足拇外翻远端截骨术后HAV角和IM角不同X线片测量方法的Bland-Altman分析

目的确定足拇外翻远端截骨术后适宜的HAV角和IM角X线测量方法。方法采用影像学测量软件对足拇外翻术后X线片进行测量,不同测量者使用6种方法测量同一张X线片;同一测量者使用6种方法测量不同X线片,对测量结果进行Bland-Altman分析和一致性评价。结果不同测量者使用6种方法对同一张片子测量,测量值之间的差异无统计学意义(P0.05)。同一测量者使用6种方法测量不同X线片,方法 C测量平均值最小,标准差和置信区间的范围最窄,其次是方法 A和D;方法 B测量值的标准差及置信区间比其他方法大。方法 A与方法 D的差值的标准差最小,在可信区间内最接近,二者具有较高的一致性。结论方法 A利用测量软件自动确定第1跖骨轴线,重复性好,测量可靠、准确,可作为足拇外翻术后X线软件测量的"金标准"。方法 D在手工测量时第1跖骨轴线参考点唯一、重复性好、最为准确,可作为足拇外翻远端截骨术后X线片的首选测量方法。     

量表测量等价性及其在护理研究中的应用

量表具有测量等价性,是进行组间差异及跨文化研究比较的前提条件.随着心理测量学及统计学的发展,传统的信效度分析已不能满足潜变量测量等价性的要求.本文结合护理研究量表引进及跨文化应用的研究背景,在介绍测量等价性的概念及意义基础上,重点阐述测量等价性的检验流程及在护理相关领域的应用,为护理领域量表的严格引进及应用推广提供借鉴和参考,促进护理学跨文化研究的合作与发展.     

Comparison of imaging modalities for measuring the diameter of intraductal papillary mucinous neoplasms of the pancreas

BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are pre-malignant pancreatic cysts detected by imaging. Cyst size is one of many features evaluated on computed tomography (CT), magnetic resonance imaging (MRI), or endoscopic ultrasonography (EUS) to help guide IPMN management. Our objective was to determine which imaging modality best predicts pathological cyst size.MethodsWe analyzed records for 57 IPMN cases surgically treated at Moffitt Cancer Center from 2008 to 2016 for whom pre-operative CT, MRI, and EUS IPMN cyst size and post-operative pathological cyst size values were available. Long axis cyst diameter measurements were compared to each other and corresponding pathological cyst measurements using within-subjects ANOVA, Bland-Altman analysis, and linear regression. Consensus measurements were also performed on CT and MRI images.ResultsCyst size measured via CT and MRI overestimated pathological size by 0.33 cm and 0.27 cm, respectively, whereas EUS underestimated pathological size by 0.05 cm and had the narrowest 95% limit of agreement (LOA). Among pathologically-confirmed cysts <3 cm, MRI overestimated pathological size by 0.30 cm (P = 0.049) and had the widest LOA, followed by EUS and CT. Among cysts ≥3 cm, EUS underestimated pathological size by 0.35 cm (P = 0.059) and MRI and CT overestimated pathological size by 0.23 cm and 0.51 cm, respectively.ConclusionsIn this small retrospective study, EUS cyst size measurements correlated best with pathologic specimens compared to CT and MRI, especially for cysts < 3 cm. Larger prospective studies are needed to determine which imaging modalities are best to risk-stratify IPMNs and guide surgical versus. Non-surgical management.     

Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information

Objective

To develop a reliable and valid instrument to assess the understandability and actionability of print and audiovisual materials.

Methods

We compiled items from existing instruments/guides that the expert panel assessed for face/content validity. We completed four rounds of reliability testing, and produced evidence of construct validity with consumers and readability assessments.

Results

The experts deemed the PEMAT items face/content valid. Four rounds of reliability testing and refinement were conducted using raters untrained on the PEMAT. Agreement improved across rounds. The final PEMAT showed moderate agreement per Kappa (Average K = 0.57) and strong agreement per Gwet's AC1 (Average = 0.74). Internal consistency was strong (α = 0.71; Average Item-Total Correlation = 0.62). For construct validation with consumers (n = 47), we found significant differences between actionable and poorly-actionable materials in comprehension scores (76% vs. 63%, p < 0.05) and ratings (8.9 vs. 7.7, p < 0.05). For understandability, there was a significant difference for only one of two topics on consumer numeric scores. For actionability, there were significant positive correlations between PEMAT scores and consumer-testing results, but no relationship for understandability. There were, however, strong, negative correlations between grade-level and both consumer-testing results and PEMAT scores.

Conclusions

The PEMAT demonstrated strong internal consistency, reliability, and evidence of construct validity.

Practice implications

The PEMAT can help professionals judge the quality of materials (available at: http://www.ahrq.gov/pemat).     

Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE:

Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight ≤1,500 g and/or gestational age ≤32 weeks.

