阻塞性睡眠呼吸暂停低通气综合征手术的主观和客观疗效分析

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者主观和客观评价相关性,评价手术的主观和客观疗效.方法 41例OSAHS患者,根据阻塞部位采用单一或联合手术,术前和术后6个月分别做多道睡眠图(PSG)监测、OSAHS疾病特异性生活质量量表--魁北克睡眠问卷简体中文版和Epworth嗜睡量表评价.评价术前及术后改...     

Epworth嗜睡量表简体中文版信度和效度评价

目的 探讨Epworth嗜睡量表(Epworth sleepiness scale,ESS)简体中文版的信度和效度.方法以585例疑似阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者及103例确诊并进行手术的OSAHS患者为研究对象,多道睡眠图(PSG)监测前填写ESS量表简体中文版,进行手术的患者术后6个月以上再次进行了PSG监测和填写ESS量表.从585例患者中选取2010年7至8月间的51例患者重新进行ESS量表评分(时间至少间隔1周).结果 ESS量表简体中文版总的Cronbach'α系数为0.814;ESS总分重测信度为0.679,表中各项条目信度为0.473～0.698(P<0.01);分半信度R=0.817(P<0.01).ESS量表效度分析中,区分效度用呼吸暂停低通气指数(AHI)指标来区分单纯鼾症和轻、中及重度OSAHS患者,单纯鼾症与不同病情程度的OSAHS患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).用最低血氧饱和度(LSaO2)指标来区分正常血氧饱和度、轻、中及重度低血氧饱和度患者,正常血氧饱和度与不同程度低氧血症患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).因素分析中有4个公因子,累积贡献率达74.270%,每项条目负荷大于0.4;各因子分值与ESS量表总分进行相关分析发现除开车等红绿灯或遇堵车停几分钟时与其他各因子的相关性较低外,其他因子之间及ESS总分之间相关性均较高(P<0.01).量表评估与临床诊断的一致率较差(Kappa值为0.099,P<0.01),预测效度差(r=0.138,P<0.01).手术前后ESS总分由15.0[10;20]分降到4[1;6]分(M[P25;P75]),手术治疗有效、无效患者在手术前后ESS总分的差异均有统计学意义(Z=-7.528,P<0.01;Z=-4.382,P<0.01).结论 Epworth嗜睡量表简体中文版具有较好的信度和效度,可以作为白天嗜睡程度自我评估工具.

Abstract：

Objective To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). Methods Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. Results The total Cronbach's Alpha of ESS was 0. 814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698 ( P ＜ 0.01 ). Split-half reliability was 0.817 ( P ＜ 0.01 ). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients( P ＜ 0.05 ), and this was also true in different degrees of lowest saturation of arterial oxygen ( LSaO2 ) patients and normal LSaO2 patients(P＜0.05). The factor analysis of construct validity showed that 4 factors were extracted.The cumulative proportion was 74.270%. The loading was higher than 0. 4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item.The ESS had low consistency with clinical diagnosis(κ =0.099,P ＜0.01 ) and the predictive validity was not good (r =0.138, P ＜0.01 ). As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] ( M[P25 ;P75] ) ,and improved to 4[1 ;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation ( Z = - 7.528,P＜0.01) ,so was the patients who got ineffective results(Z= -4.382, P＜0.01) . Conclusions The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.     

