Pentacam系统与A超角膜测厚仪测量中央角膜厚度的一致性和重复性

目的 探讨Pentacam三维眼前节分析诊断系统测量角膜厚度的可重复性,比较其结果与A型超声角膜测厚仪测量结果的一致性。方法 112例拟行准分子激光角膜屈光手术的受检者,只选取右眼作为研究对象,分别由两位检查者肓法使用Pentacam系统和A超角膜测厚仪测量中央角膜厚度3次,将结果进行对比分析。角膜厚度值的比较采用配对t检验进行统计学分析;一致性检验采用Bland-Altman法。结果 角膜厚度均值分别为Pentacam系统(538.63±31.55) μm,超声测厚仪(541.02±30.45) μm,两者差异具有统计学意义（t=- 3.414,P=0.001）,两者的差值平均为（-2.39±7.42）μm。两法具有较好的一致性,95％的一致性界限为（- 16.93 μm,12.15 μm）。Pentacam系统与超声测厚仪测量值的组内相关系数分别为0.86和0.88,两种仪器的测量结果都比较稳定、重复性好。结论 Pentacam系统与超声测厚法具有较好的一致性,测量结果的重复性也较好,但要注意增加测量次数。     

Comparison between central corneal thickness measurements by oculus pentacam and ultrasonic pachymetry

Purpose To compare the accuracy of central corneal thickness (CCT) measurements by the oculus pentacam scheimpflug system, with those obtained with the DGH ultrasound pachymeter (UP) and to assess the agreement between the two devices. Methods In a prospective study, measurement agreement was assessed in 984 eyes of 492 healthy subjects using both oculus pentacam and ultrasonic pachymetry at the Eye Consultants Center, Riyadh, Saudi Arabia. Result In the measurement agreement experiment, the mean CCT was 552.4 ± 37.0 μm with oculus pentacam and 544.1 ± 35.4 μm with ultrasonic pachymetry. Regression analysis showed a high correlation between the values obtained with both devices (r = 0.912, P < 0.001). Compared with UP, pentacam overestimated the CCT by a mean of 8.2 μm as demonstrated in a Bland-Altman plot. Conclusion the CCT measurements by the pentacam and UP are highly correlated. The pentacam agrees well with UP and is a reliable alternative to UP in CCT measurements.     

Evaluation of the efficacy of the guideline on reading CT images of malignant pleural mesothelioma with reference CT films for improving the proficiency of radiologists

Purpose

To assess the efficacy of the developed guideline on reading CT images of malignant pleural mesothelioma for improving radiologists’ reading proficiency.

Materials and Methods

Three radiologists independently read the CT films of 22 cases including definite mesothelioma and non-mesothelioma cases at two times before and after studying the malignant pleural mesothelioma CT Guideline. The sensitivity and specificity for mesothelioma were calculated and compared between the 1st and 2nd trials. The kappa statistics was examined for agreement with experts for mesothelioma probability and for mesothelioma features recorded by three radiologists.

Results

After studying the mesothelioma CT Guideline, the sensitivity for mesothelioma shown by the three radiologists at the 2nd trial was 100%, 100% and 80%, which were higher than 80%, 85% and 60% at the 1st trial, respectively. The average kappa for agreement between radiologists and experts on dichotomized mesothelioma probability were 0.69 (good) at the 2nd trial vs. 0.38 (fair) at the 1st trial. The average kappa for the agreement with experts for each of 7 features by three radiologists were 0.52–0.80 at the 2nd trial, which were significantly higher than 0.34–0.58 at the 1st trial (Wilcoxon Signed Rank Test: P < 0.01), and as to five features “unilateral pleural effusion”, “nodular pleural thickening”, “tumoral encasement of lung”, “mediastinal pleural thickening”, and “diminished lung”, they achieved good agreement with average kappa of 0.61–0.80.

Conclusion

The developed mesothelioma CT Guideline was suggested to have substantial effect in improving the radiologists’ proficiency for reading CT images of mesothelioma, and may contribute to accurate diagnosis of mesothelioma.     

Consensus analysis of sastric formulations used by non-institutionally trained siddha medical practitioners of Virudhunagar and Tirunelveli districts of Tamil Nadu,India

Ethnopharmacological relevance

Siddha system of traditional medicine has been practiced in Tamil Nadu. This system of medicine has a high number of non-institutionally trained practitioners but studies on their traditional medicinal knowledge are not adequate. The present study is aimed to document and analyze the sastric (traditional) formulations used by the non-institutionally trained siddha medical practitioners in Virudhunagar and Tirunelveli districts of Tamil Nadu, India.

Methods

After obtaining prior informed consent, interviews were conducted with 115 non-institutionally trained siddha medical practitioners about the sastric formulations used by them for the treatment. Successive free listing method was adopted to collect the data and the data were analyzed by calculating Informant Consensus Factor (F_ic) and Informant Agreement Ratio (IAR).

