糖皮质激素与洗涤红细胞输注联合治疗AIHA的疗效观察

目的探究自身免疫性溶血性贫血（AIHA）患者的输血对策及其疗效和安全性。方法将206例AIHA患者根据治疗方案的不同分为A组和B组,各103例。A组患者予以糖皮质激素治疗,同时筛选ABO、Rh血型系统与患者相同的献血员进行交叉配血,采用反应强度最弱且凝集强度小于自身对照的红细胞悬液,制成洗涤红细胞进行输血治疗。B组患者仅予以糖皮质激素治疗。分析红细胞不相合输注治疗AIHA的疗效和安全性。结果A组患者输血治疗后Hb水平明显高于输血治疗前（P＜0.05）。A组与B组患者治疗前Hb水平比较无统计学差异（P＞0.05）;而治疗后,A组患者Hb水平高于B组患者（P＜0.05）。A组患者均无溶血性输血反应发生。结论对于重度贫血的AIHA患者,采用糖皮质激素与最少不相合洗涤红细胞输注联合治疗能有效缓解贫血,是安全和有效的,值得在临床推广应用。     

Antisociality, underarousal and the validity of the Concealed Information Polygraph Test

The Concealed Information Polygraph Test has been advocated as the preferred method for the physiological detection of deception. In this study, we further examined the validity of the Concealed Information Test in antisocial individuals. Physiological responding to concealed information was assessed in 48 male prisoners, and compared with responding in 31 male community volunteers. Based upon the association between antisociality and autonomic hyporesponsivity, lower detection rates were expected in the prisoners. Participants were questioned on five personally significant items (e.g., day of birth), instructed to deny recognition of this information, and promised a financial reward when able to hide recognition. Prisoners showed reduced autonomic reactivity in comparison to the community volunteers. This hyporesponsivity had little impact on the sensitivity of the Concealed Information Test. Detection efficiency in the prisoners was significantly above chance (d=2.67; a=0.82; 79%), and did not differ significantly from that obtained in the community volunteers (d=3.04; a=0.85; 87%). The present data support the validity of the Concealed Information Test in criminal populations.     

Validating the Medical Data Interpretation Test in a Dutch population

Objective

To validate the Dutch translation of the Medical Data Interpretation Test.

Methods

A test–retest design with a 2-week interval was used.

Results

The intraclass correlation coefficient (ICC = .82), the limits-of-agreement interval (LOA = −8.96 to 2.48) and the test–retest reliability (Pearson's r = 86) suggest that the Dutch translation has good reproducibility. Construct validity was tested by two hypotheses, both of which were confirmed. University participants had higher test scores than non-university participants (p = .02), and males did not score differently than females (p = .61).

Conclusion

The results suggest that the Dutch version of the Medical Data Interpretation Test is an adequate scale to assess ability to interpret medical data.

Practice implications

Assessing patients’ numeracy skills before a counseling session will enable the counselor to adjust subsequent communication accordingly and, as such, improve the session's effectiveness.     

Measuring a state of mind indicative of thriving using the Student Pharmacist Inventory of Professional Engagement (S-PIPE)

Background

Professional engagement has importance to the professional of pharmacy, and in particular the growth of student pharmacists. Measurement of this construct would allow investigation of factors that may increase or decrease professional engagement.

脑卒中高危筛查意向量表的编制与信效度检验研究

背景 我国正在大力开展社区脑卒中高危筛查项目,居民的参与意向是影响项目成效的重要因素。但是目前缺乏可靠的社区居民脑卒中高危筛查意向量表。 目的 编制脑卒中高危筛查意向量表并评价其信效度,为评估居民脑卒中高危筛查意向提供可靠的工具。 方法 基于计划行为理论,通过文献回顾、实地走访和头脑风暴,形成量表条目池。2021年7—8月,遴选5名脑卒中相关研究或精通量表编制的专家,进行2轮专家评价,形成初始版脑卒中高危筛查意向量表（包含3个维度,28个条目）。2021年8—9月,采用便利抽样法,选取湖北省襄阳市、武汉市、荆门市,广东省广州市、惠州市、深圳市的社区居民为研究对象,对初始版脑卒中高危筛查意向量表进行信效度检验。 结果 共发放问卷535份,有效问卷524份,有效回收率为98%。最终形成4个维度25个条目的量表,分为积极态度、消极态度、主观规范、知觉行为控制。总量表Cronbach's α系数为0.904,重测信度的组内相关系数（ICC）为0.810。各条目内容效度（I-CVI）为0.8~1.0,量表的全体一致内容效度（S-CVI/UA）为0.93,平均内容效度（S-CVI/Ave）为0.99。探索性因子分析显示,因子累积方差贡献率为61.945%,各条目因子载荷量为0.482~0.828。验证性因子显示拟合优度χ2=361.040,df=267,χ2/df=1.352,近似误差均方根（RMSEA）=0.038,拟合优度指数（GFI）=0.897,比较拟合指数（CFI）=0.958,调整拟合优度指数（AGFI）=0.875,增值拟合指数（IFI）=0.959,非规准适配指数（TLI）=0.953,规范拟合指数（NFI）=0.859。 结论 脑卒中高危筛查意向量表具有较好的信效度,可作为测量居民脑卒中高危筛查意向的工具。     

脑卒中影响量表的测试研究

目的探讨应用汉化的脑卒中影响量表（SIS）的可行性。方法使用汉化的SIS量表对130例中老年首发脑卒中患者发病后1个月时的生存质量进行评定，并对其中的105例患者在发病后进行为期3个月的随访评定。根据结果对该量表的信度、效度、反应度和可行性进行全面分析。结果SIS量表8个分量表和总量表中表示内部一致性的克朗巴赫α系数（Cronbach’s α）均〉0．8，重测结果的组内相关系数ICC（intraclasscorrelation coefficients，IOC）值均〉0．7（P〈0．05）。各分量表的Pearson相关系数均〉0．5（P〈0．05）。因子分析法提取的8个因子总共解释总体变量的80％。情绪、ADL／IADL、移动能力、参与4个方面及总分方面的变化差异有显著性（P〈0．05）。结论汉化SIS量表具有良好的信度、效度、反应度和可行性，可应用于临床和社区护士对中老年脑卒中患者的生存质量和护理效果的评定。     

Accurately measuring the quality and effectiveness of lumbar surgery in registry efforts: determining the most valid and responsive instruments

Background contextProspective registries have emerged as a feasible way to capture real-world care across large patient populations. However, the proven validity of more robust and cumbersome patient-reported outcomes instruments (PROis) must be balanced with what is feasible to apply in large-scale registry efforts.PurposeTo determine the relative validity and responsiveness of common PROis in accurately determining effectiveness of lumbar fusion for degenerative lumbar spondylolisthesis in registry efforts.Study designProspective cohort study.Patient sampleFifty-eight patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spondylolisthesisOutcome measuresPatient-reported outcome measures for pain (numeric rating scale for back and leg pain [NRS-BP, NRS-LP]), disability (Oswestry Disability Index [ODI]), general health (Short Form [SF]-12), quality of life (QOL) (EuroQol five dimensions [EQ-5D]), and depression (Zung depression scale [ZDS]) were assessed.MethodsFifty-eight patients undergoing primary TLIF for lumbar spondylolisthesis were entered into an institutional registry and prospectively followed for 2 years. Baseline and 2-year patient-reported outcomes were assessed. To assess the validity of PROis to discriminate between effective and noneffective improvements, receiver operating characteristic curves were generated for each outcomes instrument. An area under the curve (AUC) of ≥0.80 was considered an accurate discriminator. The difference between standardized response means (SRMs) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each instrument.ResultsFor pain and disability, ODI had AUC=0.94, suggesting it as an accurate discriminator of meaningful improvement. Oswestry Disability Index was most responsive to postoperative improvement (SRM difference: 2.18), followed by NRS-BP and NRS-LP. For general health and QOL, SF-12 physical component score (AUC: 0.90), ZDS (AUC: 0.89), and SF-12 mental component score (AUC: 0.85) were all accurate discriminators of meaningful improvement, however, EQ-5D was most accurate (AUC: 0.97). EuroQol five dimensions was also most responsive (SRM difference: 2.83).ConclusionsFor pain and disability, ODI was the most valid and responsive measure of effectiveness of lumbar fusion. Numeric rating scale-BP and NRS-LP should not be used as substitutes for ODI in measuring effectiveness of care in registry efforts. For health-related QOL, EQ-5D was the most valid and responsive measure of improvement, however, SF-12 and ZDS are valid alternatives with less responsiveness.     

