Consequences of ignoring the response-shift and measure non-invariant items in sleep studies: an empirical data based simulation of the treatment effect of CBT-I on dysfunctional sleep beliefs

IntroductionPrevious studies have shown that psychological interventions do not only improve patients' mental symptoms (i.e., true change) but may also change the internal standards patients use to evaluate their symptoms (i.e., response shifts). Although the response shifts could reflect patients’ cognitive changes toward their disorders as the interventions aim to achieve, failing to differentiate them from the true change during data analyses could bias the research conclusions. Considering this issue is seldom discussed in sleep studies, this study thus examined the impacts of response-shift items in an intervention study of cognitive behavioral therapy for insomnia (CBT-I) via empirical-data based simulations.MethodWe used longitudinal measurement invariance tests to identify the items in an abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale that are non-invariant (response shifted) against CBT-I based on data from 114 insomnia patients. The partial invariance model built accordingly was then used as a population model for simulations to examine the impacts of the response-shift items on follow-up paired t-tests.ResultsInvariance tests indicate CBT-I would lift the intercept of one item in DBAS-10 and cause non-uniform calibrations in three items. The following up simulations showed that failing to exclude the intercept-lifted item from the calculations of the subscale scores would lower the probability of using paired t-test to correctly detect the treatment effect by up to 53%.ConclusionsWe recommend sleep researchers to consider the issues of response-shift when assessing sleep-related constructs in interventional studies for insomnia.     

公立医院编制影响因素及测算研究

目的为科学合理的测算公立医院人员编制以及编制管理改革提供参考。方法对各省市公立医院机构编制标准以及相关文献进行系统分析,系统总结编制影响因素以及编制测算方法。结果公立医院人员编制受多方面因素影响,而现阶段人员编制测算主要以床位数与门诊量为主要考量因素,其他因素为辅。结论结合我国公立医院人事管理改革方向,在公立医院人员编制管理上,首先需要科学核定医院应配备人员总量,全方位考虑各影响因素,并设定一定的可伸缩区间,使医院可根据实际情况在一定范围内自主选择。     

术前MRI测量在胸椎单侧入路经皮椎体成形术中的应用价值

目的：评价术前MRI测量对胸椎单侧入路经皮椎体成形术（Percutaneous Vertebroplasty,PVP）的指导价值。方法 对2组接受胸椎单侧入路PVP的骨质疏松性椎体压缩性骨折患者进行回顾性对比研究。其中一组（A组）22例（27个椎体）于2005年10月至2007年2月进行胸椎单侧入路PVP;另一组（B组）18例（24个椎体）于2007年3月至2008年6月接受完成胸椎单侧入路PVP,该组病例PVP术前均进行常规MRI测量。于术前MRI病椎横断面图像确定穿刺目标区域,循单侧后外侧入路模拟穿刺,测量得出皮肤穿刺点距后正中线的垂直距离及穿刺角度,测量结果用于指导PVP术中操作。比较两组病例单椎体平均操作时间、穿刺成功率及术中骨水泥泄露发生率;对两组病例进行随访,平均14.2月（12月～23月）,分析手术前后（术后3月、12月）VAS评分、ODI指数变化;以及病椎高度丢失、后凸畸形等远期并发症的发生率。结果 A组患者单椎体操作时间平均为34.7±5.4min,B组患者单椎体操作时间为23.3±4.2min;两组病例的穿刺成功率分别为74.1%、95.6%。术后3月、12月A、B两组患者的VAS评分平均下降值5.8±2.1、6.1±1.8,6.1±2.0、6.2±1.6;术后3月、12月两组患者ODI指数平均提高41.6±5.7%、40.6±6.0%,46.3±5.2%、46.1±6.7%。对上述各组数值进行配对t检验显示,A、B两组单椎体操作时间及穿刺准确率之间的差异具有明显的统计学意义（P值均<0.05）;而VAS评分、ODI指数下降值之间的差异均无明显的统计学意义（P值均>0.05）。并发症方面,统计学分析显示两组之间差异无明显统计学意义。结论 该种术前MRI测量方法可以有效的降低胸椎单侧入路PVP手术操作时间、提高其穿刺成功率,无额外的操作风险和相关并发症,临床治疗效果确切,且该方法不需要昂贵的医疗设备、简单易行,具有良好的临床应用价值。     

成人腰椎椎弓根的多排螺旋CT测量与临床意义

目的影像学方法测量腰椎椎弓根参数,为临床实践提供数值参考。方法选取200例受检者行64排螺旋CT扫描后数据处理,测量L1～L5腰椎椎弓根水平面角度及椎弓根后缘皮质至椎体前缘中点的长度,按性别分组进行统计学分析。结果男、女性随着椎体序列的增加,椎弓根水平面角度均有逐渐增大的趋势,L3、L4、L5椎体的椎弓根水平角度男、女性之间有显著性差异（P〈0．05）,L1、L2、L3椎体的椎弓根后缘皮质至椎体前缘中点长度男、女性之间有显著性差异（P〈0．05）。结论腰椎椎弓根水平面角度及椎弓根后缘皮质至椎体前缘中点的长度存在性别差异,多排螺旋CT是一种有效可行的测量评估手段。     

中文版简明疼痛量表在癌症患者中内在一致性和重测信度分析

目的探讨中文版简明疼痛量表在癌症患者中的内在一致性和重测信度。方法 50例癌症患者参与本研究。在上午和下午由护士各自独立地应用中文版简明疼痛量表对患者进行调查,检验简明疼痛量表的内在一致性和重测信度。结果内在一致性统计分析结果显示,在前后两次调查中简明疼痛量表的Cronbach′sα系数为0.954和0.958。简明疼痛量表的12个项目Cronbach′sα系数范围为0.947-0.961。重测信度统计分析结果显示,简明疼痛量表12个项目的 ICC值范围在0.774-0.89之间。结论中文版简明疼痛量表具有良好的内在一致性和重测信度。     

