OSTA在慢性阻塞性肺疾病患者骨质疏松风险评估中的应用

目的:探讨亚洲人骨质疏松自我筛查工具(Osteoporosis Self-assessment Tool for Asians,OSTA)在慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者骨质疏松风险评估中的应用前景。方法:根据OSTA风险分层,对33例呼吸系统疾病患者,其中COPD23例,进行相关特征的分析。结果:COPD组骨质疏松中、高风险患者所占比例较对照组高。COPD组中不同风险组间在身高差、体重、BMI,甲状旁腺激素(PTH)、同型半胱氨酸(Hcy)水平,任何重要的骨质疏松性骨折(Major osteoporotic)、髋部骨折(Hip Fracture)概率及深吸气量(IC)的差异,存在统计学意义。OSTA与下列因素的相关性存在统计学差异,其中与身高差、Major osteoporotic概率、Hip Fracture概率、PTH、Hcy呈正相关,与体重、BMI、用力肺活量(FVC)、IC呈负相关。结论:COPD患者骨质疏松的风险较高,对于尚不具备双能X线吸收测量法(DXA)检测条件的基层医院,OSTA不失为一种有效的初步筛选工具。     

Gastrointestinal Symptoms Rating Scale in Coeliac Disease Patients on Wheat Starch-based Gluten-free Diets

Background: A wheat starch-based gluten-free diet is widely adopted in the treatment of coeliac disease, even though the products contain trace amounts of gluten. The aim here was to establish whether such a diet sustains abdominal symptoms. Methods: The Gastrointestinal Symptom Rating Scale (GSRS) was applied to 58 coeliac disease patients on gluten-free diets and 110 non-coeliac controls. An estimate was made of daily dietary fibre and wheat starch-derived gluten. Psychological well-being was evaluated by a structured interview. Twenty-three coeliac patients consented to small-bowel biopsy. Results: The mean GSRS score in coeliac disease patients did not differ from that in control subjects. Poorer psychological well-being was associated with abdominal symptoms in coeliac patients, whereas the daily amount of wheat starch had no effect on GSRS score. Overall dietary compliance was good, and villous atrophy was found in only 2 out of 23 patients. The average fibre consumption, 13 g per day, was lower than recommended. Conclusions: Wheat starch-based gluten-free products are well-tolerated in coeliac disease patients, provided that their diets are otherwise strict.     

Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale

OBJECTIVE: In patients with chronic pain, catastrophizing is a significant determinant of self-rated pain intensity and disability. The Pain Catastrophizing Scale (PCS) was developed to assist with both treatment planning and outcome assessment; to date, no German version has been validated. METHODS: A cross-cultural adaptation of the PCS into German was carried out, strictly according to recommended methods. A questionnaire booklet containing the PCS, visual analogue scales (numeric rating scale) for pain intensity and general health, the ZUNG self-rating depression scale, the Modified Somatic Perception Questionnaire (MSPQ), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Roland-Morris (RM) disability questionnaire was completed by 111 patients with chronic low back pain (mean age, 49 years), 100 of which also completed it again 7 days later. RESULTS: Cronbach's alpha (internal reliability) for the three subsections of the PCS--helplessness, magnification, rumination--and for the whole questionnaire (PCSwhole) were .89, .67, .88, and .92, respectively. The intraclass correlation coefficients of agreement for the reproducibility were .81, .67, .78, and .80, respectively. The PCSwhole scores correlated with the other scores as follows: pain intensity r=.26, general health r=-.29, ZUNG r=.52, MSPQ r=.53, FABQactivity r=.51, FABQwork r=.61 and RM r=.57. Factor analysis revealed three factors, with an almost identical factor structure to that reported in previous studies. CONCLUSION: The psychometric properties of our German version of the PCS were comparable to those reported in previous studies for the original English version. It represents a valuable tool in the assessment of German-speaking chronic low back pain patients.     

Patient assessment and management examination: lack of correlation between faculty assessment and resident self-assessment

BACKGROUND: The Patient Assessment and Management Examination (PAME) is a standardized patient examination designed to assess management skills of senior residents. This study explored the relationship between faculty and resident self-evaluation by using PAME. METHODS: Nine postgraduate year (PGY) 4 and PGY5 residents were examined with a 5 case PAME. Faculty rated interactions between residents and standardized patients and residents rated themselves based on review of audio-video recordings of their interactions. We examined correlations between faculty and resident self-assessments. RESULTS: Faculty and resident ratings of physical examination skills was the only competency that correlated significantly. Correlations were not significant for the other 15 competencies (Pearson r, -.197 to .262). Correlation was no better when examined within each case. CONCLUSIONS: Although PAME may be a useful tool, this study suggests that even senior residents do not assess their performance as clinicians similarly to faculty. Further research is needed to better understand the source of these disagreements.     

