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.     

Examining the feasibility,acceptability, validity and reliability of physical activity,sedentary behaviour and sleep measures in people with schizophrenia

BackgroundSchizophrenia is associated with a more than doubled risk of death from cardiovascular disease (CVD). Risk factors for CVD include low levels of physical activity, sedentary behaviour and sleep problems. These risk factors are not systematically assessed by health services.AimsExamine the feasibility, acceptability, validity and reliability of tools measuring physical activity, sedentary behaviour and sleep.MethodsThirty participants with schizophrenia measured their physical activity, sedentary behaviour and sleep by wearing ActiGraph wGT3X-BT accelerometers on their wrist and waist, and recorded their sleep using the SleepBot smartphone app for 7 days. After 7 days they completed the 5-item Simple Physical Activity Questionnaire (SIMPAQ) to retrospectively measure their physical activity and sedentary behaviour over the study period. Concurrent SIMPAQ and SleepBot validity and inter-rater reliability were assessed against accelerometer-derived measures of physical activity, sedentary behaviour and sleep. A qualitative interview was conducted at the end of the study to assess acceptability.ResultsThe tools were feasible: 93% of participants provided valid wear-time accelerometry data and 83% provided SleepBot data. The SIMPAQ showed moderate concurrent validity but poor agreement for moderate-vigorous physical activity (MVPA) and moderate validity and agreement as a measure of sedentary behaviour. The SleepBot app showed poor concurrent validity and agreement for measures of sleep. The qualitative interviews demonstrated the tools were acceptable.ConclusionMonitoring physical activity, sedentary behaviour and sleep by accelerometry, smartphone and questionnaire was feasible and acceptable to people with schizophrenia. The SIMPAQ could be a valid and appropriate tool for routine clinical use.     

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     

人体牙齿颜色测量系统口内活体牙测量重复性的研究

对人体牙齿颜色测量系统的重复性进行研究。方法：采用ＣＩＥ１９７６Ｌ＾＊ａ＾＊ｂ＾＊色度参数对７名自愿者上中切牙进行测量,通过比较不同时间、不同损伤者测量结果差异,计算、比较不同时间测量色差偏差的大小,研究人体牙齿颜色测量系统的重复性。结果：本实验所测人体牙齿颜色系统在不同时间测量结果的色差偏差为１．０２６个单位,且不同时间比较该色差值无显著性差异;不同时间内测量指标比较除ａ＾＊以外,Ｌ＾＊,ｂ＾＊     

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.     

Closed loop control of anaesthesia: an assessment of the bispectral index as the target of control

We investigated the performance of a closed-loop system for administration of general anaesthesia, using the bispectral index as a target for control. One hundred patients undergoing gynaecological or general surgery were studied. In 60 patients, anaesthesia was maintained by intravenous infusion of a propofol/alfentanil mixture. In 40, an isoflurane/nitrous oxide based technique was used. For each technique, patients were randomly allocated to receive either closed-loop or manually controlled administration of the relevant agents (propofol/alfentanil or isoflurane), with an intra-operative target bispectral index of 50 in all cases. Closed-loop and manually controlled administration of anaesthesia resulted in similar intra-operative conditions and initial recovery characteristics. During maintenance of anaesthesia, cardiovascular and electro-encephalographic variables did not differ between closed-loop and manual control groups and deviation of bispectral index from the target value was similar. Intra-operative concentrations of propofol, alfentanil and isoflurane were within normal clinical ranges. Episodes of light anaesthesia were more common in the closed-loop group for patients receiving propofol/alfentanil anaesthesia and in the manual group for patients receiving isoflurane/nitrous oxide anaesthesia. Convenience aside, the closed-loop system showed no clinical advantage over conventional, manually adjusted techniques of anaesthetic administration.     

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.