广西全科医学定向毕业生的毕业后现状调查

背景　基于分级诊疗制度、全科医生制度以及住院医师规范化培训逐步推进的大背景,充分跟踪和了解广西全科医学生的毕业后情况,不断完善全科医学住院医师规范化培训,对分级诊疗制度在基层的后续发展有重大意义。目的　通过对广西全科医学定向毕业生（以下简称定向生）毕业后情况的调查,分析、讨论其在基层发展的主要制约因素,为基层全科医疗的改革、发展提供有效建议。方法　2017年7月—2018年1月选取广西前3届（2010—2012年入学,2015—2017年毕业）全科医学定向生199例为调查对象。采用自制问卷对其进行调查,问卷内容包括：一般资料、报到转接情况、就业签约情况、编制落实情况、薪资水平、满意度、继续教育意愿、基层服务意愿、期待薪资水平。根据《2017广西统计年鉴》提供的数据,按照人均国内生产总值,分别将广西14个城市划分为高产值区、中产值区、低产值区。结果　共发放问卷199份,回收有效问卷199份,有效回收率为100.0%。199例定向生毕业时间：2015年41例（20.6%）,2016年78例（39.2%）,2017年80例（40.2%）;地区：高产值区56例（28.1%）,中产值区79例（36.7%）,低产值区64例（35.2%）。不同毕业时间、分区定向生签约服务单位落实情况、就业签约情况、编制落实情况、薪资水平、继续教育意愿、规培结束后的工作打算、签约服务期满后的工作打算、期待薪资水平比较,差异无统计学意义（P>0.05）。2017年毕业定向生十分满意度高于2015年（P<0.05）。不同分区定向生满意度比较,差异无统计学意义（P>0.05）。定向服务地卫生与计划生育局未能于定向生报到后1个月内顺利为其落实签约服务单位的主要原因为有关部门没有处理经验（86.3%,44/51）。影响定向生继续在基层服务的因素主要为薪资待遇较低（92.5%,184/199）。结论　广西全科医学定向生的毕业后报到转接效率有待提高,就业签约协议有待规范,编制落实进度有待跟进;尽管广西全科医学定向生的履约意愿高、满意度也有所提升,但基层薪资待遇偏低、继续教育与后续发展的激励机制不完善,仍不足以为基层留住更多的全科医学人才。建议完善定向生毕业后转接、履约管理等机制,切实加强各部门联系,开辟政策落实、监督跟进、长期持续的绿色通道。同时,加快全科医生培养与使用激励机制的贯彻落实、完善全科医学毕业后继续教育机制、保障基层全科医生稳定的可持续发展。     

异丁司特对类固醇抵抗型变应性鼻炎患者生活质量的影响

目的观察异丁司特对类固醇抵抗型变应性鼻炎(allergic rhinitis,AR)患者生活质量的影响。方法进行随机、双盲、安慰剂的平行对照研究,应用SF-36生活质量量表(中文版)进行调查。类固醇抵抗型AR患者66例,年龄20～60岁。随机分为2组:异丁司特组34例,男18例,女16例;安慰剂组32例,男17例,女15例。两种药物服用方法均为每天2次,每次2粒(片),共服用21天,于服药前及服药后第7、14、21天记录症状和体征记分,于服药前、服药后第21天采用SF-36量表分别进行生活质量评价,评价内容包含36个项目,主要包括患者自己对功能状态、幸福和健康的评价。结果治疗前两组患者症状记分、生活质量记分差异无统计学意义。服药21天后异丁司特组AR症状和体征明显改善,生活质量明显提高(P均<0.001),安慰剂组未见明显改善。结论异丁司特能有效改善类固醇抵抗型AR患者的临床症状和体征,同时能提高患者的生活质量,安慰剂组虽然也能短时间内改善部分患者症状,但不能提高患者的生活质量记分。     

Dental Students’ Attitudes and Perspectives regarding Online Learning during the COVID-19 Pandemic: a Cross-sectional,Multi-university Study

ObjectivesThe aim of the study was to evaluate the attitude and perspectives of dental students of four Croatian universities towards online learning during the COVID-19 pandemic.Material and methodsAn anonymous internet-based survey was administered to undergraduate dental medicine students at the Universities of Zagreb, Rijeka, Split and Osijek. The 29-item questionnaire collected data on students’ demographics, online learning organization and management, and perception of online classes.ResultsFive hundred and four participants (85.1% female) took part in the survey. The majority of the participants (63.5%) were from the University of Zagreb. 39.6% of students reported agreement regarding online learning satisfaction. Individual university satisfaction ratings on overall online learning were: Osijek 3.69, Zagreb 3.22, Split 3.05 and Rijeka 2.64. Most students considered that lectures (82.9%) and seminars (78.9%) could be successfully delivered in an online learning format. The online learning format cannot successfully deliver laboratory, preclinical, clinical practicals or clinical clerkship, as agreed by more than 80% of the total student sample. 60% of students consider online learning a valuable alternative to face-to-face instruction.ConclusionOnline learning was highly praised for educational formats such as lectures and seminars, and was considered a useful substitute for conventional learning. Conventional practical courses cannot be substituted with online learning. Overall perspective about online learning was mixed among the students of four universities. The findings of the present study can serve to help individual universities address the shortcomings and reinforce the strengths of their OL programs.     

