Validation of quality indicators for radical prostatectomy

The feasibility and validity of proposed radical prostatectomy quality indicators has not been well studied. We assessed indicator availability from treating charts. We tested the convergent construct validity of a modified subset that were available from this information source by correlating them to hospital prostatectomy volume, a variable repeatedly associated with the quality of surgical care. The study population consisted of a stratified random sample of prostate cancer patients who were: (i) diagnosed between 1990 and 1998 in Ontario and (ii) treated by radical prostatectomy with curative intent within 6 months of diagnosis (n = 645). Of the 9 candidate quality indicators assessed, 4 were missing for 25-56% of study subjects and were not analyzed further. We discuss the implications of this missing information on feasibility of their use. For blood transfusions of 3 units or greater, length of hospital stay and use of non-nerve-sparing surgical technique, worse outcomes were generally apparent with decreasing hospital volume. Acute complication rates and positive surgical margin rates did not increase with decreasing hospital volume. We were able to demonstrate convergent construct validity for 3 quality indicators. Upon further validation, this readily available information may be applied to aid providers and quality councils to more effectively identify problems and guide change in the management of early prostate cancer.     

Development and Construct Validation of the Hand Function Sort

The construct validity of the Hand Function Sort (HFS) was investigated in 126 adults of working age (65% male) with medical impairments. Principal components factor analysis identified one major factor and two minor factors, which was consistent with the findings of a subsequent Harris Image Analysis. A Kaiser Image Analysis identified seven factors, partitioning the first global factor. Construct validity also was studied. HFS scores of subjects who had impairment of the dominant upper extremity were compared with subjects whose dominant upper extremities were not impaired. Significant differences were found between groups for total scores and in categories of tasks for which hand dominance was likely to be important. Conversely, there were no significant differences with tasks for which hand dominance was not important. HFS scores were compared with grip strength, which accounted for significant variance in the total HFS score. When categories of tasks were considered, substantial variance in the factors for which grip strength was important was accounted for by grip strength. For tasks in which grip strength was not likely to be important, variance accounted for by grip strength was negligible.     

尊重患者知情同意权 构建和谐医患关系

因侵害患者知情同意权引发的医疗纠纷越来越多,已影响到和谐医患关系的构建。医疗机构及其医务人员应当充分认识患者知情同意权的本质,尊重患者知情同意权;增强责任心,防止过失侵害患者知情同意权;提高医疗水平,避免对患者知情同意权的侵害;严格规范告知义务履行的程序和方式,防止医患之间因侵害知情同意权而发生纠纷,保护医患双方的合法权益,构建和谐的医患关系。     

Cup-cage construct for massive acetabular defect in revision hip arthroplasty- A case series with medium to long-term follow-up

ObjectiveCup-cage reconstruction has emerged as a possible solution for managing massive acetabular defects with a few existing studies reporting encouraging results at mid-term follow-up. We present our experience with this unitised construct.MethodSix patients (7 hips) with a mean age of 76 years (73–81) were revised due to catastrophic aseptic failure of a primary cup implanted 10–19 years previously, having a Paprosky type 3B acetabular defect.ResultsAt a mean follow-up of 72 months (63–140) no cases have required re-revision. Oxford Hip Scores improved from an average of 8 (1–17) preoperatively to an average of 36 (18–45) at the last follow-up. WOMAC scores preoperatively averaged 76 (49–96) and postoperatively averaged 26.5 points (0–69) at the last follow-up. SF-12 scores improved in both components. One patient showed non-progressive osteolysis around the ischial flange and one had less than 5 mm migration of the construct. One patient died of unrelated causes.ConclusionOur study presents one of the longest follow-up of cup-cage construct and supports the previously reported good results; it encourages the use of this construct in reconstruction of massive acetabular defect, with or without pelvic discontinuity.     

Development and Validation of the General Dietary Behavior Inventory (GDBI) in Scope of International Nutrition Guidelines

Unhealthy eating is associated with various diseases, such as cardiovascular, neurodegenerative, or oncological. There are neither economical nor behavior-related questionnaires available in the German language to assess general dietary behavior. Therefore, the aim of this validation study was to develop an instrument considering these aspects and verifying its construct and criterion validity. The new questionnaire is based on the general nutrition recommendations of the World Health Organization and the German Nutrition Society. It consists of 16 items that contrast dietary behaviors on a semantic differential scale. Our German-speaking convenience sample consisted of 428 participants. The construct validity of the General Dietary Behavior Inventory (GDBI) could be confirmed by examining convergent and discriminant validity. Furthermore, criterion validity was confirmed (significant negative correlations with body weight, Body Mass Index, and positive correlations with physical/mental health as well as life satisfaction). A cluster analysis revealed two different dietary behavior clusters representing a rather healthy and a rather unhealthy dietary behavior cluster. The results indicate that the GDBI is a validated and economical instrument to assess general dietary behavior. In practical research, this questionnaire helps to assess dietary behavior and to derive interventions for a healthy dietary behavior in concordance with international nutrition recommendations.     

