中文版库欣综合征患者生活质量问卷的信效度研究

目的评价中文版库欣综合征患者生活质量问卷(Cushing-Qol)的信度和效度。方法采用中文版库欣综合征患者生活质量问卷(Cushing-Qol)和简明健康调查问卷(SF-36)对79名库欣综合征患者进行问卷调查,应用SPSS 19.0软件对问卷的调查结果统计分析,检验问卷的内部一致性和重测信度以及内容效度、结构效度、效标关联效度。结果中文版Cushing-Qol问卷的内部一致性信度Cronbach’sα系数值为0.890,重测信度(2周后)为0.881,各条目的重测信度均大于0.7,折半信度为0.866;该问卷的内容效度指数CVI为0.95,探索性因子分析结果显示问卷为单维度,中文版Cushing-Qol问卷与SF-36量表的相关系数为0.732,表明两者呈强相关。结论中文版Cushing-Qol问卷具有较好的信度和效度,可作为库欣综合征患者生活质量评估的可靠工具应用于临床实践和相关研究中。     

SF-36在慢性软组织疼痛患者中的信度和效度初步评价

目的探讨中文版36条健康状况简明调查问卷（SF-36）在慢性软组织疼痛患者健康生存质量评价中的信度和效度。 方法采用中文版SF-36和医院结局疼痛用量表（MOSPM）,同时对210例慢性软组织疼痛患者进行问卷调查,以后者为效度标准,其中有57例（27.1%)患者进行了二次测评。收集资料输入SPSS软件包,采用Spearman相关分析,进行内部一致性、复测信度和效标效度的评价。 结果SF-36量表具有良好的内部一致性和重测信度,8个维度的Cronbachs α系数均&rt;0.7,重测信度的组内相关系数除SF为0.336（P<0.05）外,其他7个维度均在0.44~0.66之间（P<0.01）;在效度评价中,SF-36的8个维度与MOSPM的大部分条目及总分均显著相关,相关系数在－0.145~－0.630之间（P<0.05,P<0.01）。 结论SF-36在慢性软组织疼痛患者人群健康相关生存质量评价中应用,具有较好的信度和效度。     

中文版ECOS-16问卷在骨质疏松患者中的应用信效度

目的:翻译英文版16条目骨质疏松症患者健康相关生存质量评估问卷(16-item Assessment o f Health-Related Quality of Life in Osteoporosis,ECOS-16),并验证其在骨质疏松患者中的信效度。方法:对英文版问卷进行翻译汉化,通过便利抽样的方法对97名骨质疏松患者进行调查,收集数据并进行项目分析、探索性因子分析、验证性因子分析、效标效度、内容效度、内部一致性及重测信度等检验和分析。结果:在效度方面,中文版ECOS-16问卷共计16个条目,各个条目的鉴别效度均较好;在结构效度方面,可分为疼痛、躯体功能和心理功能3个维度,共可解释69.3%的方差贡献率,各条目因子载荷度0.501~0.863,共同度0.479~0.733,与总分的相关性0.483~0.822,同时各拟合指数均在合理范围内;在效标关联效度方面,问卷各维度与简明健康测量问卷(Short Form 36 Health survey Questionnaire,SF-36)对应维度的相关系数在.0.632~.0.489(P0.01);在内容效度方面,各条目的内容效度0.94~1.0,量表的总内容效度为0.90;各维度间的相关性系数r=0.406~0.465(P0.05),各维度与总量表的相关性系数0.635~0.732(P0.05);在信度方面,问卷的总克伦巴赫α系数为0.898,重测信度为0.918。结论:中文版ECOS-16问卷具有较高的信效度,适用于中国骨质疏松患者的生活质量评估。     

糖尿病眼科随访依从性问卷的汉化及信效度检验

目的:编译中文版糖尿病眼科随访依从性问卷并评价其信效度。方法:按Brislin翻译模型将英文版糖尿病眼科随访依从性问卷译成中文并进行文化调适。采用便利抽样法,于2019年6—12月抽取广州市某医联体内287例糖尿病患者进行问卷调查,对中文版问卷进行内容效度、结构效度、内部一致性、校标效度和重测信度的检验。结果:提取出5个公因子,共含25个条目,累计方差贡献率为62.878%,问卷及其各维度间呈正相关。问卷总的Cronbach'sα系数为0.902;问卷总分及各维度得分与校标的相关系数为0.472~0.658(P<0.01);问卷及其各维度的重测信度系数为0.813~0.917(P<0.01)。结论:中文版糖尿病眼科随访依从性问卷具有良好的信度和效度,条目内容与理论框架契合度较好,可用于我国糖尿病患者眼科随访依从性的测量。     

中文版器官移植患者症状发生和症状困扰量表的信度及效度检验

目的：翻译英文版器官移植患者症状发生和症状困扰量表（MTSOSD）并检验其信度及效度。方法：在征得原作者同意后,取得英文版MTSOSD,通过翻译和本土化形成中文版MTSOSD。采用中文版MTSOSD、健康相关生活质量问卷（SF-36）及医院焦虑抑郁量表中的抑郁分量表对106例肾移植患者进行测评,根据是否抑郁患者的症状评分判断工具的区分效度,根据症状与生活质量之间的相关性判断工具的校标关联效度;在1周后对12例患者进行二次测评,根据两次测评的相关性判断工具的重测信度。结果：抑郁组患者的症状发生总分及症状困扰总分均高于非抑郁组患者,差异有统计学意义（P〈0.01）;106例患者的症状发生总分、症状困扰总分与除外“生理功能”的SF-36各维度得分均呈显著负相关,相关系数为-0.391～-0.510（P〈0.01）;中文版MTSOSD的Cronbach’sα系数为0.897（按照症状发生情况）和0.919（按照症状困扰情况）,重测信度系数为0.825（按照症状发生情况）和0.817（按照症状困扰情况）。结论：中文版MTSOSD具有较好的信度和效度,适用于在临床中测评器官移植患者免疫抑制治疗的相关症状。     

