Braden-Q量表评估我国儿童压疮危险因素适用性研究

目的 探讨Braden-Q儿童压疮危险评估量表(下称Braden-Q量表)对国内ICU患儿压疮评估的预测效力.方法 采用儿童日常活动能力分类量表(POPC)、Braden-Q量表对133例ICU患儿进行评估.结果 POPC评分1～5(1.12±0.63)分;Braden-Q量表7个条目评分为2.10±0.89～3.84±0.43,压疮发生率为5.26%;Braden-Q量表临界值为13～16分时,灵敏度为0.15～0.23,特异度为0.96～0.98,阳性预测值为0.07～0.53,阴性预测值为0.86～0.99.结论 ICU患儿病情危重度不高,BrademQ量表临界值取15分时其灵敏度和特异度较好,Braden-Q量表对国内患儿压疮的预测效果不佳,其适用性尚需进一步扩大样本深入研究.     

Braden量表对住院患者压疮危险预测效度的Meta分析

目的对前瞻性诊断研究进行Meta分析,以评价Braden量表对住院患者压疮危险预测的有效性。方法计算机检索Cochrane图书馆、PubMed、Springlink、EBSCO、中国知网、维普数据库和万方数据库和其他方式收集关于压疮危险评估量表预测压疮的前瞻性试验研究。利用诊断性研究质量评价工具(QUADAS-2)对纳入的文献进行质量评价,并采用Meta-Disc1.4软件进行数据分析。结果最终纳入20篇文献,共5 896例患者。显示合并灵敏度为0.71(95%CI0.67~0.74),合并特异度为0.69(95%CI0.68~0.70),SROC曲线下面积为0.78。结论 Braden量表作为单独指标对压疮的预测有效性为中等水平。关于Braden量表对住院患者压疮预测的有效性仍需更多研究证实。     

Caprini血栓评估量表在ICU非手术患者高危血栓风险预测中的应用

目的探讨Caprini风险评估量表在ICU非手术患者中高危血栓风险的最佳界值。方法采用回顾性病例对照研究,选取154例ICU非手术深静脉血栓形成(DVT)患者作为病例组,选择同时期入住ICU的154例非手术非DVT患者作为对照组。运用受试者工作特性曲线(ROC)分析Caprini风险评估量表的准确度及高危血栓风险最佳临界值。结果 Caprini风险评估量表的ROC曲线下面积为0. 709,95%CI为0. 655～0. 759,当临界值为7分时,约登指数为0. 331,灵敏度为70. 78%,特异度为62. 30%,阳性预测值为65. 27%,阴性预测值为68. 09%。结论 Caprini风险评估量表在ICU非手术患者高危血栓风险预测中的最佳界值为7分,其可用于血栓风险评估。     

3种评估表对消化科老年患者压疮预测效果的比较

目的比较Braden、Norton、Waterlow3种压疮评估表对消化科老年患者压疮的预测效果。方法运用Braden、Norton、Wa-terlow3种评估表对于消化科住院的204例患者(年龄≥60岁)进行压疮评估和皮肤完整性检查,计算各评估表首次、末次评估灵敏性、特异性、阳性预测值、阴性预测值和ROC曲线下面积。用Pearson相关系数、Kappa值评价量表间一致性。结果 204例中,压疮发生率为8.82%;Braden、Norton、Waterlow3种评估表评估表最佳临界值首次评估分别为14、14和17分,末次评估分别为Waterlow与Braden12、12和19分;ROC曲线下面积首次评估分别0.85、0.85和0.90,末次评估分别0.93、0.94和0.95。首次及末次评分的总体一致性差异有统计学意义(均P0.05)。Kappa值显示Waterlow末次评分与实际观测结果内部一致性最好(0.609)。结论 Waterlow评估表对消化科老年患者压疮的预测效果较好。     

3种压疮评估工具的临床效度测定

目的 测定Braden、Norton、Waterlow 3种压疮评估工具在新疆患者中使用的临床效度.方法 运用3种评估工具对随机抽取的500例住院患者进行压疮评估和皮肤完整性检查.计算各评估工具的灵敏度(Se)、特异度(Sp).结果 压疮发生率为2.8%;对于全部人群,Braden量表的临床效度较好(Se=0.8571,Sp=0.7160);对于汉族患者.Braden量表的临床效度较高(Se=0.8750,Sp=0.7438);对于少数民族患者,Waterlow量表具有较高的临床效度(Se=0.8333,Sp=0.7366).结论 临床初步评估压疮时,建议首选Braden量表,对于少数民族患者,辅以Waterlow量表.     

