Comparison of the PROMIS Preference Score (PROPr) and EQ-5D-5L Index Value in General Population Samples in the United Kingdom,France, and Germany

ObjectivesThe Patient-Reported Outcome Measurement Information System (PROMIS) Preference score (PROPr) can be used to assess health state utility (HSU) and estimate quality-adjusted life-years in cost-effectiveness analyses. It is based on item response theory and promises to overcome limitations of existing HSU scores such as ceiling effects. The PROPr contains 7 PROMIS domains: cognitive abilities, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. We aimed to compare the PROPr with the 5-level EQ-5D (EQ-5D-5L) in terms of psychometric properties using data from 3 countries.MethodsWe collected PROMIS-29 profile and EQ-5D-5L data from 3 general population samples (United Kingdom = 1509, France = 1501, Germany = 1502). Given that cognition is not assessed by the PROMIS-29, it was predicted by the recommended linear regression model. We compared the convergent validity, known-groups construct validity, and ceiling and floor effects of the PROPr and EQ-5D-5L.ResultsThe mean PROPr (0.48, 0.53, 0.48; P<.01) and EQ-5D-5L scores (0.82, 0.85, 0.83; P<.01) showed significant differences of similar magnitudes (d = 0.34; d = 0.32; d = 0.35; P<.01) across all samples. The differences were invariant to sex, income, occupation, education, and most conditions but not for age. The Pearson correlation coefficients between both scores were r = 0.74, r = 0.69, and r = 0.72. PROPr’s ceiling and floor effects both were minor to moderate. The EQ-5D-5L’s ceiling (floor) effects were major (negligible).ConclusionsBoth the EQ-5D-5L and the PROPr assessed by the PROMIS-29 show high validity. The PROPr yields considerably lower HSU values than the EQ-5D-5L. Consequences for quality-adjusted life-year measurements should be investigated in future research.     

成人下凳骨第三磨牙阻生关系的研究

目的 观测成人下颌骨第三磨牙的阻生关系。方法 根据吴氏《人类骨骼测量方法》中规定的年龄估计及性别鉴定的标准,观测成人颌骨的形态结构。结果 302个下颌骨标本的观察结果为,男女混合阻生率为10.60％,女性阻生率高于男性,肉眼见无第三磨牙萌出者106例,经X线拍片验证,5例有埋没牙存在,故实际第三睡缺如率为33.44%。从测量数据可见阻生组（无第三磨牙组）的第二磨牙后间隙、下颌斜长、下颌体长及髁突间宽均较正常组小。结论 无第三磨牙可能是人类进化过程中,下颌骨与牙齿均衡退化的结果,而阻生是人类进化从有第三磨牙向第三磨牙演化的过渡阶段。     

蝶鞍的X线观测及临床意义

目的 :为临床颅内占位性病变的诊断提供依据。方法 :随机选取成年头颅侧位 X线平片 ,对鞍背厚度 ,鞍结节形态及角度 ,蝶鞍形态、前后径及深径进行观测。结果 :鞍背厚度为 5 .0 9± 1.13mm;鞍结节形态常见型 93.5 % (2 46例 )、锐利型 1.2 %(3例 )、平坦型 1.2 % (3例 )、垂直型 2 .3% (6例 ) ,鞍结节角度 12 5 .6 4°± 11.97°;蝶鞍形态为椭圆形的占 88% (2 2 7例 ) ,圆形的占8.1% (2 1例 ) ,扁平形的占 3.9% (10例 ) ,蝶鞍前后径 11.7± 2 .31mm ,深径 9.5± 1.6 9mm。结论 :所测结果可作为国人正常 X线解剖数据标准     

Measurement of cardiac output-transtracheal Doppler versus thermodilution

The ABCOM 1 transtracheal Doppler (TTD) has been developed as a non-invasive cardiac output monitor. With this device, cardiac output is continuously calculated from ascending aortic blood flow velocity and aortic diameter obtained via an ultrasound transducer incorporated into the tip of an endotracheal tube. We evaluated the clinical use of the ABCOM 1 monitor and compared cardiac outputs obtained using the TTD system with simultaneous thermodilution (TD) measurements. We found the operation of the ABCOM 1 monitor to be difficult and time-consuming. In our operating rooms, acceptable Doppler signal quality was difficult to obtain. There was no correlation between 36 simultaneously obtained TTD and TD cardiac output measurements. The average difference between measurement techniques and the limits of agreement were unacceptably large (mean difference = 3.04 L.min-1, mean +/- 2 SD = -6.04 to 12.48 L.min-1). Separately analyzing only those measurements during which Doppler signal quality was adequate did not improve agreement between TTD and TD measurements. On the basis of these findings, TTD cannot be recommended as a clinical cardiac output measurement technique.     