METHODS:

A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT00648687","term_id":"NCT00648687"}}NCT00648687

RESULTS:

One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001).

CONCLUSIONS:

One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.     

Improving the Efficiency of Screening for Major Depression in People With Spinal Cord Injury

Abstract

Background/Objective: To investigate the metric properties, relative efficiency, sensitivity and specificity, and positive predictive value of a short form of the Patient Health Questionnaire-9 (PHQ-9) that may be used as a screening test for depression.

Methods: Data from the National Spinal Cord Injury Statistical Center Database containing 3,652 records with complete data for the PHQ-9 were analyzed using Confirmatory Factor Analysis, Item Response Theory Graded Response Model analysis, and sensitivity and specificity analysis of classification.

Results: A scale comprised of items 1, 2, and 6 from the PHQ-9 has a relative efficiency of 0.66 compared to the 9-item scale. Using this 3-item scale and a cutoff score of 3 or more provides specificity of 0.93 and sensitivity of 0.87; a cutoff of 4 provides specificity of 0.95 and sensitivity of 0.82. The shorter version of the scale reduces the effect of response bias caused by gender. The relative efficiency of the 9-item scale is 0.88 for women compared to men; the 3-item scale increases the relative efficiency to 0.93.

Conclusion: A 3-item scale provides adequate information for clinical screening purposes. Cutoff scores of either 3 or 4 are acceptable and present options for decision making within a particular clinical setting. Additionally, the 3-item scale reduces the effect of gender of the respondent on the score obtained.     

Feasibility of accelerometer technology with individuals with autism spectrum disorder referred for aggression,disruption, and self injury

BackgroundMost research on aggression, self-injury, and disruption in autism spectrum disorder (ASD) has relied on caregiver report or direct observation, both of which have limitations. Past studies demonstrate preliminary evidence for direct detection of these behaviors using accelerometers, but additional research is needed to determine the feasibility during actual clinical assessments and times when a therapist cannot be present for direct observation, as measurement during these periods has the most applied significance.AimsThis study addressed these gaps by evaluating the feasibility of accelerometer use with children with ASD and severe aggression, self-injury, and disruption in clinical and home contexts.Methods and ProceduresWe evaluated the feasibility of individuals with ASD wearing accelerometers during behavioral assessments following structured habituation procedures. We also evaluated the feasibility of caregivers applying sensors to individuals with ASD in the home setting.Outcomes and ResultsMost participants passed habituation and tolerated sensors during behavioral assessments (e.g., functional analyses). Caregivers applied sensors in the home with variable fidelity with wear time duration and data-collection.Conclusions and ImplicationsThe feasibility of using accelerometers with this population is promising and should be explored further in future research.     

枢椎后路峡部螺钉固定的相关影像学测量

目的：通过CT测量探讨枢椎峡部螺钉固定技术的安全性和可行性。方法：收集2016年1月至2019年12月进行全颈椎CT检查的137例结构完整的上颈椎CT数据,其中男71例,女66例;年龄22~65（41.8±17.4）岁。通过Mimics19.0软件测量峡部螺钉技术相关的解剖学数据,包括峡部宽度、峡部垂直长度、峡部垂直高度、峡部螺钉通道长度、峡部螺钉通道头倾角度。并分析各项指标之间的相关性。结果：枢椎峡部宽度（9.05±1.63） mm,垂直长度（11.21±1.43） mm,垂直高度（17.53±2.93） mm。螺钉通道长度为（19.07±3.20） mm。峡部螺钉通道长度>14 mm的占94.53%,14~16 mm的占82.12%,16~18 mm的占63.14%,18~20 mm的占39.78%。螺钉通道的头倾角度为30°~68°,平均（46.06±8.06）°。螺钉通道长度和头倾角度呈高度正相关（r=0.965,P=0.000）。峡部垂直长度和螺钉通道长度,峡部垂直长度和螺钉的头倾角度之间都呈轻度正相关（r=0.240,P=0.000;r=0.163,P=0.007）。峡部宽度和螺钉通道长度,峡部宽度和螺钉通道的头倾角度之间都呈中度负相关（r=-0.333,P=0.000;r=-0.380,P=0.000）。结论：进行枢椎后路峡部螺钉固定安全、可靠,比枢椎后路椎弓根螺钉固定具有更大的适用范围,可以作为椎弓根螺钉的替代选择。     

电影MR对测定心功能价值的探讨

目的探讨电影MR测定心功能的价值。材料和方法；通过对21例健康成人电影MR成像，采用双盲法，分析和测量左心功能指标，并与超声心动图（UCG）测值进行相关性t检验。结果：电影MR测定左室短径、左室后壁／室间隔厚度、左室舒末／缩末容积等指标，与UCG比较，具有良好的相关性（r＝0．87－0．99）。结论：电影MR是又一检测心功能准确、无创的影像新技术，具有较大发展潜力。