3.0T MRI(薄层、小视野T2WI)对直肠癌术前分期的临床意义

目的研究3.0TMRI(薄层、小视野T2WI)对直肠癌术前分期的临床意义.方法利用3.0T磁共振对同济医院46例经结肠镜证实的直肠癌患者进行盆腔检查,所有T2WI序列都采用小视野、薄层扫描.然后由两名腹部影像诊断医师共同阅片,对直肠癌进行术前T、N分期,然后与手术病理结果进行对照分析.结果MR-T分期正确率为86.9%(40/46),直肠癌MRI-T分期与术后病理T分期的一致性良好,kappa值=0.74.N分期的正确率为73.9%(34/46),直肠癌MRI-N分期与术后病理N分期的一致性一般,kappa值=0.57.结论高分辨率3.0TMRI可以对直肠癌做出精准的分期,还可以清楚的显示病灶及邻近组织侵犯情况.     

动态增强磁共振检查在前列腺良恶性病变鉴别诊断中的应用价值

目的 探究动态增强磁共振(DCE-MRI)检查在前列腺良恶性病变鉴别诊断中的应用价值。方法 选择2019年3月至2021年10月本院收治的经穿刺活检明确为前列腺病变患者88例,穿刺活检病理结果：恶性病变36例,良性病变52例。所有患者均行磁共振(MRI)检查、DCE-MRI检查。以穿刺活检结果作为诊断“金标准”,分析MRI、DCE-MRI在前列腺良恶性病变中的诊断价值,比较MRI、DCE-MRI在前列腺良恶性病变诊断中与穿刺活检结果的一致性。结果 MRI检查中共检出前列腺良性病变34例,恶性病变54例;DCE-MRI检查中共检出前列腺良性病变38例,恶性病变50例。相比于MRI检查,DCE-MRI检查在前列腺良恶性病变诊断中的准确度、灵敏度及阳性预测值均较高,差异均有统计学意义(均P<0.05);而两种方法的特异度、阳性预测值比较差异均无统计学意义(均P>0.05)。kappa检验结果显示：MRI检查与“金标准”的一致性尚可(kappa=0.668,P=0.000);DCE-MRI检查与“金标准”的一致性良好(kappa=0.907,P=0.000)。结论 DCE-MRI检...     

Xpert MTB/RIF技术在肺结核诊断中的应用价值

目的探究Xpert MTB/RIF(结核分支杆菌/利福平)技术在肺结核诊断中的应用价值。方法使用Xpert MTB/RIF技术、抗酸染色涂片镜检、罗氏固体培养法对147例疑似肺结核初诊患者进行诊断,评价Xpert MTB/RIF技术检测MTB的敏感度和特异性、与金标准的一致性。结果三种诊断方法阳性率分别为抗酸染色涂片法30.61%,罗氏固体培养法38.10%,Xpert MTB/RIF法42.18%,Xpert MTB/RIF阳性率显著高于抗酸法,但与罗氏固体培养法相当(2=4.246 4,0.509 6)。以罗氏固体培养结果为金标准,Xpert MTB/RIF对涂阳患者敏感度更高(100%vs 94.12%),但对涂阴样本的特异度高于涂阳患者(33.33%vs 92.31%);全部样本敏感度为98.21%,特异度为92.31%,阳性预测值为88.71%,阴性预测值为98.82%,kappa=0.887。Xpert MTB/RIF与金标准对痰样本分级一致性适中(kappa=0.579),差异不显著(u=0.820 9,P=0.411 7)。结论 Xpert MTB/RIF技术检测肺结核阳性率、敏感度与特异度均较高,对痰样本带菌量分级与罗氏固体培养法相仿,但其检测周期短,生物安全性高,可作为临床参考。     

