and are more difficult to remove than the IUDs commonly used in North America. Also, most Chinese IUDs have a distinct sonographic appearance; therefore, sonography can play an important role when assessing a woman who has a retained Chinese IUD or has a complication associated with the IUD. Conclusions. Knowledge about the different types of Chinese IUDs will enable physicians to provide optimal care to their patients.