Five-year prospective patient evaluation of bladder and bowel symptoms after dose-escalated radiotherapy for prostate cancer with the BeamCath technique

PURPOSE: Late side effects were prospectively evaluated up to 5 years after dose-escalated external beam radiotherapy (EBRT) and were compared with a previously treated series with conventional conformal technique. METHODS AND MATERIALS: Bladder and bowel symptoms were prospectively evaluated with the Prostate Cancer Symptom Scale (PCSS) questionnaire up to 5 years posttreatment. In all, 257 patients completed the questionnaire 5 years posttreatment. A total of 168 patients were treated with the conformal technique at doses<71 Gy, and 195 were treated with the dose-escalated stereotactic BeamCath technique comprising three dose levels: 74 Gy (n=68), 76 Gy (n=74), and 78 Gy (n=53). RESULTS: For all dose groups analyzed together, 5 years after treatment, urinary starting problems decreased and urinary incontinence increased in comparison to baseline values. No increase in other bladder symptoms or frequency was detected. When comparing dose groups after 5 years, both the 74-Gy and 78-Gy groups reported increased urinary starting problems compared with patients given the conventional dose (<71 Gy). No increased incontinence was seen in the 76-Gy or the 78-Gy groups. Bowel symptoms were slightly increased during the follow-up period in comparison to baseline. Dose escalation with stereotactic EBRT (74-78 Gy) did not increase gastrointestinal late side effects after 5 years in comparison to doses<71 Gy. CONCLUSION: Dose-escalated EBRT with the BeamCath technique with doses up to 78 Gy is tolerable, and the toxicity profile is similar to that observed with conventional doses<71 Gy.     

The quality of life: design and evaluation of a self-assessment instrument for use with cancer patients

An attempt was made to define the concept of ‘quality of life’ and outline the development of a self-assessment instrument for detecting the changes in life as a whole which result from the presence and treatment of malignant disease. A comparison was made between three different scoring systems, familiar in psychometric assessment, although less familiar in nursing.The items selected for inclusion in the measurement instrument were based on an existing symptom distress scale and on the previously identified concerns of cancer patients. The relationship between such symptoms and the activities of daily living was explored. Each item, and the instrument as a whole, appeared to be reliable and to represent a valid means of assessing the impact of the disease on patient well being. It was simple to use and straightforward to score and appeared accurately to reflect the patients’ general condition.     

Self-assessment in simulation-based surgical skills training

BACKGROUND: Simulation-based training provides minimal feedback and relies heavily on self-assessment. Research has shown medical trainees are poor self-assessors. The purpose of this study was to examine trainees' ability to self-assess technical skills using a simulation-trainer.METHODS: Twenty-one medical students performed 10 repetitions of a simulated task. After each repetition they estimated their time and errors made. These were compared with the simulator data. RESULTS: Task time (P < 0.0001) and errors made (P < 0.0001) improved with repetition. Both self-assessment curves reflected their actual performance curves (P < 0.0001). Self-assessment of time did not improve in accuracy (P = 0.26) but error estimation did (P = 0.01) when compared with actual performance. CONCLUSIONS: Novices demonstrated improved skill acquisition using simulation. Their estimates of performance and accuracy of error estimation improved with repetition. Clearly, practice enhances technical skill self-assessment. These results support the notion of self-directed skills training and could have significant implications for residency training programs.     

Analysis of factors related to low health-related quality of life in children with epilepsy using a self-assessed Japanese version of the KIDSCREEN-52

BackgroundThere is a paucity of studies on self-assessed generic health-related quality of life (HRQOL) in children with epilepsy. The purpose of this study was to investigate generic HRQOL and associated factors among Japanese children with epilepsy.MethodsIn this clinic-based study, 277 children (aged 8–18 years) with epilepsy and 429 children without any chronic illnesses were recruited. HRQOL was evaluated using the Japanese version of the KIDSCREEN-52 self-reported questionnaire, which consisted of 52 items categorized into 10 dimensions related to the environment surrounding children. Multiple regression analysis was applied to explore related factors with low HRQOL in each dimension.ResultsWe obtained the questionnaire from 171 (61.7%) and 306 (71.3%) children in the epilepsy and control groups, respectively. Short treatment period (<2 years), seizure lasting >30 min, and post-ictal symptoms were associated with a low HRQOL for School Environment (OR: 3.81; 95% CI: 1.34–10.86), Moods & Emotions (OR: 3.82; 95% CI: 1.67–8.78), and Parent Relations & Home Life (OR: 3.53; 95% CI: 1.29–9.72) dimensions, respectively. Complex neurodevelopmental disorders were associated with a low HRQOL for Social Support & Peers (OR: 3.59; 95% CI: 1.33–9.66), School Environment (OR: 2.49; 95% CI: 1.07–5.77), and Psychological Well-being (OR: 3.47; 95% CI: 1.20–10.00) dimensions.ConclusionsOur results suggest that early psychosocial support and better management of epilepsy may improve HRQOL. More support in school environments may be required for children with epilepsy and neurodevelopmental disorders.