Results

The study documented data regarding 194 sastric formulations and they were classified into plant, mineral and animal based formulations. Quantitative analysis showed that 62.5% of the formulations were plant based, while the mineral based formulations had a high mean number of citations and versatile uses. Gastrointestinal (12.0%), kapha (11.3%) and dermatological (10.8%) ailments had a high percentage of citations. Jaundice had a high F_ic value (0.750) followed by the dermatological ailments. The illness categories with high F_ic values under each type of formulation were as follows: jaundice, aphrodisiac and urinary ailments (plant based); jaundice, cuts & wounds and dermatological ailments (mineral based); and hemorrhoids, kapha ailments and heart ailments (animal based formulations). The scientific studies conducted with important formulations under each illness category are discussed.

Conclusion

The present study indicated the importance of some illnesses over the others and inclusion of new illnesses under each formulation. The ingredients used to prepare these formulations have shown varying degrees of scientific evidence; generally limited studies were available on the efficacy of them as formulations. Further in-depth studies on the formulations with high IAR value and F_ic value of illness categories will be helpful to improve health status of the people.     

The Bologna Agreement and its impact on the Master in Advanced Nursing Practice Program at Rotterdam University of Applied Science: incorporating mandatory internationalization in the curriculum

Aim:  The aim of this paper is to discuss the impact on nursing education in the Netherlands since the implementation of the Bologna Agreement.
Background:  In 1999, the Bologna Agreement was constructed to establish a comparable and transferable degree system in universities within the European Union for nine subject areas (chemistry, physics, mathematics, geology, history, business, education science, nursing and European studies). The target date for implementation of the undergraduate and graduate degrees is 2010.
Conclusion:  Since 2004, Rotterdam University of Applied Science has offered a Master in Advance Nursing Practice degree. This graduate study offers nursing students the opportunity to continue career and academic mobility within the nursing profession. This paper reports on the need for internationalization within nursing curriculum to meet the demands of the increasingly mobile nursing workforce.     

Repeatability intraexaminer and agreement in amplitude of accommodation measurements

Background  Clinical measurement of the amplitude of accommodation (AA) provides an indication of maximum accommodative ability. To determine whether there has been a significant change in the AA, it is important to have a good idea of the repeatability of the measurement method used. The aim of the present study was to compare AA measurements made using three different subjective clinical methods: the push-up, push-down, and minus lens techniques. These methods differ in terms of the apparent size of the target, the end point used, or the components of the accommodation response stimulated. Our working hypothesis was that these methods are likely to show different degrees of repeatability such that they should not be used interchangeably. Methods  The AA of the right eye was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18 to 32). The repeatability of the tests and agreement between them was estimated by the Bland and Altman method. We determined the mean difference (MD) and the 95% limits of agreement for the repeatability study (COR) and for the agreement study (COA). Results  The COR for the push-up, push-down, and minus lens techniques were ±4.76, ±4.00, and ±2.52D, respectively. Higher values of AA were obtained using the push-up procedure compared to the push-down and minus lens methods. The push-down method also yielded a larger mean AA than the negative-lens method. MD between the three methods were high in clinical terms, always over 1.75D, and the COA differed substantially by at least ±4.50D. The highest agreement interval was observed when we compared AA measurements made using minus lenses and the push-up method (±5.65D). Conclusions  The minus lens method exhibited the best repeatability, least MD (−0.08D) and the smallest COR. Agreement between the three techniques was poor. Presentation at ARVO 2007. This study was supported by grant PR1/07-14909 from the Universidad Complutense de Madrid.     

一致性评价系数应用于无序多分类资料的效果评价

目的 基于AC1系数的构建思想,建立一致性评价系数（CEA）在两评价者无序多分类结局的评价方法,并可避免Kappa系数的缺陷。方法 通过随机抽样生成诊断试验类型数据,使用Monte Carlo模拟,在样本量、指定事件在总体的占比、偶然评价率、类别数等不同参数组合下进行重抽样,比较Kappa系数、AC1系数和CEA系数的均方误、方差和方差的期望。通过从总体中随机抽样1000次得到CEA系数的分布描述。结果 偶然评价率的不一致会导致CEA系数的均方误波动较大。与Kappa系数相比,AC1系数和CEA系数在指定事件的占比为极端值的情况更为稳定。在小样本、偶然评价率不一致的情况下,Kappa系数的方差和方差的期望变大,CEA系数变化较小。大样本条件下,CEA系数近似服从正态分布。结论 Kappa系数、AC1系数、CEA系数均受偶然评价率的影响最大,样本量次之。针对无序多分类结局,CEA系数在不同的样本量、偶然评价率下具有更稳健的性质。     

800份病案知情同意书填写质量调查分析

目的了解我院知情同意书实施的情况.方法抽查我院2003年7-12月出院,需要建立知情同意书的内、外科病案,共800份进行统计.结果在抽查的800份病案中,全部符合要求的581份,占72.6%,存在问题的219份,占27.4%;有40份没有填写知情同意书,有36份只建立在电子病案中,未能及时打印出来让患者签名,无患者或家属签字的有22份.结论写好知情同意书,必须要转变观念,提高对知情同意书重要性的认识,要进一步规范对患方家属签名的要求.