Assessment of Standing Aids for the Physically Handicapped

The suitability of four commercially available standing aids was assessed for routine therapy of a group of severely handicapped patients in hospital care. The problems which arose were mainly technical and these are considered. From experience gained during the study the design requirements of an ideal aid for these patients are proposed.     

Using a ‘talk’ model of shared decision making to propose an observation-based measure: Observer OPTION

Objective

To propose a revised Observer OPTION measure of shared decision making.

Methods

We analyzed published models to identify the core components of a parsimonious conceptual framework of shared decision making. By using this framework, we developed a revised measure combining data from an observational study of clinical practice in Canada with our experience of using Observer OPTION^{12 Item}.

Results

Our conceptual framework for shared decision making composed of justifying deliberative work, followed by the steps of describing options, information exchange, preference elicitation, and preference integration. By excluding items in Observer OPTION^{12 Item} that were seldom observed or not aligned to a robust construct, we propose Observer OPTION^{5 Item}.

Conclusion

Although widely used, Observer OPTION^{12 Item} did not give sufficient attention to preference elicitation and integration, and included items that were not specific to a core construct of shared decision making. We attempted to remedy these shortcomings by proposing a shorter, more focused measure.

Practice implications

Observer OPTION^{5 Item} requires evaluation; we hope that it will be useful as both a research tool and as a formative measure of clinical practice.     

Development and validation of the General Health Numeracy Test (GHNT)

Objective

Because existing numeracy measures may not optimally assess ‘health numeracy’, we developed and validated the General Health Numeracy Test (GHNT).

Methods

An iterative pilot testing process produced 21 GHNT items that were administered to 205 patients along with validated measures of health literacy, objective numeracy, subjective numeracy, and medication understanding and medication adherence. We assessed the GHNT's internal consistency reliability, construct validity, and explored its predictive validity.

Results

On average, participants were 55.0 ± 13.8 years old, 64.9% female, 29.8% non-White, and 51.7% had incomes ≤$39 K with 14.4 ± 2.9 years of education. Psychometric testing produced a 6-item version (GHNT-6). The GHNT-21 and GHNT-6 had acceptable-good internal consistency reliability (KR-20 = 0.87 vs. 0.77, respectively). Both versions were positively associated with income, education, health literacy, objective numeracy, and subjective numeracy (all p < .001). Furthermore, both versions were associated with participants’ understanding of their medications and medication adherence in unadjusted analyses, but only the GHNT-21 was associated with medication understanding in adjusted analyses.

Conclusions

The GHNT-21 and GHNT-6 are reliable and valid tools for assessing health numeracy.

Practice implications

Brief, reliable, and valid assessments of health numeracy can assess a patient's numeracy status, and may ultimately help providers and educators tailor education to patients.     

猪股骨头支持带动脉入头分支的解剖学研究

目的　探索猪股骨头支持带动脉入头分支的数量、分布规律及外径大小并阐述其意义。 方法　解剖39例带有髋周血管的猪股骨头离体标本,分离支持带动脉,采用30%硫酸钡悬浮液显微灌注,观察支持带动脉入头分支的走形、数量、分布及外径。以时钟点位记录支持带动脉入头的分布规律,显微标尺测量支持带动脉入头分支的外径,并对各组支持带动脉入头最粗支的位置进行测量统计。 结果　猪股骨头共有（6.10±1.32）支动脉入头,主要分为后上、后下及前方3组,每组支持带动脉最粗支入头的时钟点位分别为（11：22~01：29）、（06：36~08：15）、（02：01~03：59）;直径分别为（0.37±0.11）、（0.52±0.11）、（0.35±0.09）mm。 结论　猪股骨头入头动脉的数量及位置相对恒定,入头动脉最粗支平均直径为（0.52±0.11）mm,来自后下组支持带动脉,为猪股骨头重要的血供来源。     

Preference for patient-centered communication among the citizens of the Visegrad countries

ObjectivesThe aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider.MethodsThe patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed.ResultsBeing female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries.ConclusionsKey demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries.Practice implicationsThese findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.     

医院药师工作压力及其测量方法研究现状

目的:分析医院药师工作压力及其测量方法现状,为提高医院药师工作压力相关研究质量提供参考。方法:以"医院""药师""压力""量表""Hospital""Pharmacist""Stress""Pressure""Scale"等为中、英文关键词检索中国期刊全文数据库、中文科技期刊数据库、万方数据、Web of Science、SciFinder、Springer Link等数据库自建库起至2019年8月发表的医院药师工作压力相关文献,探索其研究现状,并总结医院药师工作压力的测量方法。结果:国外医院药师工作压力的相关研究较多,包括压力状况、原因、压力产生的结果、作用机制模型等方面,但存在年代久远、数据陈旧等问题,而国内相关研究较为少见,尚缺乏对医院药师工作压力全面、系统的研究。大部分国内外研究使用量表测量医院药师的工作压力,包括医院药师专用量表(如医院药师压力源量表、药师压力清单)与一般职工通用量表(如健康职业压力调查、工作压力项目和知觉心理压力量表),其中医院药师压力源量表比较符合我国医院药师工作特征,其余量表存在覆盖领域少、条目数过多、不符合我国医院药师工作特征等问题。结论:为提高医院药师工作压力相关研究质量,需要对已有量表进行调整或者开发新的测量量表,以期测量我国医院药师真实工作压力状况,为改善医院药师工作质量、提高临床药学服务水平提供参考。     

Measurement of Opening and Closing Angles of Aortic Valve Prostheses In Vivo Using Dual-Source Computed Tomography: Comparison with Those of Manufacturers' in 10 Different Types

Objective

The aims of this study were to compare opening and closing angles of normally functioning mechanical aortic valves measured on dual-source computed tomography (CT) with the manufacturers'' values and to compare CT-measured opening angles according to valve function.