中文版SF-36用于评价亚急性脑卒中患者生存质量的信度和效度

目的:检测中文版健康调查简表SF-36(the medical outcomes study 36-item short-form,SF-36)用于中国亚急性期脑卒中后遗症人群的生存质量评估的信度和效度情况。方法:选取福建中医药大学附属康复医院、复旦大学附属华山医院、暨南大学附属第一医院、广东省中医院和新疆维吾尔自治区中医院五家合作单位,共377例(女性35.73%,平均年龄60.95±10岁)脑卒中后遗症患者,在完成第一次评估后的6—7天,随机选取75例患者进行SF-36重测。量表的信度分析采用内部一致性和重测信度,效度分析采用内容效度和结构效度检验。结果:(1)中文版SF-36量表内部一致性Cronbachα系数为0.801(0.761—0.807);量表重测信度ICC为0.731(0.672—0.884)(2)对量表的8项内容的得分进行探索性因子分析,共抽取了3个公因子,总体方差解释力为67.3%。结论:中文版SF-36量表在评估我国亚急性期脑卒中患者具有良好的信度和效度,是一个可靠、有效的适用于临床脑卒中患者生存质量的测量工具。     

生活质量测定量表简表在神经症患者中应用的信度及效度研究

目的:评价世界卫生组织生活质量测定量表简表(WHOQOL-BREF)在神经症患者中的信度和效度。方法:由专业医生对同济大学附属同济医院精神医学科门诊及住院初诊患者53例行健康状况调查问卷(SF-36),WHOQOL-BREF评定,在治疗的第4周予以重测。对量表的内部一致性、重测信度、劈半信度及效标关联效度等指标进行分析。结果:WHOQOL-BREF的Guttman劈半信度为0.840,Cronbach'sα系数为0.763,各维度的Cronbach'sα系数较好,重测后各项目的相关系数为0.348～0.761。WHOQOL-BREF各维度分与SF-36的各维度分除生理功能和生理职能,以及社会关系领域分和躯体疼痛、情感职能外,均呈明显相关。结论:WHOQOL-BREF具有较好的信度和效度,部分分量表能较好反映神经症患者的情绪状态,基本适用于神经症患者生活质量评价。     

癫痫青少年至成人过渡期准备评估问卷的汉化和信效度检验

目的 汉化癫痫青少年至成人过渡期准备评估问卷（Epilepsy Transition Readiness Assessment Questionnaire,EpiTRAQ）,并评价其信度和效度。方法 按照改良版Brislin问卷翻译模型,对原问卷进行翻译、文化调适,并通过预调查后形成中文版EpiTRAQ。采用便利抽样法,选取2022年3月—6月在国内8所儿童专科医院和成人综合医院就诊的433例癫痫青少年作为调查对象,进行问卷调查,评价中文版问卷的信效度。结果 中文版EpiTRAQ共2个部分,第1部分包括用药管理、预约、健康问题追踪、医患交流、日常活动管理、女性患者6个维度,共35个条目;第2部分用于评估青少年对自我健康管理的认知,共2个条目,不计入问卷总分。中文版问卷总的Cronbach’s α系数为0.919,各维度的Cronbach’s α系数为0.724～0.984,重测信度为0.923;问卷水平的内容效度指数为0.910,条目水平的内容效度指数为0.863～1.000;以中文版癫痫自我管理行为量表作为校标,问卷的效标关联效度为0.449(P<0.001)。探索性因子分析提...     

中文版炎症性肠病问卷的信度和效度研究

目的评价中文版炎症性肠病问卷(1BDQ)的信度和效度。方法采用IBDQ和健康状况调查问卷(SF-36)对71例炎症性肠病患者进行问卷调查,分析量表的内部一致性、分半信度、标准关联效度和结构效度等指标。结果IBDQ各维度的Cronbach’sα系数为0.7430~O.8763,分半信度为0.9029,IBDQ的各维度与SF-36中除生理机能外的各维度均呈显著正相关。结构效度中,经因子分析,各主因子中各条目与其主成分大致相符。结论中文版的IBDQ具有良好的信度和效度,适用于评价我国IBD患者的生存质量。     

心肌梗死多维度评估量表的信效度研究

目的翻译“心肌梗死多维度评估量表”(Myocardial Infarction Di mensional Assessment Scale,MIDAS),评价其效度、信度及文化相关性,提供一种有效评估心肌梗死患者生活质量的中文版问卷。方法应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对88例心肌梗死患者应用问卷对其内部一致性、效标关联效度及结构效度进行评价,对其中30例心梗患者在2周内重新应用问卷收集资料,进行重测信度的评价。结果问卷中所有条目均具有较好的文化相关性,其中2个条目被重新修订。中文版“心肌梗死多维度评估量表”具有较好的表面和内容效度,内容效度指数(CVI)为0.94,其内部一致性及重测信度均可接受,问卷7个亚量表的Cronbach'sα为0.73~0.91,重测信度系数为0.74~0.94,总体Cronbach'sα为0.93,重测信度系数为0.85。中文版MIDAS中的各亚量表与中文版“36条目简明量表”(Short Form36,SF-36)中的相关亚量表具有显著相关性(P<0.05)。因子分析结果提示中文版MIDAS具有与原英文量表一致的结构效度。结论中文版“心肌梗死多维度评估量表”是一种具有较高效度和信度的疾病专用量表,可为医护人员量化评估心肌梗死患者生活质量提供可靠的依据。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.