Munro与Braden压疮评估表用于手术患者压疮评估预测效度比较

目的比较Munro与Braden评估表预测手术患者压疮的效果。方法 2名护士分别应用2种评估表,同时、独立、连续地于术前、手术结束、术后返回病房2h内对111例外科手术患者进行压疮风险评估,另1名护士在手术结束、返回病房交接、术后24h、48h、72h评估压疮发生情况并记录,计算ROC曲线下面积、灵敏度和特异度。结果手术结束11例发生压疮(9.9%),术后24h内共有4例压疮患者,其中2例新发(1.8%);Munro评估表术前、中、后的ROC曲线下面积分别为0.850、0.889、0.864,高于Braden评估表(0.727、0.724、0.600);术前、中、后Braden评估表最佳临界值分别为19分、13分、14分,灵敏度分别为0.545、0.909、0.250,特异度0.700、0.350、0.916;术前、中、后Munro评估表最佳临界值为9分、22分、29分,灵敏度分别为0.818、0.909、0.750,特异度为0.610、0.730、0.822。结论 Munro评估表评估压疮更具有针对性,对手术压疮诊断价值高于Braden评估表,但在使用过程中需要与其他医务人员配合,且个别评估指标不是常规监测项目,增加了护理工作量,需进一步研究和加以完善。     

基于决策树的肿瘤患者难免性压疮风险预测模型研究

目的评价决策树预测肿瘤患者难免性压疮风险的准确性与合理性,为压疮预防提供依据。方法收集Braden评分高风险肿瘤患者611例的临床病例资料,采用CHAID算法构建肿瘤患者难免性压疮风险预测的决策树模型,并通过ROC曲线下面积、灵敏度和特异度指标比较其与Braden评分的预测效果。结果 46例发生难免性压疮,发生率为7.53%。决策树模型包含3层共11个节点,提取6条分类规则,筛选出4类高危人群,即Braden评分≤11分,翻身计划无法落实;Braden评分11分,皮肤有现存或潜在损伤;Braden评分≤11分,翻身计划可以落实,但存在增加压疮发生风险的特殊情况;Braden评分11分,皮肤没有现存或潜在损伤,但翻身计划无法落实。决策树模型ROC曲线下面积为0.840;决策树模型的灵敏度为0.848、特异度为0.774。结论决策树模型ROC曲线下面积、灵敏度及特异度均较好,可以用于肿瘤患者难免性压疮高危人群的筛选和管理。     

应用Norton评分预测神经外科患者压疮的效果探讨

目的:探讨Norton评估表对神经外科患者压疮预测的有效性.方法:对1219例神经外科患者应用Norton评估表进行持续性评分,观察患者压疮发生情况并记录,分析该评估表对神经外科患者及不同年龄组预测压疮的准确性.结果:该量表对神经外科患者压疮预测灵敏度为100％、特异性70.87％、阳性预测值1.97％、阴性预测值100％.结论:Norton评估表能有效预测神经外科患者发生压疮的危险性,并且不同年龄患者可以统一使用Norton量表进行压疮高危患者筛查.     

骨科患者的压疮影响因素分析

目的:探讨骨科患者的压疮相关危险因素,为压疮的预防提供借鉴。方法:以Br aden量表为评分标准,分别采用Logi s t i c回归分析,评价骨科患者压疮危险情况。结果:骨科患者的Braden分级与年龄、吸烟、胖瘦情况、偏瘫、截瘫、血清白蛋白、大便失禁、小便失禁、外固定支架、牵引情况、手术等级及防旋鞋有显著性差异(P<0.05)。Logi st i c回归分析显示对Braden分级进行判别的总正确率为89.55%(χ2=133.31,P<0.01),结合Logi s t i c回归分析,年老、偏瘫、小便失禁、外固定支架及骨牵引与Braden分级的对数优势呈线性关系。结论:年老、偏瘫、小便失禁、使用外固定支架及骨牵引是骨科卧床患者压疮发生的高危因素。     