Analysis of intracranial pressure

Methods for the acquisition and analysis of intracranial pressure (ICP) signals are reviewed from clinical and technical perspectives. The clinical importance of ICP monitoring is presented, and methods for ICP transduction are briefly discussed. These methods include intraventricular catheters, subarachnoid screws, epidural techniques, and the new fiberoptic ICP measurement systems. Approaches to the visual analysis of the ICP waveform are presented, with special emphasis on the relationship between the ICP waveform and the arterial blood pressure signal. Methods of computer-based ICP analysis are also reviewed, including histogram and systems analysis methods. Methods to predict ICP pressure rises and to estimate intracranial compliance are also discussed. Finally, ICP monitoring is reviewed from the point of view of patient outcome. It is concluded that advanced ICP waveform analysis methods warrant further clinical evaluation to demonstrate their clinical usefulness.     

Measurement Issues in Health Disparities Research

Background. Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse groups. Measurement error might lead to biased results, e.g., estimates of prevalence, magnitude of risks, and differences in mean scores. Addressing measurement issues in the assessment of health status may contribute to a better understanding of health issues in cross-cultural research.
Objective. To provide a brief overview of issues regarding measurement in diverse populations.
Findings. Approaches used to assess the magnitude and nature of bias in measures when applied to diverse groups include qualitative analyses, classic psychometric studies, as well as more modern psychometric methods. These approaches should be applied sequentially, and/or iteratively during the development of measures.
Conclusions. Investigators performing comparative studies face the challenge of addressing measurement equivalence, crucial for obtaining accurate results in cross-cultural comparisons.     

栀子药材中三种有效成分HPLC定量分析结果不确定度的评定

采用HPLC方法同时测定栀子药材中栀子苷、绿原酸和藏红花素Ⅰ的含量,通过对测试方法流程进行分析,确定不确定度来源,结合含量测定方法验证数据,计算了不确定度分量、合成不确定度及扩展不确定度;结果表明,用HPLC方法定量分析栀子药材中栀子苷、绿原酸和藏红花素1的方法满足现代药物分析方法学的要求,且三者的扩展不确定度分别为0.1024,0.2254,0.1265.     

剖宫产的社会因素分析及对策

目的探讨影响剖宫产率上升的社会因素并采取对策控制剖宫产率上升。方法采用问卷调查方法对本院2006年1月至2007年12月间的1100例社会因素所致剖官产进行原因分析。结果社会因素所致剖宫产占手术分娩率62．7％,而因错误观念和孕妇心理状态占社会因素的主要部分,医务人员对孕妇分娩方式选择也有着重要影响。结论剖宫产率的上升应该作为一个社会问题来整体看待;要从根本上改变社会因素对剖宫产的影响,必须从社会、家庭和个人观念三个方面进行变革。     

西北地区成人髌骨测量分析及临床指导意义

目的:通过对西北地区成人髌骨厚度的测量,以提供和完善国人髌骨的解剖学数据及X线资料。方法:选择对实体髌骨及膝关节X线片(侧位、切线位)髌骨的测量分析,共120例。结果:经初步测量,结果如下:H为22.03±0.12mm,最大厚度为26.79mm,最小厚度16.16mm;F1为42.25±0.16mm;F2为41.05±0.32mm;T为21.51±0.18mm;T1为19.38±0.56mm;T2为20.08±0.60mm。结论:对西北地区成人髌骨的测量分析,以提供和完善国人髌骨的解剖学数据及X线资料,为全膝关节置换术及髌骨置换术提供比较准确的数据资料,有利于设计出更适合国人使用的髌骨假体(特别是西北地区),并能使临床医生在手术实践中应用更适合国人解剖特点的髌骨截骨原则。     

全科医疗特征功能的评价、影响因素分析及政策涵义

目的:全科医疗特征功能是构成基础保健高绩效的基础,是区别于专科医疗的核心所在。本研究将测量全科医疗特征功能,剖析其影响因素,探讨问题原因,为制定强化全科医疗特征功能政策提供依据。方法:使用本土化的基础保健测量工具PCAT-AE,选择8家社区卫生服务中心和深圳市港大医院全科医疗门诊部作为调查机构。采用面对面、一对一形式的问卷调查方法,共调查1 712名病人,有效问卷1 645份。结果:全科医疗特征功能总分49.0分,首诊利用(69.8)、连续性(63.1)和文化胜任力(51.2)维度得分相对较高,可及性(40.8)和以社区为导向(31.0)维度得分相对较低。全科医疗特征功能得分受人口社会学特征、健康特征和服务利用等多种因素影响,特征功能对病人的满意度起积极作用(OR1)。结论:国内全科医疗特征功能得分较低,与国外相比差距较大。可以从病人个体、组织和系统三个层面,全面强化全科医疗特征功能。