登革热抗原抗体联合检测与双抗体检测效能比较

目的 比较抗原抗体联合检测与双抗体快速检测2种方法检测登革热的效能,为登革热快速诊断提供依据。方法 收集登革热临床诊断病例血清样本449份(病例组)、流行病学和(或)临床上判断与登革热无关血清样本689份(阴性对照组),分别进行抗原抗体联合检测(IgM、IgG和NS1抗原)及双抗体检测(IgG和IgM),以临床诊断为金标准,对2种方法检测结果进行描述分析和一致性分析。结果 纳入研究的449例病例组和689例阴性对照组中,联合检测阳性率(34.1%)高于双抗检测(29.7%),且均低于临床诊断阳性率(39.4%),差异均有统计学意义(χ²值分别为20.61、7.03和51.33,P值均<0.01)。联合检测结果与实际临床诊断一致性(kappa=0.863)高于双抗检测(kappa=0.745),联合与双抗检测法结果一致性较好(kappa=0.729)。阴性对照组有9份样本经联合和(或)双抗检测法检测为登革热阳性,其中4例(3例发热待排查病例,1例体检人员)2种方法均为阳性,增补为登革热临床诊断病例。结论 抗原抗体联合胶体金检测登革热不仅方便、快捷、经济,与临床...     

超声严重指数评价急性胰腺炎分级的效能探讨

目的:探讨超声严重指数(USSI)对急性胰腺炎(AP)的分级效能。方法:选取2016年1月-2018年10月我院收治的85例AP患者,患者入院后均行增强螺旋CT及超声造影检查,以增强螺旋CT为对照,分析USSI对AP分级的效能。结果:USSI评价APⅠ级20例、Ⅱ级47例、Ⅲ级18例,CT严重指数(CISI)评价APⅠ级、Ⅱ级、Ⅲ级分别为22例、44例、19例。USSI与CISI对AP分级具有极好的一致性[一致率(PO)=0.935、kappa=0.901、χ~2=39.351、P=0.000]。结论:USSI与CISI比较对AP分级具有极好的一致性,可代替CT成为临床的首选。     

广州市公众对流感大流行相关信息需求的调查

目的 了解公众在疫情的不同时期对H5N1禽流感、甲型H1N1流感及流感大流行的信息需求,制定有针对性的沟通信息.方法 采用电话问卷调查方法获得所需信息.自制调查表,经预调查修订后,再进行正式调查.结果 广州市电话调查有效应答率为54.33%.公众认为政府在甲型H1N1流感流行初期所做的宣传工作比静息期人禽流感的宣传内容更有帮助和指导意义(χ2=17.41,P=0.000);流感流行初期公众对政府的信任程度更高(χ2=8.15,P=0.004).流感流行静息期公众以H5N1禽流感基本知识为需求;而在流行初期,则以可操作性的预防措施为主要需求.公众对于流感大流行的信息需求在疫情不同时期却基本相同,反映出公众对流感大流行缺乏感性认识,对流感大流行的相关信息了解甚少.公众对于不去人多的地方、少外出、勤洗手等预防常识掌握得较好,但不习惯打喷嚏掩住口鼻.2%～6%的公众没有任何信息需求.结论 电话调查应答率较高,广州市居民可以接受电话访问的调查方式.     

公共卫生应急人员N95过滤式防护口罩适合性调查

【目的】评价公共卫生应急人员对常用N95防护口罩的适合性,比较适合性测试结果与佩戴气密性主观评价结果的一致性,指导公共卫生应急人员科学选用防护口罩。【方法】采用环境气溶胶冷凝核计数器法,对235名上海市市、区两级疾病预防控制中心公共卫生应急人员进行定量适合性测试;通过问卷法调查佩戴气密性主观评价,比较适合性测试结果与佩戴气密性主观评价结果的一致性。【结果】160人通过适合性测试,通过率为68.1%;通过各项测试动作佩戴气密性主观评价结果与适合性测试通过率的一致性比较,kappa值范围为-0.09～0.43,除测试动作5(大声说话)的kappa值0.4,其他6个测试动作的kappa值均0.4,测试动作8(正常呼吸)的kappa值和符合率均为最低,分别为0.09和49.7%。【结论】口罩佩戴气密性主观评价结果的准确性较差,无法反映真实防护效果,无法取代适合性测试。建议公共卫生应急人员以适合性测试结果为依据,正确选择和使用适合的呼吸防护产品,以保证高水平的呼吸防护效果。     

