冠状动脉CT血管造影评估冠状动脉慢性完全性闭塞

目的 观察冠状动脉CT血管造影(CCTA)评估冠状动脉慢性完全闭塞(CTO)的可靠性。方法 回顾性分析201例经有创冠状动脉造影(ICA)确诊的CTO患者共207处病变的CCTA资料,观察CCTA与ICA显示CTO特征的一致性、差异及符合率,包括冠状动脉闭塞段头端形态(钝形/锥形),闭塞段内有无钙化、纡曲、近端分支及闭塞段长度是否≥20 mm。结果 CCTA与ICA检出冠状动脉闭塞段头端钝形(Kappa=0.50)、闭塞段内有无钙化(Kappa=0.48)、闭塞段近端有无分支(Kappa=0.56)及病变长度≥20 mm(Kappa=0.53)与否的结果具有中度一致性(P均＜0.01),二者判断闭塞段是否纡曲的一致性好(Kappa=0.80,P＜0.01)。CTA与ICA对冠状动脉闭塞段钙化[38.65%(80/207)vs.21.74%(45/207)]及闭塞近端分支[31.40%(65/207)vs.43.48%(90/207)]的检出率差异有统计学意义(P均＜0.01),对闭塞段头端钝形[35.75%(74/207)vs.36.71%(76/207)]、闭塞段纡曲[20.29%(42/207)vs.23.19%(48/207)]及病变长度≥20 mm[38.65%(80/207)vs.41.06%(85/207)]的检出率差异均无统计学意义(P均＞0.05)。CCTA与ICA检出冠状动脉闭塞段头端钝形、钙化、纡曲、近端存在分支及长度≥20 mm的符合率分别为76.81%(159/207)、77.29%(160/207)、93.24%(193/207)、79.23%(164/207)及77.29%(160/207)。结论 利用CCTA能可靠评估CTO病变特征。     

幼儿饮食行为量表的编制与评价

目的 编制一套本土化的幼儿饮食行为量表,以早期识别、干预幼儿饮食行为问题。方法 对349名幼儿行初始问卷调查。运用因子分析、区分度分析、Cronbach′s α系数及Spearman相关分析筛选条目,形成试用问卷。对1 021名幼儿行试用问卷调查,筛选条目并形成正式量表。运用折半信度、重测信度、探索性因子分析和验证性因子分析等方法评价量表的信效度。结果 1)形成包含7个维度、39个条目的幼儿饮食行为量表,Cronbach′s α系数为0.889,折半信度为0.922,重测信度0.735,与各维度的相关系数为0.455~0.817。验证性因子分析示χ²/df=2.980,GFI=0.815,CFI=0.802,RFI=0.708,RMSEA=0.062。2)幼儿体重与出生体重、家庭结构、不良饮食习惯相关(P<0.05);幼儿身长与家庭结构和低盐饮食相关(P<0.05)。父母文化水平对幼儿饮食行为的影响显著(P<0.05)。家庭收入对幼儿挑食偏食影响显著(P<0.05)。不同家庭结构对食物响应、过饱响应和共同进餐机会的影响差异有统计学意义(P<0.05)。结论 幼儿饮食行为量表具有稳定性和可靠性,可真实客观地反映幼儿的饮食行为问题,是我国本土化幼儿饮食行为评估的科学可信工具。     

Development and Psychometric Testing of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale

ObjectivesCaregiver self-efficacy—a caregiver’s belief in his/her ability to contribute to patient self-care—is associated with better patient and caregiver outcomes in single chronic conditions. It is, however, unknown if caregiver self-efficacy improves patient and caregiver outcomes in multiple chronic conditions (MCCs) because there is no instrument to measure this variable. We developed the 10-item Caregiver Self-Efficacy in Contributing to patient Self-Care (CSE-CSC) scale for that purpose, and we tested its psychometric characteristics in caregivers of patients with MCCs.MethodsIn this cross-sectional multisite study, we tested the structural validity of the CSE-CSC scale with exploratory and confirmatory factor analysis, and we tested construct validity by correlating CSE-CSC scores with those of the Caregiver Contributions to Self-Care of Chronic Illness Inventory. We also tested reliability, and precision of the CSE-CSC scale.ResultsThe 358 enrolled caregivers (mean age 54.6 years; 71.5% female) cared for patients with an average of 3.2 chronic conditions. Structural validity was good, and it showed 2 factors within the scale. Construct validity showed significant correlations between scores of the CSE-CSC scale and the Caregiver Contributions to Self-Care of Chronic Illness Inventory. Reliability coefficients were between 0.90 and 0.97. Measurement error yielded satisfactory results.ConclusionsThe CSE-CSC scale is valid, reliable, and precise in measuring caregiver self-efficacy in contributing to patient self-care in MCCs. Because caregiver self-efficacy is a modifiable variable, the CSE-CSC scale can be used in clinical practice and research to improve patient and caregiver outcomes.     

Categorical Models of Childhood Disorder: A Conceptual and Empirical Analysis

In this review we explore the clinical and scientific status of categorical models of childhood disorder. Three themes are developed. First, the practical origins of standardised category-based diagnostic schemes are examined along with their contemporary philosophical and psychological significance. Next, the impact that these systems have had on the science of child psychopathology is explored. We look at their link to the medical model and the assumption that childhood disorders are categorical, endogenous, and dysfunctional in nature. We argue that these assumptions underpin the dominant paradigm in child psychopathology and so constrain empirical study and theory development. In the final section, the different ways in which researchers have responded to this link and its impact on science are presented. We present the sort of scientific realism associated with Meehl (1995) as the most appropriate basis for a philosophically respectable child psychopathology. Following this approach means unpacking the paradigmatic assumptions, including the assumption of the categorical structure of disorder, into hypotheses that are then put to empirical test. The sorts of data that would allow us to test the categorical hypothesis are identified. We conclude by discussing the results from three recent studies using behaviour genetic analysis of twin data that, in fact, lead us toward a rejection of this hypothesis. The implications for diagnostic and clinical practice of such a rejection are discussed.     