改善医患关系的重要途径——患者满意度测评

近些年,我国医患关系处于紧张状态,已经影响到了医院的正常运营及发展。如何改善医患关系,引导医患关系走向和谐发展,是当前医药体制改革过程中面临的问题和挑战。本文分析了医患关系的现状和改善医患关系的基本途径,探讨了通过患者满意度测评改善医患关系的途径,意在帮助医院提高服务质量,改善医患关系,增强竞争力。     

64排螺旋CT重建层厚及时相间隔对左心室容积测量的影响

目的比较不同重建时相间隔及重建层厚对左心室舒张末期容积(EDV)、收缩末期容积(ESV)及射血分数(EF)的影响,优化重建方案。方法回顾性分析20例冠状动脉CTA检查的患者资料,将患者原始CT数据分别重建为层厚0.625、1.25、2.5mm的横断面图像,并以心动周期的10%和5%为间隔拆分为10和20个时相。利用图像工作站中基于CT值的容积分割算法计算舒张末期及收缩末期左心室容积以及左心室射血分数(LVEF),比较不同重建时相间隔和不同重建层厚左心室容积测量值的差异。结果 2.5mm获得的左心室容积测量值为,EDV(142.4±24.8)ml,ESV(48.9±16.9)ml;小于0.625mm[EDV(152.5±26.6)ml,ESV(56.9±19.5)ml]及1.25mm的值[EDV(152.3±26.3)ml,ESV(56.6±21.3)ml,P<0.001]。LVEF2.5mm的测量值大于0.625及1.25mm的值[(66.4±6.5)%vs.(63.3±7.5)%,(63.7±8.7)%,P<0.001]。不同重建时相间隔获得的左心室收缩末期容积存在差异,以间隔5%的心动周期时相获得的结果小于间隔10%重建的结果(P<0.01)。左心室舒张末期容积两者之间无显著性差异。两种重建方法获得的LVEF存在差异,间隔5%重建获得的LVEF值大于间隔10%重建的结果(P<0.01)。结论 64排螺旋CT能够以不同重建时相间隔和图像层厚获得左心室容积数据。较大的重建层厚和较少重建时相间隔可减少后处理图像数量,但导致低估或高估左心室容积。     

应用Micro CT下颌磨牙"C"形根管的解剖学研究

目的 应用Micro CT技术研究尚未修复或牙髓治疗的下颌第二磨牙"C"字形根管的患病率及解剖学特点.方法 应用Micro CT(Skyscan1072,Antwerpen,Belgium))及cutome计算机软件分析"C"字形牙根管结构.测量下颌第二磨牙"C"形根颈部、中部、根尖部位牙体组织最小厚度及正常下颌第二磨...     

腰椎滑脱X线诊断测量方法的比较研究

目的探讨腰椎滑脱X线诊断的最佳测量方法。方法研究组为55例第5腰椎（the 5th lumbar verte-bra,L5）双侧峡部裂的男性招飞学生,对照组为127例无滑脱的同龄男性招飞学生,拍摄站立的侧位X线片,采用Gar-land、Meyerding、Taillard及作者提出的椎间隙中线垂线测量法（Mid-Intervertebral Perpendicular,MIP）测量并发滑脱的程度。对4种测量方法的阳性率进行统计比较。结果研究组中,Garland、Meyerding、Taillard和MIP法对L5滑脱的阳性率分别为81.8%（45/55）、58.2%（32/55）、87.3%（48/55）和94.5%（52/55）,有统计学差异（P〈0.01）。Garland测量法对轻度的L5滑脱有较高假阳性率,Meyerding、Taillard、MIP 3种测量法诊断腰椎滑脱无假阳性结果。Garland、Meyerding、Taillard 3种测量方法均存在不同程度的假阴性结果,用MIP测量法均得以纠正。结论在腰椎峡部裂并脊柱滑脱的X线测量中,MIP法对腰椎滑脱的检出率高且无假阳性结果。     

Using Short-Term Dietary Intake Data to Address Research Questions Related to Usual Dietary Intake among Populations and Subpopulations: Assumptions,Statistical Techniques,and Considerations

Many research questions focused on characterizing usual, or long-term average, dietary intake of populations and subpopulations rely on short-term intake data. The objective of this paper is to review key assumptions, statistical techniques, and considerations underpinning the use of short-term dietary intake data to make inference about usual dietary intake. The focus is on measurement error and strategies to mitigate its effects on estimated characteristics of population-level usual intake, with attention to relevant analytic issues such as accounting for survey design. Key assumptions are that short-term assessments are subject to random error only (i.e., unbiased for individual usual intake) and that some aspects of the error structure apply to all respondents, allowing estimation of this error structure in data sets with only a few repeat measures per person. Under these assumptions, a single 24-hour dietary recall per person can be used to estimate group mean intake; and with as little as one repeat on a subsample and with more complex statistical techniques, other characteristics of distributions of usual intake, such as percentiles, can be estimated. Related considerations include the number of days of data available, skewness of intake distributions, whether the dietary components of interest are consumed nearly daily by nearly everyone or episodically, the number of correlated dietary components of interest, time-varying nuisance effects related to day of week and season, and variance estimation and inference. Appropriate application of assumptions and recommended statistical techniques allows researchers to address a range of research questions, though it is imperative to acknowledge systematic error (bias) in short-term data and its implications for conclusions.