护理硕士研究生质量与安全能力临床评估量表的汉化及信效度检验

口咽通气导管为一种非气管导管性通气管道,其操作简便,易于掌握,不需要特殊器械能在数秒钟内迅速获得有效通气,并保持呼吸道通畅,在抢救危重、昏迷患者过程中发挥着重要的作用[1].但传统口咽通气导管使用中因不易固定,容易全部滑入患者口腔,有并发食管、气管异物,引起患者误吸、窒息甚至危及患者生命的危险[2].为此,我科对传统口咽通气导管进行改良,介绍如下.     

Validity and reliability of the Portuguese version of Mandibular Function Impairment Questionnaire

The aim of this study is to evaluate the validity and reliability of the Mandibular Function Impairment Questionnaire (MFIQ) (Portuguese version). Face and content validity of the Portuguese version were performed. To assess reproducibility of the data gathered with MFIQ, it was applied to 62 individuals who completed the questionnaire on two occasions. Validity and reliability of the data gathered with MFIQ were evaluated in a sample of 249 patients. Construct-related validity was assessed through factorial validity (by means of a confirmatory factor analysis), and convergent and discriminant validities were assessed, respectively, by the average variance extracted (AVE), composite reliability (CC) and bivariate correlations between factors. The internal consistency was estimated by the standardised Cronbach's alpha coefficient (α) and reproducibility by the intra-class correlation coefficient (ICC). All the items of MFIQ showed content validity. Reproducibility was excellent in both the 'functional capacity' dimension (D1) (ICC(D1) =0·895, 95% CI=0·832 to 0·935) and the 'feeding' dimension (D2) (ICC(D2) =0·825, 95% CI= 0·726 to 0·891). Items 1, 2, 6 and 7 of D1 had factor weights below the desired cut-off (0·5), and overall fit of the original bifactorial structure of the MFIQ was poor [(confirmatory fit index) CFI= 0·850, (goodness of fit index) GFI= 0·781, (root mean square error of approximation) RMSEA= 0·118]. Thus, these items were excluded, and the new, reduced version of the MFIQ showed good fit (CFI=0·933, GFI=0·879, RMSEA=0·099). The convergent validity was adequate (AVE≥0·5, CC≥0·7) for both factors. However, their discriminant validity was low (AVE(D1) = 0·51 and AVE(D2) = 0·66 <ρ(2) (D1D2) =0·70). The internal consistency was excellent (α(D1) =0·874; α(D2) =0·918). The Portuguese version of the reduced MFIQ produced data with good validity and reliability.     

The effect of rater training on scoring performance and scale-specific expertise amongst occupational therapists participating in a multicentre study: a single-group pre–post-test study

Purpose: In order to enhance the quality of the data collected in a multicentre validation study of a revised Danish version of the McGill Ingestive Skills Assessment (MISA), the authors developed a rater training programme. The purpose of the present study was to evaluate the effect of the training on scoring performance and scale-specific expertise amongst raters. Method: During 2 days of rater training, 81 occupational therapists (OTs) were qualified to observe and score dysphagic clients’ mealtime performance according to the criteria of 36 MISA-items. The training effects were evaluated pre- to post-training using percentage exact agreement (PA) of scored MISA items of a case-vignette and a Likert scale self-report of scale-specific expertise. Results: PA increased significantly from pre- to post-training (Z = ?4.404, p < 0.001), although items for which the case-vignette reflected deficient mealtime performance appeared most difficult to score. The OTs scale-specific expertise improved significantly (knowledge: Z = ?7.857, p < 0.001 and confidence: Z = ?7.838, p < 0.001). Conclusion: Rater training improved OTs scoring performance when using the Danish MISA as well as their perceived scale-specific expertise. Future rater training should emphasis the items identified as those most difficult to score. Additionally, further studies addressing different training approaches and durations are warranted.

• Implications for Rehabilitation

• When occupational therapists (OTs) use the McGill Ingestive Skills Assessment (MISA) they observe, interpret and record occupational performance of dysphagic clients participating in a meal. This is a highly complex task, which might introduce unwanted variability in measurement scores.

• A 2-day rater training programme was developed and this builds on the findings of several studies. These suggest that combinations of different training methods tend to yield the most effective results.

• Participation in the newly developed training programme on how to administer the MISA significantly reduces unwanted variability in measurement scores and improves OTs’ competency.

• The training programme could be used in undergraduate and postgraduate dysphagia education initiatives to help OTs understanding of the content and the scoring criteria for each aspect of occupational performance during a meal, thus developing observation skills as well as recognizing and avoiding the most common errors in measurement scores.

     

三维超声多平面模式计数窦卵泡可靠度

目的  对比经阴道三维超声多平面模式与二维超声在计数窦卵泡（AFC）方面的可靠度及计数时间。方法  以2012年10月-2015年4月在该院妇产科就诊或检查的妇女为受试对象,由两名经验丰富的工作人员独立以二维和三维模式进行AFC,对比其计数差异,计算相关系数及一致性限度,对比计数时间。结果  ①对3个不同年龄段受试者而言,两名观察者的计数结果差异无统计学意义（P >0.05）,同一观测者以不同方法的计数结果也未见显著差异（P >0.05）;②不同观察者以同一方法行AFC所用时间差异无统计学意义（P > 0.05）,但同一观察者以三维超声模式行AFC所需时间明显高于二维超声（P <0.01）;③两名观察者以三维超声多平面模式行AFC的差值范围与一致性限度范围更小,差值的均值更低,相关系数更高;④三维超声多平面模式对卵巢低反应性的诊断的准确度与敏感均更高。结论  三维超声多平面模式在行AFC时具有比二维超声更高的可靠度、一致性及准确度,虽其计数时间明显增加,但可大大缩短患者暴露的时间。