Validity and reliability of the Spanish Version of the Psychological General Well-Being Index

The Psychological General Well-Being Index (PGWBI) was adapted for use in Spain. The American version was translated and back-translated independently by three bilinguals and the comprehensibility of a consensuated version was tested in a pilot study. The construct validity and internal consistency of the questionnaire were tested in 104 patients (52 high blood pressure patients attending a primary health care centre and 52 end-stage renal disease patients undergoing hemodialysis). Concurrently to the PGWBI, patients were administered the General Health Questionnaire (GHQ-12) and three psychosocial categories of the Sickness Impact Profile (SIP-PD). Patients in the dialysis group were administered the PGWBI on two occasions, two weeks apart. The PGWBI was moderately to highly correlated with the GHQ-12 (r=-0.71) and with the SIP-PD (r=-0.69). Overall internal consistency as measured by Cronbach's coefficient was 0.94. By dimensions, PGWBI coefficients ranged from 0.56 (Self-control) to 0.88 (Anxiety). No differences were found in mean PGWBI scores between the two groups of patients studied. Two-week test-retest intraclass correlation coefficient was 0.76. the similarity of the operating characteristics supports the contention that the Spanish and American versions of the PGWBI are conceptually equivalent. More research is needed on the reliability and responsiveness of the different dimensions of the questionnaire. Our results suggest that only global scores should be used when making individual comparisons.This project was funded by Laboratorios ASTRA España SA.     

The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires

A self-report questionnaire module consisting of 24 items, comprising 5 scales and 7 single items, has been developed for measuring health-related quality of life in patients with brain cancer. Module development proceeded through several stages, including a listing of patient, family and health care professional concerns, the writing of items, field testing in 105 patients with brain cancer and subsequent item reduction and scale construction after multitrait scaling analysis and assessment of internal consistency (Cronbach's coefficient ). The final version of the module exhibits reasonable test-retest stability over a period of one week. Differences in the responses between patients with recently-diagnosed and recurrent cancer and between patients with a Karnofsky Performance Score (KPS) of 50–70 and 80–100 were in the expected direction, indicating that the module of questions is responsive to differing conditions. Patients with either mental confusion, motor deficit or dysphasia indicated problems in several domains and single items as compared to patients without these neurological deficits. Thus, differences in the responses to the items in the brain cancer module appear to reflect differences in neurological status. In adclition, deteriorating neurological status was accompanied by a marked increase in emotional distress, future uncertainty and motor dysfunction. A comparison of the responses in the module with the KPS and with a modified Barthel Activities of Daily Living Index (BADLI) shows moderate correlations, primarily with scales and items that pertain to motor dysfunction, while other scales (such as emotional distress, visual disorder and communication deficit) and most single items are not associated with the KPS or BADLI. Since the emotional distress scale of the module was found to be highly correlated with the emotional function scale of the EORTC QLQ-C30, it could be omitted when the module is used in combination with the QLQ-C30. This would reduce the module to a total of 20 items with four scales and seven single items. The intention is to combine this module of questions with other core or general quality-of-life questionnaires when studying patients with brain cancer in clinical trials.M.-A. Hsu is currently with Pfizer, New York, NY, USA.     

Registration of lung cancer in Scotland: an assessment of data accuracy based on review of medical records

Lung cancer represents a major public health problem in Scotland. Cancer registration data permit the approximate incidence of this disease to be measured directly and the projected incidence to be modelled. Thus, in addition to epidemiologic studies and survival analyses, cancer registration data may be used for planning and monitoring relevant health services. Since the value of the data depends on their quality, we undertook a largescale study of the accuracy of cancer registration data in Scotland. The medical records of a random sample of cancer registrations attributed to the year 1990 were sought. The sample contained 340 registrations of lung cancer, 309 (91 percent) of which had relevant medical records available for scrutiny. Registration details were reabstracted from available records and compared with data in the registry. Results revealed 19 discrepancies in identifying items of data (surname, forename, gender, and date of birth) involving 16 (5.2 percent) patients. Most were trivial and would not disturb record linkage. Discrepancy rates were found to be: 7.8 percent in postcode of residence at the time of diagnosis, 10 percent in anniversary date (excluding differences of six weeks or less), 12.5 percent in histologic verification status; 4.2 percent in ICD-9 site code (the first three digits), and 15.5 percent in four digit ICD-O morphology code (excluding inferred morphology codes). This relatively high level of accuracy gives weight to routinely published incidence figures and supports the use of these data for exploratory epidemiologic studies, assessment of health care needs, and calculation of survival.     

Inter-observer Reliability of Indicators and Decision of Pattern Identification Using Diagnostic Flowchart with Traditional Korean Medicine

Objective: To evaluate the consistency of patterns and pattern identification(PI), and the improvement in the diagnosis of blood stasis after the standard operating procedures(SOPs) were enhanced by using a diagnostic flowchart. Methods: A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results: The improvements in inter-observer agreement for the indicators(for al patients) and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from "poor"(κ=–0.051) to "good"(κ=0.968). The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators(for the subjects) general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from "moderate"(AC1=0.408) to "excel ent"(AC1=0.996). Conclusions: In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency(e.g., in the diagnostic criteria used), it is necessary to analyse the reasons for inconsistency and to improve clinician training.(Trial registration No. KCT0000916)