How do you measure trust in the health system? A systematic review of the literature

People's trust in the health system plays a role in explaining one's access to and utilization of medical care, adherence to medications, continuity of care, and even self-reported health status. Yet it is not easy to find trust measures and understand what they are measuring. A systematic review of scales and indices identified 45 measures of trust within the health system with an average of 12 questions each, which quantified levels of trust among various relationships across the health system. Existing evidence was narrow in scope, where half examined the relationship between doctors/nurses and patients, and the majority were designed, tested and validated in the United States. We developed a health systems trust content area framework, where we identified that honesty, communication, confidence and competence were captured frequently in these measures, with less focus on concepts such as fidelity, system trust, confidentiality and fairness. Half of the measures employed a qualitative method in the design of these measures and 33% were pilot tested. Reporting of test–retest reliability and inter-rater reliability were less common. This review identifies a need to develop measurements of trust beyond doctor–patient relationships and outside of U.S. contexts, and strengthen the rigor of existing trust measures. Greater development and use of trust measures in the health system could improve monitoring and evaluation efforts, which may in turn result in better health outcomes.     

Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function

ObjectiveTo compare the discriminatory ability of Rasch-based and summative scoring in the context of assessing upper limb function of patients with stroke.Study Design and SettingData were from a cohort study of 497 adults with stroke undergoing physiotherapy. Upper limb function was assessed at admission and discharge using the upper limb subscale of the Motor Assessment Scale (UL-MAS). Rasch analysis was used to transform raw UL-MAS scores into interval measures. A relative precision (RP) index was used to differentiate patients by discharge destination.ResultsThe analysis confirmed the unidimensional structure of UL-MAS at both admission and discharge and demonstrated the adequate fit of the items. The RP index favored the Rasch-based scoring over the summative scoring in differentiating between the two patient groups, with significant gains in precision at admission (15%) and discharge (11%). When examining patients in the upper or lower quartile of UL-MAS, the gains in precision were statistically significant in favor of the Rasch-based scoring, with 20% precision at admission and 19% precision at discharge.ConclusionRasch-based scoring was more precise in differentiating patient groups by discharge destination than the summative scoring used to measure upper limb function, especially at the extreme range of the scale.     

Screening and Quantification of Depression in Mild-to-Moderate Dementia Through the GDS Short Forms

Abstract

We evaluated the validity of the 1-, 4- and 15-item versions of the GDS in 51 patients affected by mild to moderate dementia, using the long form as standard. The following sensitivity and specificity values were obtained: 66% and 91% for GDS-1, 93% and 87% for GDS-4, 79% and 100% for GDS-15. GDS-15 also showed good agreement with GDS-30 in defining the severity of depression. These findings support the use of GDS-4 for the screening of depression and of GDS-15 for its severity assessment.     

人类干细胞再生研究的哲学透视

目的：人类干细胞再生研究对生命科学和医药学等的发展具有极大的价值，在新科技革命中占有举足轻重的重要地位，理所当然地居于当代科技发展的最前沿。方法：人类干细胞再生研究在国内外都进入了实质性研究开发的初级阶段，但很快就形成了中西方的“原位”和“体外”两种相反的模式。结果：不同的模式取决于不同的医学哲学思路。思路模式的不同，必然地使其关键技术、优劣长短和面临的伦理法律问题等也不同。结论：两种模式优势互补，将使人体固有机能和人类生物医学高科技都得到极致性的发挥。     

Relation between vertical orientation and stability of acetabular component in the dysplastic hip simulated by nonlinear three-dimensional finite element method

In acetabular dysplasia, more vertical orientation of the acetabular component is often used to minimize the superolateral bone grafting. This study was designed to determine the effects of vertical orientation of the cup on the stability and polyethylene wear of the acetabular component in uncemented total hip arthroplasty (THA). Three-dimensional finite element models of the hemipelvis with dysplastic acetabulum were developed. Metal-backed hemispherical cups were placed in the true acetabulum with abduction angles of 35, 45, 55, and 65 degrees. It was found that more vertical orientation of the cup was associated with larger relative motion of the metal shell between the acetabulum and metal shell. Furthermore, tilting and torsional shear stresses in the model of the cup abduction angle of 65 degrees were found to be 1.7 times larger than that in the model with 35 degrees at the bone-metal shell interface. More vertically oriented cups caused larger contact stresses at the articulating surfaces of the polyethylene liners. The results suggest that the abduction angle of the acetabular component significantly influences cup loosening and polyethylene wear in THA.     

Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

Image and geometry processing with Oriented and Scalable Map

We turn the Self-organizing Map (SOM) into an Oriented and Scalable Map (OS-Map) by generalizing the neighborhood function and the winner selection. The homogeneous Gaussian neighborhood function is replaced with the matrix exponential. Thus we can specify the orientation either in the map space or in the data space. Moreover, we associate the map’s global scale with the locality of winner selection. Our model is suited for a number of graphical applications such as texture/image synthesis, surface parameterization, and solid texture synthesis. OS-Map is more generic and versatile than the task-specific algorithms for these applications. Our work reveals the overlooked strength of SOMs in processing images and geometries.