床边B超判断重症急性胰腺炎病人鼻肠管位置的应用评价

目的:介绍床边B超判断鼻空肠营养管位置的方法,并评价该方法的可行性和准确性. 方法:结合前期研究成果,执行床边放置鼻肠管操作规范,连续为51例重症急性胰腺炎(SAP)病人放置鼻肠管,并使用床边B超判断鼻肠管位置,记录操作时间、评价置管耐受性、管端位置及相关并发症.然后每例病人再行影像学检查作为判断鼻肠管位置的金标准,确定鼻肠管位置.评价使用B超判断鼻肠管位置的正确率、敏感性、特异性以及与影像学方法的一致性. 结果:51例病人均在入院后采用床边放置鼻肠管的操作流程放置鼻肠管.B超验证提示鼻肠管在位的42例,不在位9例;影像学(x线片与腹部CT)判断尖端在位46例,不在位5例.B超判断鼻肠管位置的正确率为92.2％(47 例/51例);敏感性为91.3％(42例/46例);特异性为100％;kappa分析判断两种方法的一致性,kappa值为0.673. 结论:床边B超验证鼻肠管技术,在SAP病人实施床边鼻肠管盲置后特异性验证其尖端位置的敏感性较高,具有良好的可行性和安全性.     

直接数字X线摄影与屏胶X摄影在尘肺病诊断中的对比

目的研究直接数字X线摄影(DR)与屏胶X线摄影(SFR)在尘肺病诊断中的差异大小,为DR技术最终应用于尘肺诊断提供基础资料。方法 105例壹期确诊病例和30例接尘工人,同期拍摄DR和SFR胸片;依据国家尘肺病诊断标准(GBZ70—2009),对两者的胸片质量、小阴影形态及密集度进行判定,并对结果进行对比分析。结果 DR胸片中质量达到一级或二级的比例明显高于SFR胸片(P<0.001);两种胸片评价小阴影形态、总体密集度、诊断分期结果的一致性处于中等水平(kappa值分别为0.73、0.48、0.53);限定两种胸片均为一级片后,相应的kappa值提高至0.77、0.64、0.67。两种胸片各肺区小阴影密集度结果(P<0.001)及小阴影密集度1/0(含)以上肺区数(P=0.006)差异均有统计学意义。结论 DR胸片较SFR胸片具有显著的质量优势,有良好的应用前景,但需制订基于DR技术的尘肺病标准片。     

腹腔镜下输卵管通液对输卵管性不孕患者的诊断价值分析

目的:评估腹腔镜下输卵管通液术对输卵管性不孕症妇女的临床诊断价值.方法:2013年1月～2014年12月该院妇科收治的120例拟诊断为输卵管性不孕症妇女作为研究对象,分别采用腹腔镜下输卵管通液检查及子宫输卵管碘比醇造影检查,并以腹腔镜探查术中所见作为“金标准”,对两种方法诊断输卵管不孕症的临床价值进行比较.结果:120例不孕症患者术中所见:双侧输卵管畅通39例(32.50％),单侧/双侧不通81例(67.50％);其中盆腔炎性疾病72例(60.00％)、子宫内膜异位症患者24例(20.00％)、其他疾病16例(13.33％)、正常盆腔8例(6.67％).子宫输卵管碘比醇造影检查诊断输卵管阻塞的灵敏度=84.62％、特异度=69.14％、Kappa=0.447、AUC =0.715,碘比醇造影检查与手术探查结果具有中等一致性.输卵管通液检查诊断输卵管阻塞的灵敏度=94.87％、特异度=83.95％、Kappa=0.735、AUC=0.904,输卵管通液检查与手术探查结果具有高度一致性.结论:腹腔镜下输卵管通液术对输卵管性不孕症妇女具有较高的诊断价值,诊断结果与手术结果具有高度的一致性,在临床上可以作为一种可靠的诊断手段.     