ICU患者压力性损伤风险评估工具准确性的网状Meta分析

目的 评价不同压力性损伤风险评估工具对ICU患者压力性损伤风险预测的准确性,为准确筛查ICU压力性损伤风险患者提供依据。 方法 计算机检索PubMed、Cochrane Library、CINAHL、EMbase、Web of Science、中国知网、维普网、万方数据和中国生物医学文献服务系统中ICU患者压力性损伤风险评估工具相关研究,经文献筛选、质量评价、资料提取后,采用ANOVA模型实现基于贝叶斯方法的诊断实验准确性网状Meta分析。 结果 共纳入28篇文献,共计11 221例患者,涵盖12个压力性损伤风险评估工具。Meta分析结果显示,改良版Cubbin & Jackson量表优势指数最高,灵敏度［0.72,95%CI（0.59,0.82）］,特异度［0.75,95%CI（0.63,0.84）］,其次为EVARUCI量表,灵敏度［0.75,95%CI（0.54,0.90）］,特异度［0.65,95%CI（0.42,0.83）］;Braden量表优势指数最低,灵敏度［0.66,95%CI（0.62,0.71）］,特异度［0.58,95%CI（0.54,0.61）］。 结论 改良版Cubbin & Jackson量表、EVARUCI量表具有较好的诊断试验准确性,临床医护人员评估ICU患者压力性损伤风险时可优先选用。     

Validation of the urgency perception scale

OBJECTIVE: To ascertain the validity and responsiveness of the Urgency Perception Scale (UPS) as an indicator of perceived urinary urgency. PATIENTS AND METHODS: The UPS was developed to assess perceived urinary urgency in clinical studies evaluating the efficacy of the antimuscarinic drug, tolterodine, for treating the overactive bladder (OAB) syndrome. Secondary analyses of clinical and patient assessment data from three clinical studies of tolterodine were conducted to evaluate the UPS. Construct validity was assessed by correlations between the UPS and patient voiding diary variables and other patient assessments, including: perception of bladder condition; perception of treatment benefit; the Medical Outcomes Study Short-Form 36 health survey; the King's Health Questionnaire; the OAB Questionnaire; and the Overall Treatment Effect scale. RESULTS: The UPS correlated well with the patients' perception of bladder condition (correlation coefficients - 0.29 to - 0.46; all P < 0.001) and with the voiding diary variables, especially incontinence episodes (-0.30 to - 0.41) and pad usage (-0.25 to - 0.38; all P < 0.001). An improvement in UPS score at the end of treatment was consistently reflected by significant improvements among all voiding variables. CONCLUSION: Urinary urgency is a central symptom of OAB and is particularly bothersome because of its unpredictability and consequent impact on daily life. The UPS is a valid scale by which urinary urgency can be assessed subjectively, and provides a useful tool for research into urinary urgency.     

Comparison of the posttraumatic stress disorder scale versus the clinician-administered posttraumatic stress disorder scale in domestic violence survivors

The posttraumatic diagnostic scale (PDS) is a self-report instrument for PTSD that is simple to administer and has demonstrated good psychometric properties. We compared the PDS with the gold standard clinician administered PTSD scale (CAPS) diagnostic interview for PTSD. We assessed 138 women who were victims of domestic violence using both the PDS and the CAPS. Findings confirmed that PTSD develops at a high base rate in this sample. The PDS generally performed well in relation to the CAPS although with a tendency to overdiagnose PTSD. The findings lend further support to the use of the PDS as a diagnostic tool for PTSD but indicate that it is better at identifying survivors with PTSD than those without the disorder.     

