以平衡计分卡理论构建护士长岗位绩效加权综合评价模型

目的 建立护士长岗位绩效加权综合评价模型。方法 以平衡计分卡绩效管理理论为依据,采用文献分析法、小组讨论法、Delphi法构建护士长岗位绩效综合评价指标并确定指标权重,采用加权综合评价法构建护士长岗位绩效加权综合评价模型。结果 构建了包括护理工作内部流程、护理人员学习与成长、服务对象、财务管理4项一级指标、12项二级指标、52项三级指标的护士长岗位绩效评价指标体系,并建立了护士长岗位绩效加权综合评价模型。结论 以平衡计分卡绩效管理理论为依据构建的护士长岗位绩效加权综合评价模型,可为护士长绩效评价提供参考。     

When fatigue promotes striving: Confirmation that success importance moderates resource depletion influence on effort-related cardiovascular response

Undergraduate volunteers performed an easy (fatigue low) or difficult (fatigue high) counting task and then were presented a difficult scanning task with instructions that the task was or was not diagnostic of an important ability (low versus high ego-involvement, respectively). As expected, systolic blood pressure responses in the second work period were positively proportional to fatigue where ego-involvement (and, thus, success importance) was high, but not where ego-involvement (and, thus, importance) was low. The pressure findings provide fresh support for the suggestion of a recent fatigue analysis that importance should moderate fatigue influence on effort-related CV responses to a performance challenge so long as fatigued performers view success as possible, conceptually replicating and extending effects from a previous fatigue experiment.     

Performance variables associated with bicycle configuration and flexibility

ObjectivesCycling races are often won by the smallest of margins. Research has focused on optimal saddle height for performance, however the relationship between freely chosen bicycle configuration and individual factors such as anthropometrics and flexibility have not yet been investigated adequately. The aim of this study was to determine if an association between power production, bicycle configuration and flexibility exists.DesignExperimental, quantitative study.MethodsFifty male cyclists were recruited for the study. Individual anthropometrics, flexibility and individual bicycle configuration were recorded before the participants performed a peak power output and peak oxygen consumption test to determine their VO_2max.ResultsThere was a significant correlation between performance and hamstring flexibility, handlebar drop, saddle setback and ankle plantarflexion. An increased lumbar flexibility demonstrated an inverse relationship with relative VO_2max. A more anteriorly rotated pelvis correlated with improved hamstring flexibility, hip flexion angle and an increased handlebar drop.SignificanceThe results from this study have clinical implications for bike fitters and cyclists. Greater saddle setback and lower handlebar height may increase peak power output. Improving a cyclist’s flexibility and ability to adopt an anteriorly rotated pelvis and lower handlebar height may increase the force generated in the push phase of the pedal stroke and thus improve cycling performance.     

Assessing the quality of epilepsy care with an electronic patient record

PurposeThe American Academy of Neurology (AAN) quality indicators for epilepsy are designed to monitor quality, identify gaps, and ultimately drive improvements in clinical care. Appreciation of electronic patient records (EPR) to support such performance management is growing.This study aimed to demonstrate the use of an epilepsy-specific EPR in applying the AAN measures to objectively monitor clinical performance.MethodA sample of out-patient clinics at Beaumont Hospital, Dublin was benchmarked against 4 of the AAN quality indicators.Results88% (142/160) of clinical encounters met the requirement to explicitly document seizure type and seizure frequency at each visit; aetiology or epilepsy syndrome was documented/updated for 58% (93/160); evidence of counselling about antiepileptic drug side effects was present in 34% (54/160) of records; counselling for women of childbearing potential was documented in 33% (18/57) of relevant records.ConclusionThe EPR makes performance monitoring efficient and objective. Results suggest either failure to carryout recommended clinical tasks or poor documentation. Whichever is the case, a baseline is provided against which improvement goals can be set.     

Association of Aurora A and gamma-tubulin expression in astrocytomas and patient survival

Abstract

Objectives:

The purpose was to evaluate the association of Aurora A and gamma-tubulin expression with disease characteristics and survival in patients with astrocytoma.