Low agreement was found between pharmacy data and physician reported use of hospital-administered antenatal corticosteroids

OBJECTIVE: To evaluate physicians' recall accuracy on starting year of routine use of antenatal corticosteroids (ACS) to women facing imminent preterm delivery. STUDY DESIGN AND SETTING: Starting year of routine treatment with ACS was evaluated by a questionnaire mailed to all 52 Swedish maternity wards. The information was compared with that obtained from a telephone interview with physicians involved in the introduction of routine ACS and with pharmacy data. From pharmacy data, routine use of ACS was defined as >or=20 mg betamethasone or dexamethasone purchased per maternity ward, year, and preterm delivery. RESULTS: 24 hospitals with >or=10 preterm deliveries/year, having started ACS 1976-1997 and with information from questionnaire, interview, and pharmacy data were included in the analyses. There was fair agreement (kappa=0.38, P<0.001) on starting year between questionnaires and telephone interviews with physicians and slight agreement (kappa=0.06, P=0.098) between questionnaires and pharmacy data. Three hospitals had complete agreement on starting year according to questionnaire, telephone interview, and pharmacy data. CONCLUSION: Agreement between information obtained from questionnaires, telephone interviews with physicians, and pharmacy data on use of ACS was low. Physician reported past drug use needs to be validated and pharmacy data can be useful for such purpose.     

The reliability of telephone interviews compared with in-person interviews using memory aids

PURPOSE: Information obtained by telephone interviews and in-person interviews is generally considered comparable, but it is unclear if extensive memory aids can be used effectively with telephone interviews. We compared a telephone interview to an in-person interview using the same questionnaire and memory aids in both. METHODS: A convenience sample of 103 women, aged 25 to 69 years, completed a telephone interview and at least four weeks later, completed an in-person interview. Memory aids included a life events calendar, cue lists, and worksheets. RESULTS: Agreement values, measured by kappa/weighted kappa, were as follows: parity (1.00), age at menarche (0.76), menopausal status (0.95), a history of reproductive organ surgery (0.98) or tubal ligation (0.91), self-reported infertility (0.76), and a first degree family history of breast/ovarian cancer (0.90). Agreement values for duration variables, measured by the intraclass correlation, were as follows: lactation (0.96), oral contraceptive use (0.98), any hormone replacement therapy (0.98), exclusive estrogen and progesterone therapy (0.83), and exclusive estrogen therapy (0.99). CONCLUSIONS: The good to excellent level of agreement found in this study indicates that telephone administration of our questionnaire with extensive memory aids is a reliable method of obtaining detailed exposure information relative to in-person interviews.     

Reliability of data on smoking habit and coffee drinking collected by personal interview in a hospital-based case-control study

A study on the reliability of information on smoking habits and coffee drinking collected via interview was conducted among 500 subjects enrolled in a case–control study on bladder cancer in Brescia, North Italy. A total of 215 cases (incident and prevalent) and 285 controls were interviewed personally in the hospital setting by a first interviewer, and then re-interviewed by telephone by either the same interviewer or another one. Agreement between the first and second interview was evaluated using the kappa statistic and the intra-class correlation coefficient and via multiple logistic regression modelling. No important differences in reliability were found according to sex, education or case/control status, while agreement was better among subjects below 65 than among older ones, and among incident than prevalent cases. A slightly better agreement was found among subjects interviewed twice by the same interviewer than those interviewed by two different individuals, which may reflect the presence of inter-observer reliability for the latter. Overall, these results show a very high reliability of data on smoking and a fairly high reliability regarding coffee drinking as collected through face-to-face interviews.     

Reliability of data on medical conditions, menstrual and reproductive history provided by hospital controls

To assess the reliability of data on medical conditions, and menstrual or reproductive history, a sample of 294 controls interviewed in hospital between 1989 and 1992 for an Italian case-control study on digestive tract neoplasms was re-interviewed at home during 1993. A high agreement between responses at the two interviews (kappa > or = 0.85) was observed for most medical conditions, including diabetes, cholelithiasis, hepatitis, duodenal ulcer, and, among female conditions, uterine fibromas, benign breast disease, hysterectomy and monolateral ovariectomy. For gastric ulcer and parotitis the reliability was less satisfactory (kappa = 0.35 and 0.20, respectively). The agreement was high (kappa > 0.80) also for age at menarche, menopausal status, type and age at menopause, number of children, age at first pregnancy, age at first and last birth, and spontaneous abortions. The agreement was lower for questions on menstrual pattern (kappa = 0.68) and induced abortions (kappa = 0.62). Thus, this study indicates that information on personal medical conditions, and menstrual or reproductive history, provided by hospital controls through an interviewer-administered questionnaire is satisfactory for the purposes of epidemiological inference, and that the interview setting does not substantially influence the recall of this information.     