Longitudinal construct validity and responsiveness of measures of walking capacity in individuals with lumbar spinal stenosis

Background contextWalking capacity is a primary outcome indicator for individuals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change.PurposeThe primary objective of this study was to examine longitudinal construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PF Scale), the Oswestry Disability Index (ODI), and the walking capacity items from these scales specifically for the assessment of walking capacity in LSS using the objective Self-Paced Walking Test (SPWT) as the external standard. A secondary objective was to examine responsiveness of measures of walking using a self-reported walking capacity change scale as the external criterion standard.Study designPatients were prospectively enrolled.Patient sampleTwenty-six patients were included in this study (17 women and 9 men), with an average age of 68.5 years (SD, 9.2). All participants had LSS diagnosed by a spine specialist surgeon based on both clinical examination and imaging, as well as self-reported walking limitations (neurogenic claudication).Outcome measuresThe self-reported outcome measures included in this study were PF Scale, ODI, and self-reported walking capacity change score.Functional measuresThe functional measure used in the study was SPWT.MethodsLongitudinal construct validity was assessed using the correlational method. Internal responsiveness was examined using Guyatt responsiveness index and external responsiveness using receiver operating characteristic analysis. Change in the SPWT and the self-reported walking capacity change score were used as external criteria for the analysis.ResultsThe highest correlations with change in the SPWT were 0.78 for the ODI walking item and 0.78 for the walking capacity change score. Changes in the PF Scale and ODI score were correlated with change in the criterion SPWT at r=0.56 and r=0.70, respectively. There were no differences observed between the PF Scale and ODI for any of the responsiveness indices.ConclusionsThe PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The individual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.     

Reliability and Validity of Digital Imaging as a Measure of Schoolchildren's Fruit and Vegetable Consumption

BackgroundAs more and more interventions aim to increase schoolchildren's fruit and vegetable (FV) consumption, less resource-intensive yet valid alternatives to weighed plate waste (WPW) are needed for assessing dietary intake.ObjectivesWe aimed to test the reliability and validity of digital imaging (DI) and digital imaging with observation (DI+O) in assessing children's FV consumption during school lunch.DesignFV consumption (in grams) was assessed on lunch trays from third- to fifth-grade children over eight visits (31 to 68 trays collected per visit) to compare WPW with DI and DI+O.SettingTwo elementary schools (327 and 631 students enrolled, respectively).Main outcome measuresInterobserver reliability of DI. Validity of DI and DI+O compared against WPW.Statistical analysesReliability was assessed by percent agreement and intraclass correlation coefficients (ICCs). Validity was assessed by Pearson correlations, paired t tests, and Bland-Altman plots.ResultsReliability was acceptable for DI; percent agreement was 96% and the ICC was 0.92. FV consumption assessments by DI and WPW (n=159) were highly correlated (r=0.96; P<0.001). Mean FV consumption using DI (96.7 g) was within 1.0 g of WPW and not significantly different from WPW (P=0.56), and Bland-Altman limits of agreement for individual-tray FV consumption were –32.9 to 31.3 g. FV consumption assessments by DI+O and WPW were highly correlated (r=0.98; P<0.001). Mean FV consumption using DI+O (99.3 g) was within 1.0 g of WPW and not significantly different from WPW (P=0.38), and limits of agreement for individual-tray FV consumption were –25.0 to 26.8 g.ConclusionsDI was reliable for assessing children's FV consumption during school lunch. DI and DI+O were valid for assessing mean consumption but less precise for estimating individual-tray consumption. Valid estimations of mean FV consumption were achieved using DI without cafeteria observations, thereby reducing labor and time. Thus, DI is especially promising for assessing children's mean FV consumption during school lunch.     

牡丹皮饮片的有效期研究

目的：进行中药材有效期方法研究。方法选用易散失气味、易变色的牡丹皮饮片作为研究对象,通过经典恒温实验和留样观察实验,用紫外色谱法测定其有效成分丹皮酚含量。推导出牡丹皮饮片中丹皮酚含量变化规律。结果在经典恒温实验中,丹皮酚含量变化符合一级反应规律。牡丹皮在20℃贮存,丹皮酚含量变化速度常数K20℃=1.194＆#215;10-4、该批牡丹皮的有效期为226 d。经典恒温实验推导的结果与留样观察有效成分含量的变化结果基本一致。结论用经典恒温实验预测牡丹皮饮片有效期的方法可行,得出有效期结论可靠。