Development of the coping scale for infertile couples

Infertility treatment involves more complicated, uncomfortable, and humbling medical procedures for women, so the coping strategies used by wives may differ from those used by husbands. The purpose of this study was to develop and test a Coping Scale for Infertile Couples that would be sensitive to the differences in gender. What couples actually do to cope with infertility and whether these strategies are different between couples were also addressed. A total of 138 infertile couples participated in this study. The Coping Scale for Infertile Couples was administered with the Infertility Questionnaire, the Perceived Stress Scale, and the Jalowiec Coping Scale as measures of concurrent validity. Factor analysis extracted 4 subscales from the Coping Scale for Infertile Couples. Test-retest and internal consistency reliability were high. Paired t tests revealed that wives used the "Increasing space and Sharing the burden" strategies to a greater degree than their husbands. Husbands used the "Being the best" strategy to a greater degree than the wives. A significant correlation with distress, stress, and coping measures provided evidence of concurrent validity. Preliminary results suggest that this measure has good reliability and validity, which can contribute toward the elucidation of coping strategies used by infertile couples and assist in planning effective interventions.     

Validation of the french translated Richmond vigilance-agitation scale

OBJECTIVE: To test reliability of the Richmond Agitation Sedation Scale (RASS) after French translation. STUDY DESIGN: Prospective psychomotor evaluation study. PATIENTS AND METHODS: Two bilingual physicians performed the translation from English to French language. The French version was then translated to English by a bilingual non physician ("backtranslation") and compared to the original version. The translated scale was tested according to usual guidelines concerning the translation of neuropsychological evaluation tools. The French version of RASS was tested on the morning of every fifth or sixth day, and 30-min after any procedure, in 43 consecutive patients admitted to a 12-bed medical-surgical intensive care unit during two months, by a group of four observers: the principal investigator, two anaesthesiology residents and one pharmacology student. Inter-rater reliability was tested using the simple and weighted Kappa coefficients (with their 95% confidence interval). A consensual and detailed "operating instructions" guide of RASS, intended for medical and nursing staff, has been added in the Annexe section. RESULTS: Four hundred twenty measures were performed during 105 grouped observations. Reliability of the French version of RASS was substantial. Simple Kappa coefficient, testing the concordance between observers, was ranged from 0.72 (0.62-0.81) to 0.87 (0.79-0.94) and weighted Kappa coefficient from 0.95 (0.92-0.98) to 0.99 (0.98-0.99). CONCLUSIONS: The French translation of RASS was acceptable. The translated scale preserved substantial inter-rater reliability. Monitoring of vigilance status in intensive care settings can be performed with this reliable clinical tool.     

Rating scale analysis of the Agitated Behavior Scale

OBJECTIVE: Evaluate the measurement properties of the Agitated Behavior Scale (ABS) using rating scale analysis. SAMPLES: Sample 1: 900 observations of 100 individuals with traumatic brain injury; Sample 2: 204 observations of 102 persons with dementia; Sample 3: 241 observations of 6 individuals with anoxia. RESULTS: The calibration indicated that the rating scale was used as intended. The hierarchies of item difficulty were similar across samples. Person and item separation values were within the acceptable range for the TBI sample. Generally, the items work well together, however 3 items misfit the measurement model moderately. CONCLUSIONS: Agitation as measured by the ABS is best represented as a unitary construct. Results provide additional support for the reliability and validity of the ABS.     

Reliability and validity of the pain observation scale for young children and the visual analogue scale in children with burns

The aim of this study was to assess if the pain observation scale for young children (POCIS) and the visual analogue scale (VAS) are reliable and valid instruments to measure procedural and background pain in burned children aged 0-4 years. Burn care nurses (n=73) rated pain from 24 fragments of videotaped children during wound care procedures and during periods of rest using the POCIS and the VAS. Intraclass correlations were used to assess inter-rater and intra-rater reliability for the POCIS and the VAS. Internal consistency for POCIS was assessed by Cronbach's alpha. The POCIS has shown poor to moderate inter-rater reliability, moderate to good intra-rater reliability and an acceptable internal consistency. The VAS turned out to have poor inter-rater reliability and poor to moderate intra-rater reliability. Due to poor results of inter-rater reliability in both scales, construct validation is left undone until more acceptable results are obtained. Factors explaining the results are the large number of raters, the manner they were trained and a lack of variation between pain classes in video fragments. Although not all results were satisfying, an easy to use scale as POCIS has promising qualities and deserves further reliability research.