Agreement between data obtained from repeated interviews with a six-years interval

The objective of the study was to compare information collected through face-to-face interviews at first time and six years later in a city of Southeastern Brazil. In 1998, 32 mothers (N=32) of children aged 20 to 30 months answered a face-to-face interview with structured questions regarding their children's brushing habits. Six years later this same interview was repeated with the same mothers. Both interviews were compared for overall agreement, kappa and weighted kappa. Overall agreement between both interviews varied from 41 to 96%. Kappa values ranged from 0.00 to 0.65 (very bad to good) without any significant differences. The results showed lack of agreement when the same interview is conducted six years later, showing that the recall bias can be a methodological problem of interviews.     

Environmental measures of physical activity supports: perception versus reality

BACKGROUND: Perceptions of the environment and physical activity have been associated using survey methods, yet little is known about the validity of environmental surveys. In this study, perceptions of the environment at neighborhood and community levels were assessed (1) to determine validity by comparing respondent perceptions to objective measures and (2) to determine test-retest reliability of the survey. METHODS: A telephone survey was administered to a stratified sample of Sumter County, South Carolina adults. Respondents' home addresses were mapped using a geographic information system (GIS) (n =1112). As an indicator of validity, kappa statistics were used to measure agreement between perceptions and objective measures identified at neighborhood and community levels using GIS. A second survey in an independent sample (n=408) assessed test-retest reliability. RESULTS: When assessing perceptions of environmental and physical activity in a defined geographic area, validity and reliability for neighborhood survey items were kappa= -0.02 to 0.37 and rho=0.42 to 0.74, and for community survey items were kappa= -0.07 to 0.25 and rho=0.28 to 0.56. CONCLUSIONS: Although causality between perception of access and safety and actual physical activity level cannot be assumed, those meeting national physical activity guidelines or reporting some physical activity demonstrated greatest agreement with access to recreation facilities, while those not meeting the guidelines demonstrated greater agreement with safety of recreation facilities. Factors such as distance and behavior may explain differences in perceptions at neighborhood and community levels. Using local environments with short distances in survey methods improves validity and reliability of results.     

Reliability of self-reported reproductive factors and childhood social class indicators in a case-control study in women

PURPOSE: Reproductive factors are often evaluated in epidemiologic interview studies as risk factors for diseases in women. Similarly, childhood social class has been implicated in the etiology of several diseases. Nevertheless, questions related to these factors have not been thoroughly evaluated for test-retest reliability. This research measured the test-retest reliability of reproductive and childhood social class variables, and determined whether reliability differed by case-control status, age, educational level, time between interviews, and interviewer-rated quality of the interview. METHODS: Subjects were participants in a population-based case-control in-person interview study of Hodgkin's disease in northern California women. Twenty-four cases and 22 controls were reinterviewed by telephone between 1992 and 1995, with an average interval of 8 months between interviews. Reliability was assessed using kappa or intraclass correlation coefficients; mean reliability coefficients and 95% confidence intervals (CIs) were estimated using the bootstrap method. RESULTS: Reliability was excellent for all variables (reliability coefficients between 0.76 and 0.96) and did not differ by case-control status (mean reliability = 0.82 for cases and 0.84 for controls), age (mean reliability = 0.85 for age < 40 and 0.82 for age > or = 40), time between interviews (mean reliability = 0.75 for 0-5 months, 0.88 for 6-11 months, and 0.87 for 1 year or more), or interviewer-rated quality of the validity of the original responses (mean reliability = 0.93 for "not too confident" and 0.83 for "confident"). However, reliability was consistently lower among less educated women (mean reliability = 0.56 for high school or less and 0.88 for more than high school), a finding consistent with results of prior studies. CONCLUSIONS: These results indicate that questions about reproductive experience and childhood social class posed in in-person interviews can be answered reliably. However, inclusion of subjects at lower socioeconomic status may result in lower reliability for some interview responses.     

