OSTA对2型糖尿病绝经妇女骨质疏松症筛查效果评价

目的评估亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)对2型糖尿病绝经妇女骨质疏松症(Osteoporosis,OP)的筛查效果,为分级诊疗中各级医疗机构,特别是基层医疗单位使用OSTA指数预测2型糖尿病绝经妇女骨质疏松症提供临床证据。方法选取2015年1月至2016年6月在我院内分泌科住院的2型糖尿病绝经妇女151名,采用双能X线吸收法(DXA)测量腰椎(L_(1-4))和股骨颈骨密度,计算OSTA指数,判断OSTA指数预测2型糖尿病绝经妇女骨质疏松症的价值。结果随年龄增长,受试者腰椎、股骨颈骨密度逐渐下降,OP检出率分别为28.5%、25.2%。OSTA各级风险中高风险指数在腰椎、股骨颈骨质疏松症检出率中最高,均为61%。OSTA中风险指数在腰椎和股骨颈OP检出率中较低,在骨量减少检出率中较高,分别是49.2%、50.8%。选取腰椎、股骨颈作为诊断的检测部位,OSTA指数预测OP的最佳截点分别是-2.9、-3.3时,对应的受试者工作特征曲线下面积最大(P=0.000)。结论 OSTA能较好的筛查出2型糖尿病绝经妇女骨质疏松症,可用于分级诊疗中基层医疗单位诊断骨质疏松症,建议OSTA最佳干预界值为-2.9。     

高职护生自我评价能力的调查研究

目的探讨高职护生自我评价的正确性。方法选择我校2004-2006级高职护生117名，调查护生对外科护理学习成绩的自我评价，并与教师评价进行比较。结果笔试与总的操作考试的自我评价均高于实际得分，r值分别为0．665和0．405。3次操作考试学生自我评价均高于实际得分，r值分别为0．346、0．460和0．462。结论高职护生自我评价的正确性并不高，学生自我评价能力有限。笔试的自评与实际得分的相关系数明显高于操作考试，高职护生更善于正确地评价自己认知性知识的掌握程度。学生自评并与教师评价结果比较可以提高护生自我评价的正确性，有助于学生能正确认识自己，更好地为走上社会打下基础。     

退休老年群体劳动参与行为对医疗服务利用的影响研究

目的：探究退休老年群体劳动参与行为对其医疗服务利用的影响,为渐进式延迟退休政策的推出提供建议。方法：使用2020年CFPS数据,采用Logit回归模型和倾向得分匹配进行分析,通过三步回归法与KHB分解法检验变量间的中介效应。结果：Logit模型显示退休后参与劳动对医疗服务利用存在负向影响(P<0.05);PSM检验显示,退休后参与劳动对门诊服务利用、住院服务利用平均处理效应分别为-0.059、-0.074,对男性老年人和退休收入低的老年人在医疗服务利用方面的作用更明显;自评健康对门诊服务利用和住院服务利用的中介效应分别占总效应的68.25%和39.07%。结论：退休后的劳动参与行为可一定程度缓解医疗资源压力,应鼓励老年人退休后参加劳动,并根据不同人群弹性调整退休政策。     

2型糖尿病患者绝经后骨质异常与OSTA指数间的相关性研究

目的：评价亚洲人骨质疏松自我筛查工具（OSTA ）指数能否作为骨折风险的初筛指标。方法 Lu-nari 双能 X 线吸收仪测量患者腰椎 L1-4,髋部股骨颈、股骨干、大转子、Ward′s 三角区的骨密度（BMD）值,并按照世界卫生组织推荐的骨质疏松诊断标准将160例患者分为骨质正常组、骨含量减少组与骨质疏松组。比较3组患者的年龄、绝经年限、糖尿病病程等危险因素的差异,及3组患者各部位的 BMD 值及矿盐水平的差异,对3组患者各部位的 BMD 值与 OSTA 指数进行相关性分析,采用受试者工作曲线（ROC）分析 OSTA 指数预测 BMD 值的价值。结果绝经后2型糖尿病（T2DM ）患者骨质疏松组、骨含量减少组、骨含量正常组,在年龄、病程两两间比较差异有统计学意义（P＜0．05）;3组患者在腰椎、股骨颈、Ward′s 区、大转子、股骨干的 BMD 值及矿盐水平,两两比较差异均有统计学意义（P＜0．05）;3组间腰椎、股骨颈、股骨干、Ward′s 三角区的 BMD 值与 OSTA 指数呈正相关关系（P＜0．05）。结论 OSTA 指数作为绝经后 T2DM 患者骨质疏松疾病筛查工具尚需进一步研究。     

Lack of correlation between the mean tender point score and self-reported pain in fibromyalgia

Objectives . To study the validity and nature of self-assessed symptoms among patients with fibromyalgia syndrome (FMS) and to compare our data with findings reported in the US. To determine whether tender point scores correlate with self-reported pain and other symptoms and to study the influence of disease duration. Methods . Tender point scores were assessed in 113 consecutive patients with FMS. All patients completed 2 self-assessment questionnaires (an extended Campbell list, the Enschede Fibromyalgia Questionnaire, and the Dutch Arthritis Impact Measurement Scales). Results . The self-assessed symptoms of the Dutch FMS patients seem to be valid and are comparable with those of American patients. No association between disease duration and number of self-reported symptoms was found. An association between self-reported pain and mean tender point score was lacking for patients with disease of shorter duration and was weak for patients with disease of longer duration. Conclusions . The use of a self-report questionnaire for patients with FMS is feasible and appears to be valid. Tender point scores and self-reported pain represent very different aspects of pain in FMS.     

疲劳自评量表

疲劳自评量表(fatigue self-assessment scale,FSAS)是在回顾国内外有关疲劳评定研究的基础上,结合中国语言习惯及人文特点编制而成。该量表由23个项目组成,可用于评定有疲劳表现的亚健康与各种疾病人群的疲劳类型、程度(包括躯体疲劳、精神疲劳与疲劳后果3个因子)及特征(包括疲劳对睡眠/休息的反应、疲劳的情境性与疲劳的时间模式3个因子)及疲劳的干预效果。     

Dental Visits and Self-assessment of Dental Health Status in the Adult Danish Population

The purpose of the present investigation was to study dental visits and self-assessment of dental health status in the adult Danish population. The study group comprised 5151 persons (86.7% of the original sample) who were interviewed in order to determine living conditions. Questions on dental visits and self-assessment of dental health status were included. 61% of the adult Danish population in the age group 20-69 had regular dental visits. Dental visit habits varied according to urbanization, age, sex and social group. Among well off persons 85% had regular dental visits as opposed to only 40% in the disadvantaged social group. Well off persons and persons with regular dental visits more often claimed good dental health than persons in the disadvantaged social group and among the non-regular visitors. In the higher social group 13% reported to have removable dentures in contrast to 51% in the disadvantaged social group. To isolate determinants of dental visits a multiple dummy-regression analysis was performed. Nearly 50% of the variation in dental visit habits was explained by the variables: urbanization, sex, age, perceived dental health status, education, work in exhausting jobs, income, social background and perceived psychological problems. Efforts to bring a greater part of the adult population in Denmark in contact with the dental health service system should consider these findings.     

Self-assessment of technical skill in surgery: the need for expert feedback

INTRODUCTION

Technical skill has been formally assessed in the Fellow of the European Board of Vascular Surgery Examinations (FEBVS) since 2002. The aim of this study was to examine the relationship between expert assessment and trainee self-assessment.

MATERIALS AND METHODS

Forty-two examination candidates performed a saphenofemoral junction (SFJ) ligation and an anterior tibial anastomosis on a synthetic simulation. Each candidate was rated by two examiners using a validated rating scale for their generic surgical skill for both procedures. Candidates then anonymously rated their own performance using the same scale. Parametric tests were used in the statistical analysis; a P-value <0.05 was considered significant.

RESULTS

The maximum mark in each assessment was 40; 24 was considered a competent score. The interobserver correlation for examiners marks were high (SFJ ligation, α = 0.68; distal anastomosis, α = 0.76). Examiners'' marks were averaged. The mean examiner score for the SFJ ligation station was 27.8 (SD = 4.1) with 36 candidates (85.8%) attaining a competent score. The mean self-assessment score for this station was 30.7 (SD = 4.66). The mean examiners'' marks for the distal anastomosis station was 29.2 (SD = 4.2); 39 candidates (92.8%) attained a competent score. The mean self-assessment score was 32.1 (SD = 4.0). There was no correlation between examiner and self-assessment scores in either station (Pearson''s correlation coefficient: SFJ, r = 0.045, P = NS); distal anastomosis, r = 0.089, P = NS). Bland and Altman plots assessed the agreement between examiner and self-assessment. These showed candidates marked themselves higher than examiners with a mean difference of 2.9 marks in each station.

CONCLUSIONS

Candidates'' self-assessment and expert independent assessment correlate poorly. Trainees overestimate their ability according to independent assessment; regular technical feedback during training is, therefore, essential.     

临床主管护师绩效考核的相关性研究

目的 通过对主管护师工作绩效考核结果 进行分析,发现存在的问题并建立有效地主管护师考核体系.方法 自设主管护师工作绩效量化考核表,采用自评、他评的方法 从10个方面对医院30名主管护师进行绩效考核,并对考核结果 进行分析及讨论.结果 不同的评估者,对主管护师的评价不同;自评的结果 高于护士长和医生的评价;护士和护师对主管护师的评价低于医生的评价;护士长、护士与护师对主管护师工作状况评价组间比较差异有统计学意义（P＜0.05）.结论 护理管理人员应根据主管护师绩效考核的结果,明确主管护师工作改进方向,采取针对性的措施,使主管护师工作与管理目标一致,以有效提高护理管理效率.     

Do I take the job?: Assessing fit with the organization

Purpose

A good ‘fit’ with an organization is critical to a leader's success yet when searching for a new position assessment an evaluation of many aspects may be overlooked, such as culture. This paper presents key considerations around ‘fit’ that applicants for leadership positions should consider prior to, during, and after the interview. Suggestions are provided on how to approach an evaluation of ‘fit’.