Translation and validation of the Arabic version of the “Suicide Behavioral Attitude Questionnaire”

Introduction : Attitudes and knowledge of health professionals are critical dimensions in the management of suicidal behavior. The “Suicide Behavioral Attitude Questionnaire” (SBAQ) was designed in Brazil to measure these variables in paramedical personnel. Aim: To translate and validate the SBAQ in literary Arabic. Methods : After author-approved translation and back-translation, the Arabic version of the SBAQ was distributed to 125 Tunisian caregivers working in psychiatric departments. Factor analysis and internal consistency were calculated. The stability was measured overtime using the paired Student’s T-test. Results : Cronbach''s alpha value was 0.741. The adequacy index of the factorization factor Kaiser-Meyer-Olkin (KMO) of our sample was 0.74. This value was higher than 0.5 which indicates that our data was suited for factor analysis. Bartlett’s sphericity test result was significant, rejecting the null hypothesis. Three factors were extracted explaining 50.7% of the overall variance. Cronbach''s alpha value for the three subscales was 0.735, 0.713 and 0.798. The instrument had good stability over time. Conclusions : The Arabic version of the SBAQ showed good reliability and validity allowing its use in Arabic speaking paramedical personnel.     

工作嵌入与职业认同在授权型领导感知与护士职业使命感间中介作用

目的 探讨工作嵌入和职业认同在授权型领导感知与护士职业使命感间的中介作用.方法 采用授权型领导感知量表、工作嵌入量表、职业认同量表和职业使命感量表对285名临床护士进行调查.结果 护士感知到授权型领导条目均分为(3.22±0.83)分,工作嵌入条目均分为(3.41±0.85)分,职业认同条目均分为(2.91±0.82)...     

A Hebrew adaptation of the tinnitus handicap inventory

Abstract

Objective: To establish a Hebrew version of the English THI. Design: The English THI (THI-E) was translated into Hebrew by two bilingual investigators, independently. A third investigator then constructed the final Hebrew THI version (THI-H) from the two translations. This version was administered to fifty consecutive patients at the tinnitus clinic. Participants also assessed tinnitus severity and loudness, and completed the Hebrew versions of the Beck's depression inventory and the state anxiety inventory. Study sample: The participants were fifty consecutive patients (older than 18 years of age, with a tinnitus lasting over three months) who were referred to a tinnitus clinic (none of them declared compensation seeking). Results: A very good internal consistency was found (α = 0.93), with significant correlation between the subscales of the THI-H and the Beck depression inventory score and the state anxiety inventory score. Conclusions: A valid and reliable THI-H questionnaire was constructed.

Sumario

Objetivo: Establecer una versión en Hebreo del THI en Inglés. Diseño: El THI en Inglés (THI-E) fue traducido al Hebreo por dos investigadores bilingües de manera independiente. Un tercer investigador elaboró después la versión final del THI en Hebreo (THI-H) a partir de las dos traducciones. Esta versión se administró a cincuenta pacientes consecutivos en la clínica de acufeno. Los participantes también evaluaron la severidad del acufeno y su intensidad subjetiva y completaron las versiones en Hebreo del Inventario de Depresión de Beck y el Inventario del Estado de Ansiedad. Muestra de Estudio: Los participantes fueron cincuenta pacientes consecutivos (mayores de 18 años con acufeno de duración mayor a 3 meses) que fueron referidos a la clínica de acufeno (ninguno de ellos declaró búsqueda de compensación). Resultados: Se encontró una muy buena consistencia interna (α = 0.93), con correlación significativa entre las subescalas del THI-H y las puntuaciones del Inventario de Depresión de Beck y del Inventario de Estado de Ansiedad. Conclusiones: Se elaboró un Cuestionario de THI-H válido y confiable.