Materials and Methods

A total of 140 patients with 10 different types of mechanical aortic valves, who underwent dual-source cardiac CT, were included. Opening and closing angles were measured on CT images. Agreement between angles in normally functioning valves and the manufacturer values was assessed using the interclass coefficient and the Bland-Altman method. CT-measured opening angles were compared between normal functioning valves and suspected dysfunctioning valves.

Results

The CT-measured opening angles of normally functioning valves and manufacturers'' values showed excellent agreement for seven valve types (intraclass coefficient [ICC], 0.977; 95% confidence interval [CI], 0.962-0.987). The mean differences in opening angles between the CT measurements and the manufacturers'' values were 1.2° in seven types of valves, 11.0° in On-X valves, and 15.5° in ATS valves. The manufacturers'' closing angles and those measured by CT showed excellent agreement for all valve types (ICC, 0.953; 95% CI, 0.920-0.972). Among valves with suspected dysfunction, those with limitation of motion (LOM) and an increased pressure gradient (PG) had smaller opening angles than those with LOM only (p < 0.05).

Conclusion

Dual-source cardiac CT accurately measures opening and closing angles in most types of mechanical aortic valves, compared with the manufacturers'' values. Opening angles on CT differ according to the type of valve dysfunction and a decreased opening angle may suggest an elevated PG.     

MSCT对健康成人肾上腺体积的测量研究

目的探讨MSCT对健康成人肾上腺体积的测量研究。方法选取2013年1月~2014年6月190例健康体检者作为研究对象,采用多层螺旋CT行增强扫描测量肾上腺体积的大小,着重观察健康成人双侧肾上腺的检出率及其与性别、年龄、体重、身高、血压等参数的关系。结果健康成人双侧肾上腺检出率为100%,左侧平均体积为(2803.18±869.74)mm3,明显大于右侧的(2010.82±726.33)mm3,比较差异有统计学意义(P0.05);男性肾上腺总体积、左侧平均体积、右侧平均体积分别为(5436.91±1576.07)mm3、(3021.48±930.45)mm3、(2448.07±764.95)mm3,均明显大于女性的,(4260.83±1510.34)mm3、(2589.85±880.61)mm3、(1634.90±796.38)mm3,差异有统计学意义(P0.05);双侧肾上腺体积56岁后缩小;肾上腺体积与体重呈正相关,与身高、血压无明显相关性。结论 MSCT可简便、准确测量肾上腺体积,是测量肾上腺的有效方法,为肾上腺病变的影像学诊断提供可靠依据,值得临床推广使用。     

IFCC参考方法对两种常规检测系统ALP结果正确度的验证

目的评价常规检测系统测定血清碱性磷酸酶(ALP)的正确度。方法以国际临床化学联合会(IFCC)参考方法和两种常规检测系统(简称A法、B法)同时测定20份新鲜单人份血清样品。按美国临床实验室标准化协会(CLSI)EP9-A2文件评价两种常规检测系统测定结果的正确度,并用改良Bland-Altman图形分析法进行验证,评价常规检测系统与参考方法测定结果的一致性,综合判断常规检测系统的测定结果。按CLSI EP14-A2文件评价A、B两种方法校准品的基质效应。结果 A法、B法与IFCC参考方法测定结果的直线回归方程分别为YA=0.982 9XIFCC+0.010 8,YB=0.938 3XIFCC+0.012 9,平均偏倚分别为-1.1%、-5.5%。A法和B法检测结果的相关方程为YB=0.955 2XA+0.001 36,R2=0.997 6。A法和B法的校准品均存在基质效应,其中A法校准品的基质效应更明显。结论 A法与IFCC参考方法正确度性能一致,B法与IFCC参考方法正确度性能不一致。     

Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury

Background/objectives

Many ambulatory patients with spinal cord injury (SCI) encountered multiple falls and serious consequences after falls, but there was no quantitative practical measure for early identification of individuals at a risk of multiple falls. This study compared the utility of the Berg Balance Scale, Timed “Up & Go” Test, 10-Meter Walk Test, Functional Reach Test (FRT), Step Test, and Five Times Sit-to-Stand Test to predict risk of multiple falls (fall ≥2 times) in these individuals.

Methods

Eighty-three independent ambulatory subjects with SCI were assessed for their functional abilities using the six tests. Then, their fall data were monitored prospectively every 2 weeks for 6 months in total. The first 25 subjects were also involved in the reliability tests.

Results

The FRT showed the best predictive ability for the risk of multiple falls (cut-off score ≥20 cm, sensitivity = 73%, specificity = 55%, area under the receiver characteristic curve = 0.64, and adjusted odd ratio = 3.18, P < 0.05), excellent inter-tester reliability, and good feasibility.

Conclusions

The FRT may be used as a screening tool to predict risk of multiple falls in independent ambulatory individuals with SCI. However, with a moderate level of specificity, a further comprehensive test may be needed to clearly indicate individuals at a risk of falls. In addition, the findings suggest that a higher level of ability increases the risk of multiple falls. Thus, programs for functional integration in an actual environment may be needed to reduce the risk of falls for these individuals.