Reliability of sport fish consumption in the New York State Angler cohort study

This paper examines the reliability of sport fish consumption data from the New York State Angler Cohort Study (NYSACS). NYSACS is a prospective cohort study conducted among New York State registered sportsmen and fishermen. Sport fish consumption information for New York State waters including the Great Lakes between June 1990 and June 1991 were collected through self-administered questionnaires, Spouses of male anglers were asked to provide their husbands' fish consumption during the same time period. A short telephone interview after the cohort was ascertained was also conducted among about 100 study participants for the purpose of quality control. Percentage agreement, kappa, and weighted kappa were calculated to evaluate the reliability of the interview using spousal data and reinterview data. Overall, for the total fish consumption between June 1990 and June 1991, percentage agreement, kappa, and weighted kappa between spousal data and primary response were 67.28%, 0.5087, and 0.6157, respectively. For reinterview data, weighted kappa ranged from 0.4510 to 0.5285 for season-specific analysis and kappa ranged from 0.4615 to 0.7006 for fish species-specific analysis. Spouses may be a good source of proxy data for fish consumption. The reliability of sport fish consumption data for the NYSACS study is acceptable, suggesting that the food frequency measuring methods employed are a viable approach to obtain retrospective sport fish consumption data from sportsmen and subsistence anglers.     

Test-retest reliability of self-reported reproductive and lifestyle data in the context of a German case-control study on breast cancer and postmenopausal hormone therapy

PURPOSE: Studies using survey questionnaires to collect epidemiologic data rely on the accuracy of participants' self-reporting. As part of the quality control protocol for a large population-based case-control study of the association between postmenopausal hormone therapy (HT) and breast cancer in German women (the Mammakarzinom-Risikofaktoren-Erhebung [MARIE] study), the authors used test-retest to evaluate the reliability of women's self-reporting of a number of putative breast cancer risk factors, including HT, reproductive history, family history, and lifestyle. METHODS: Of those women interviewed between November 2002 and July 2003, 62 cases and 61 controls were re-interviewed an average of 10 months later, using a shortened version of the original study questionnaire. RESULTS: Agreement between the first and second interviews was assessed using Cohen's kappa and proportion of agreement. There was very good overall agreement between the two questionnaires for HT ever/never use (kappa = 0.90), type of therapy (kappa = 0.83), and form of application (kappa = 0.73) and good agreement for duration of use (kappa = 0.60). Agreement for other factors ranged from kappa = 1.00 for age at first birth to kappa = 0.43 for weekend bicycle riding. Agreement was nondifferential by disease status. CONCLUSIONS: These findings indicate that the MARIE survey instrument was of good quality and had a low likelihood of misclassification.     

Validity and reliability of self-reported arthritis: Georgia senior centers, 2000-2001

BACKGROUND: Arthritis and other rheumatic conditions are a common cause of disability among adults in the United States. Telephone interviews of the state-based Behavioral Risk Factor Surveillance System (BRFSS) are used by states and territories to estimate the prevalence of arthritis. The purpose of this study was to assess the validity and reliability of the 1996-2001 BRFSS arthritis case definition in a senior center population. METHODS: A total of 487 respondents at selected senior centers in Georgia were surveyed by telephone, evaluated 3 to 4 weeks later by board-certified rheumatologists, and completed a written survey in 2000 to 2001. Using the rheumatologists' summary assessment "Does this person have arthritis or a related condition" as the standard, the sensitivity and specificity of the BRFSS arthritis case definitions were calculated. Reliability for the BRFSS arthritis case definition was also calculated by comparing responses to the telephone survey with responses to a written survey. RESULTS: Sensitivity was 70.8% (95% confidence interval [CI]=65.9-75.6), and the specificity was 70.3% (95% CI=62.9-77.8). The agreement between the telephone and written responses indicating self-reported arthritis was high (kappa=0.68). Analyses were conducted in 2002 to 2004. CONCLUSIONS: Self-reported arthritis in the 1996-2001 BRFSS was highly reliable, and moderately sensitive and specific among these senior center participants.