Social care-related outcomes in Finland. Construct validity and structural characteristics of the Finnish ASCOT measure with older home care users

The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded home care services, which was conducted in 2016–2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi-square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well-being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ-5D-3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.     

Categorical Models of Childhood Disorder: A Conceptual and Empirical Analysis

In this review we explore the clinical and scientific status of categorical models of childhood disorder. Three themes are developed. First, the practical origins of standardised category-based diagnostic schemes are examined along with their contemporary philosophical and psychological significance. Next, the impact that these systems have had on the science of child psychopathology is explored. We look at their link to the medical model and the assumption that childhood disorders are categorical, endogenous, and dysfunctional in nature. We argue that these assumptions underpin the dominant paradigm in child psychopathology and so constrain empirical study and theory development. In the final section, the different ways in which researchers have responded to this link and its impact on science are presented. We present the sort of scientific realism associated with Meehl (1995) as the most appropriate basis for a philosophically respectable child psychopathology. Following this approach means unpacking the paradigmatic assumptions, including the assumption of the categorical structure of disorder, into hypotheses that are then put to empirical test. The sorts of data that would allow us to test the categorical hypothesis are identified. We conclude by discussing the results from three recent studies using behaviour genetic analysis of twin data that, in fact, lead us toward a rejection of this hypothesis. The implications for diagnostic and clinical practice of such a rejection are discussed.     

Outcomes of Locking-Plate Fixation for Hindfoot Fusion Procedures in 15 Patients

Tibiotalocalcaneal arthrodesis is a salvage procedure for various end-stage foot and ankle pathologic entities. Several factors are known to influence the union rate after these procedures, including construct rigidity. The data on locked plates as a fixation technique have been inconclusive, with variable union rates reported. One recent study suggested that locking plates can lead to high nonunion rates owing to excessive rigidity. The purpose of the present study was to retrospectively examine the outcomes of locking plate fixation. We retrospectively reviewed the cases of 15 patients (7 [46.7%] male, 8 [53.3%] female) who underwent tibiotalocalcaneal, tibiocalcaneal, or tibiotalar arthrodesis fixed with a locking plate from January 2013 to January 2014. The average age was 52.19 ± 5.8 years. The mean follow-up period was 17 ± 5.3 months. We examined the overall union rates and the effects of smoking, diabetes, and rheumatologic status on the union rate. Of the 15 cases, 11 (73.3%) did not achieve union. The mean time to failure was 10 ± 5.3 months. Age, gender, smoking, diabetes, use of augmentation screws outside the plate, and operating surgeon did not have an effect on the failure rate (p > .50). In addition, gender, smoking, and diabetes did not predict for nonunion. The high failure rate of rigid locking plate fixation reported might be attributable to the high incidence of smoking and diabetic comorbidities in our study. However, excessive construct rigidity might play an important role. Larger studies are needed to establish more reliable union rates with the use of locking plates in foot and ankle fusion.     

4味归肺经中药的黄酮成分簇“印迹模板”特征分析及其体外归经研究方法建立

目的 对归肺经4味中药黄酮成分簇的“印迹模板”特征进行研究,建立中药体外归肺经的研究方法。方法 以普通高等教育“十三五”国家级规划教材《中药学》中只归肺经的苍耳子、鱼腥草、金荞麦、射干等13味中药为基础,确定鱼腥草、金荞麦、射干、桑白皮4味代表中药,通过高效液相色谱法（HPLC）建立指纹图谱,并计算4味中药中所含各类成分的分子连接性指数,运用夹角余弦法计算其与平均分子连接性指数的相似性,以此建立构印定量关系,确定各成分归肺经次序。选择绿原酸、芦丁、槲皮苷、异槲皮苷、金丝桃苷、表儿茶素、野鸢尾苷共7种对照品验证模型的黄酮类成分整体的构印关系及其预测能力。结果 鱼腥草、金荞麦、射干和桑白皮共含有437种化学成分,其平均分子连接性指数相似度为0.995 6,4味中药共含黄酮类成分204个,平均分子连接性指数相似度为0.978 0,仅次于生物碱的0.985 1。7个对照品的保留时间（t_R）与分子连接性指数相似度（S）呈良好构印关系（t_R=831.4×S-790.3,r=0.861 4,P<0.01）,适用于98.04%黄酮类成分簇的位次、相似度、相对相似度与t_R的体外归经研究。据此可得第1位为桑黄酮D,分子连接性指数相似度为0.987 7,t_R为30.88 min;第200位为绿原酸,分子连接性指数相似度为0.958 2,t_R为6.36 min;按指纹图谱的总量统计矩法算得的4味中药的总量一阶矩为24.26 min,列位21,能表征整体的99.19%,7种对照品的药材峰面积总量一阶矩为20.00 min,列位46,能表征整体的98.68%。结论 黄酮类成分簇是研究归肺经的“印迹模板”特征的适宜探针,据此能建立起定量结构信息与t_R关系的体外中药归经研究方法。