Methods:

This is a retrospective study of patients who had surgical specimens that were pathologically diagnosed as astrocytoma. The expression level of Aurora A and gamma-tubulin in tumor tissue was evaluated by immunohistochemistry. Clinical information, Karnofsky performance status scale, and survival status of patients were collected.

Results:

We found that high protein levels of gamma-tubulin or Aurora A were associated with patients 45 years of age, high tumor grade, more advanced non-fully resectable tumors, and poorer survival status. The survival time for patients whose tumors had high gamma-tubulin and Aurora A expression was about 12 months compared with approximately 41 months for patients with low levels of expression of these proteins. Poor patient performance status following resection was also associated with high levels of gamma-tubulin and Aurora A expression.

Discussion:

The expression levels of gamma-tubulin or Aurora A kinase were associated with patients’ age, astrocytoma grade, respectability, as well as patient survival and performance. These findings support the idea that these factors may potentially be important prognostic indicators for patients with astrocytomas.     

Reliability Concerns in the Repeated Computerized Assessment of Attention in Children

Assessment of attentional processes via computerized assessment is frequently used to quantify intra-individual cognitive improvement or decline in response to treatment. However, assessment of intra-individual change is highly dependent on sufficient test reliability. We examined the test–retest reliability of selected variables from one popular computerized continuous performance test (CPT)—i.e., the Conners’ CPT – Second Edition (CPT-II). Participants were 39 healthy children (20 girls) ages 6–18 without intellectual impairment (mean PPVT-III SS = 102.6), LD, or psychiatric disorders (DICA-IV). Test–retest reliability over the 3–8 month interval (mean = 6 months) was acceptable (Intraclass Correlations [ICC] =.82 to.92) on comparison measures (Beery Test of Visual Perception, WISC-IV Block Design, PPVT-III). In contrast, test–retest reliability was only modest for CPT-II raw scores (ICCs ranging from.62 to.82) and T-scores (ICCs ranging from.33 to.65) for variables of interest (Omissions, Commissions, Variability, Hit Reaction Time, and Attentiveness). Using test–retest reliability information published in the CPT-II manual, 90% confidence intervals based on reliable change index (RCI) methodology were constructed to examine the significance of test–retest difference/change scores. Of the participants in this sample of typically developing youth, 30% generated intra-individual changes in T-scores on the Omissions and Attentiveness variables that exceeded the 90% confidence intervals and qualified as “statistically rare” changes in score. These results suggest a considerable degree of normal variability in CPT-II test scores over extended test–retest intervals, and suggest a need for caution when interpreting test score changes in neurologically unstable clinical populations.     

Patient preferences and performance bias in a weight loss trial with a usual care arm

Objectives

This qualitative study examines performance bias, i.e. unintended differences between groups, in the context of a weight loss trial in which a novel patient counseling program was compared to usual care in general practice.

Methods

14/381 consecutive interviewees (6 intervention group, 8 control group) within the CAMWEL (Camden Weight Loss) effectiveness trial process study were asked about their engagement with various features of the research study and a thematic content analysis undertaken.

Results

Decisions to participate were interwoven with decisions to change behavior, to the extent that for many participants the two were synonymous. The intervention group were satisfied with their allocation. The control group spoke of their disappointment at having been offered usual care when they had taken part in the trial to access new forms of help. Reactions to disappointment involved both movements toward and away from behavior change.

Conclusion

There is a prima facie case that reactions to disappointment may introduce bias, as they lead the randomized groups to differ in ways other than the intended experimental contrast.

Practice implications

In-depth qualitative studies nested within trials are needed to understand better the processes through which bias may be introduced.     

Time from Prior Chemotherapy Enhances Prognostic Risk Grouping in the Second-line Setting of Advanced Urothelial Carcinoma: A Retrospective Analysis of Pooled,Prospective Phase 2 Trials

Background

Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM).

Objectives

The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors.

Design, setting, and participants

Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n = 570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n = 352).

Outcome measurements and statistical analysis

Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures.

Results and limitations

ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic = 0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable.

Conclusions

Shorter TFPC enhances prognostic classification independent of ECOG-PS >0, Hb <10 g/dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials.