Literature review and analysis of the application of health outcome assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.

Literature review and analysis of the development of health outcomes assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.

Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study

AIM To verify how malnutrition is related to health-related quality of life(HRQL) impairment in patients with cirrhosis.METHODS Data was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the Subjective Global Assessment(SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ~2 test, Fisher's exact test or Student's t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression. RESULTS A total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25(19.7%) were classified as A(compensated), 76(59.8%) as B, and 26(20.5%) as C(B/C = decompensated). According to SGA, 58(45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients(59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition(P < 0.0001). The most important impaired characteristics in malnourished patients were: Presence of body pain, dyspnea on exertion with daily activities, decreased appetite, generalized weakness, trouble lifting or carrying heavy objects, and decreased level of energy(P < 0.0001).CONCLUSION Malnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.

Development of a Self-Assessment Questionnaire for Nurses’ Risk-Taking Behavior in Medication

Purpose: The purpose of this study was to prepare a self-assessment questionnaire for nurses’ risk-taking behavior (RTB) in medication and to develop a reliable and valid questionnaire. Method: In the first study, a draft of the self-evaluation questionnaire for nurses’ RTB in medication was prepared based on the literature study and qualitative analysis of important case information included in the Project to Collect Medical Near-miss/Adverse Event Information Annual Report of the Ministry of Health, Labor and Welfare. Following the studies, face validity was confirmed, and a questionnaire survey was conducted for nurses who oversee medication nationwide to verify the reliability and validity. Result: The number of subjects was 586 (valid response rate: 94.1%). Item analysis and exploratory factor analysis showed that 4 factors and 12 items for the RTBs in daily life and 4 factors and 20 items for RTBs in medication could be extracted. Confirmatory factor analysis confirmed the fit of the hypothetical model obtained by exploratory factor analysis. In addition, Cronbach’s α coefficient was 0.888. Thus, high reliability and validity were obtained. A correlation was found by comparing the total scores of each RTB factor with the incident/accident group, and a standard for self-evaluation value could be established (p < 0.01). Conclusions: We were able to develop a self-assessment questionnaire for nurses’ risk-taking behavior in medication. This questionnaire will be used by nurses to find out their trends.

Validation of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy

Objective:This study aims to evaluate the reliability and validity of neuropathic pain assessment tools among Chinese patients with painful diabetic peripheral neuropathy(PDPN).Methods:One hundred patients with PDPN and 70 patients with non-neuropathic pain were recruited from five grade III general hospitals in Guangzhou.Pain was assessed using the Leeds Assessment of Neuropathic Symptoms and Signs(LANSS),Douleur Neuropathique 4 questionnaire(DN4),and Brief Pain Inventory for Painful Diabetic Peripheral Neuropathy(BPI-DPN).Reliability was evaluated by internal consistency of the Cronbach's a coefficient and Guttman split-half.Construct validity was analyzed by factor analysis and Spearman correlation coefficients.Sensitivity and specificity were also assessed.Results:The Cronbach's a coefficients of the LANSS,DN4,and BPI-DPN were 0.735,0.750,and 0.898,respectively.The Guttman split-half coefficients of the LANSS,DN4,and BPIDPN were 0.660,0.726,and 0.849,respectively.The cumulative contributions of the LANSS,DN4,and BPI-DPN to the total variance were 61.945%,57.010%,and 66.056%,respectively.The items of the LANSS,DN4,and BPI-DPN presented high factorial loads,ranging from 0.387 to 0.841,0.137 to 0.948,and 0.487 to 0.953,respectively.The LANSS and DN4 exhibited sensitivities of 58.0%and 82.7%,respectively,and specificity of 97.1%.Conclusions:The LANSS or DN4 can be used to detect neuropathic pain in Chinese patients with PDPN.The BPI-DPN can be employed to monitor the effectiveness of pain intervention.

大型教育监测:误解与启示

面向多地区多种群的大型教育监测可对各地教育情况进行有效比较。基于对参与学生能力国际评估项目(PISA)中各经济体测评与调查结果的分析,探讨东西方教育几个颇具启发意义的问题,结果发现:1)一些亚洲经济体靠“背诵”学习的学生的百分比较西方经济体要低,亚洲学生偏离好的学习原则、只懂背诵的传统看法并不符合事实;2)学生的科学成绩高低并不能决定其对未来从事科技类工作的兴趣程度,中国学生虽然PISA科学成绩卓越,但其对未来从事科技类工作兴趣不大;3)内在动机高有利于提高学生的学习成绩,外在工具性动机对西方学生的学习成绩并无帮助,但是可以帮助缺乏内在动机的亚洲学生提高其学习成绩;4)相较于西方学校之间的成绩差异较小、学校内部不同社会经济地位学生之间水平差距较大的现象,亚洲很多地区的学校则反之,为反映某一地区教育系统的学生差异,计算校内差异+学校间差异的总和更为科学;5)从参测地区学生10余年来的PISA成绩看,整体上使用信息科技工具较多地区的学生成绩不升反降,使用信息科技工具较少地区的学生成绩反而上升更多,为此需要探索如何善用科技以赋能教学和学习。除关注监测内容及结果外,也要对监测时采用的问卷调查工具进一步反思和改进,以便更好地用实证数据推动未来教育的发展。

The Application of Assessment of the Quality of Life in the Clinical Efficacy Evaluation System and the Selection of Questionnaires of Chinese Medicine Treating Tumors

In China, CM has been applied to treat almost every cancer patient, especially during the observation period after surgery, routine radiotherapy and chemotherapy. Several decades of CM treatment results have shown that CM treatment could be helpful in improving patients＇ physical rehabilitation, relieving symptoms and strengthening immunity. CM also could aid in the decline of rates of recurrence and metastasis, prolong the survival time, and especially, have significant effects on relieving symptoms such as relieving fatigue, improving syndromes caused by conventional therapies （surgery, radiotherapy, chemotherapy and biological treatment）, and indescribable discomforts caused by the unknown reason. It has been found in several studies that conventional medical treatment combined with CM could significantly improve QOL, and reduce treatment-related and disease-related symptoms. Patients treated with CM and Western medicine have higher scores in the fields of psychology, society,

理查兹-坎贝尔睡眠量表的护患一致性评估研究

目的:调查重症监护室病人自我报告的睡眠质量情况及每日评估睡眠的可行性,探究病人与护士分别使用理查兹-坎贝尔睡眠量表(Richards-Campbell Sleep Questionnaire,RCSQ)评估病人夜间睡眠质量的一致性。方法:选取2022年10月—2023年7月在我院重症监护室(ICU)住院的140例重症监护病人,采用RCSQ分别由护士对病人和病人对自身完成夜间睡眠质量评价,采用配对t检验、组内相关系数(ICC)、Bland-Altman图比较护患评价的一致性。结果:最终共收集到101例病人的727份睡眠报告,总睡眠平均分为52.28分,93例(92.1%)病人至少完成了1次报告,80例(79.2%)病人提供2次及以上的报告。101例病人共完成299次护患配对评估,ICC为0.31~0.59,相关性介于一般到中等,在睡眠深度、睡眠觉醒、重回睡眠、总分上,护士得分高于病人,差异有统计学意义(P<0.05)。结论:采用RCSQ评估睡眠可行性高。睡眠报告表明重症监护室病人睡眠质量低,护士倾向高估病人感知的睡眠质量。

老年人口腔自我保健健康信念问卷的编制及信效度检验

目的编制老年人口腔自我保健健康信念问卷并检验其信效度。方法以健康信念模式为理论基础,通过文献回顾、半结构访谈构建条目池,通过专家函询、预调查形成初始问卷,便利抽样选取565名社区老年人进行问卷调查,检验信效度。结果老年人口腔自我保健健康信念问卷包括感知益处、感知障碍、感知严重性、感知易感性和感知自我效能5个维度共25个条目。探索性因子分析共提取5个公因子,累计方差贡献率为71.524%;验证性因子分析:χ2/df=2.766,IFI=0.929、CFI=0.928、TLI=0.917、PCFI=0.798、PNFI=0.768,RMESA=0.079。I-CVI为0.833~1.000,S-CVI/UA为0.920;问卷总体Cronbach′sα系数为0.959。结论老年人口腔自我保健健康信念问卷信效度良好,可用于老年人口腔自我保健健康信念测评。

生态学理论在建成环境评价体系中的融合与应用--BREEAM英国策略性生态框架研究

当前,生态学与人居环境科学之间的交叉融合成为建成环境可持续发展的重要研究方向。由于国家级的建成环境评价标准对城市建设活动具有引领性和导向性作用,因此如何将生态学理论融入标准中成为研究内容之一。本文介绍了BREEAM英国策略性生态框架的制定思路、总体目标和各项任务,以及在其指导下的基础设施评价、社区评价和建筑评价中关于场地生态影响评价部分的条款设置与实施重点。期望通过本研究能对如何将生态影响评价系统性、层级式、可实践化地融入国家级的建成环境评价标准起到一定的借鉴作用。

某三级甲等公立医院基层党支部考核评价探索

目的以党内法规为基础,优化某医院党支部工作评价指标体系,以多样化考核方法,使支部建设与医疗教学科研业务发展融合。方法采取文献检索及文本分析方法,搜索相关文献,以质性访谈及方便抽样方式,向医院的各层各级党代表发放问卷25份,回收有效问卷25份。运用Likert 5级评分法对遴选的74项考核指标按重要性进行打分评价。结果建立了一套包含5个一级指标、14个二级指标、53个三级指标的综合考核评价体系。结论现有的党支部综合量化考核体系得以优化,多样化的考评方法促使党支部建设的目标更加明确、清晰、规范,促进了引导激励作用。

大规模职业能力测评背景问卷的研制与检验

大规模测评为循证导向的教育研究、实践和决策提供了数据基础。能力测评与问卷调查是大规模测评采集数据的主要方法。参考背景问卷研发的国际经验,本研究构建了我国职业院校学生职业能力发展影响因素的理论模型,整合了环境、活动、个人三个层次和学校、校企、企业三种类型的因素,提出由学生背景、活动特征、组织环境三部分构成的问卷框架。在此基础上设计了包括职业动机、实习实训支持等十二个量表的综合问卷。预测试和大规模测评的数据分析显示,问卷信度和效度良好。调查问卷可用于诊断技术技能人才培养过程中存在的问题和整体把握职业教育体系的状况与特征。

金华市医疗机构医院感染管理风险评估现况问卷调查

目的对金华市各级医疗机构感控风险评估的开展、感控专职人员知晓风险评估技术等现况进行调查。方法自制感控风险评估相关调查问卷,于2023年8—9月采用腾讯问卷对在金华市医疗机构工作的52名感控专职人员进行调查。调查内容包括人员基本信息、对风险评估的知晓程度、所在医疗机构风险评估开展情况、对医院感控能力及风险隐患的了解情况等。结果52名感控专职人员以女性、专业背景为护理学、从事医院感染管理工作≤4年的人群为主,分别占96.15%(50/52)、78.85%(41/52)、71.15%(37/52)。其中49名(94.23%)接受过感控风险评估培训、43名(82.69%)参与过感控风险评估工作。53.85%(28/52)的调查对象所在医疗机构能做到全院层面风险评估每年开展1次、重点部门(科室)半年开展1次。超过48.00%的调查人员认为本医疗机构存在相关院感风险隐患,占比最高的2个风险点分别是医院环境清洁与消毒不到位,占63.46%(33/52);疑似医院感染暴发处置不到位,占61.54%(32/52)。结论金华市医疗机构院感风险评估制度整体落实到位,感控专职人员大部分都能知晓相关技术且具有一定的实践经验。同时,全面、定期地对风险隐患进行识别、评价、控制与监测,提高评估效果的实用性,防范院感事件的发生,仍是当前及今后管理风险研究的重要趋势。

银行理财客户风险测评的行为实验研究:方法比较与效果分析

长期的低收益率与刚性兑付使得客户对银行理财产品的风险形成了保本保息的扭曲认识。理财产品的规范化与监管新规的执行引起了理财产品的大幅亏损,导致客户的不满及银行与客户关系的恶化。理财产品风险分级与客户风险类型不匹配可能是问题背后的潜在原因。为此,本文重新审视和检验商业银行理财风险测评的效果。通过行为实验,本文将风险测评问卷、经典的彩票选择测试和新兴的炸弹诱导测试方法进行对比。研究发现风险测评问卷度量的风险厌恶程度显著低于炸弹诱导测评,但与彩票选择测评无显著差异。三种测评方法的结果对风险追求客户的分类表现一致,但对风险厌恶客户的分类存在差异。另外,风险测评问卷将大部分客户划分为稳健与谨慎两类,导致客户类型的区分度不高。客户风险分类是风险测评的核心目的,因此银行需要更好地理解不同测评方法的差异,并慎重地选择测评方法。本研究为解决理财新规下的新问题提供了可能的思路,并为进一步改进理财风险测评提供了建议。

ICU患者压力性损伤风险评估工具使用现状调查及分析

目的 了解ICU患者压力性损伤风险评估工具的使用情况。方法 于2023年5月8—21日采用自行设计调查问卷对9所三级临床教学医院综合ICU和专科ICU护理的270名人员压力性损伤风险评估工具使用状况进行问卷调查。结果 1家医院使用Waterlow评估表对ICU患者进行压力性损伤风险评估,其他8家均使用Braden评估表;护理人员认为现使用的评估工具存在评估结果的风险程度相似、评估内容缺乏针对性等问题。结论 目前使用的ICU患者压力性损伤风险评估表缺乏针对性,尚无使用简单、信效度高的专科压力性损伤风险评估工具。

基于问卷调查的汽车召回效果评估方法研究

召回是国际通行的汽车安全监管制度,召回效果评估是对召回活动消除缺陷的效果进行综合评估的过程,其结果客观反映了生产者开展召回活动的全过程,对召回实施至关重要。本文旨在研究基于问卷调查的汽车召回效果评估方法,从实际应用出发,探讨通过问卷调查方法开展汽车召回效果评估的技术方案,详细阐述了问卷调查的主要流程,包括方案设计、问卷发送、数据管理等关键环节。通过某合资品牌车辆的气囊召回案例,对问卷调研方法在汽车召回效果评估中的应用进行论证。通过问卷调研分析,发现存在召回通知到达率不足、召回措施可靠性待提升等问题,为召回监管决策提供了有效支撑。实践结果表明,其可以为汽车召回效果评估工作提供技术支持。

基于公众需求的慢行道更新提升研究

城市慢行道是与老百姓日常出行最密切的城市线性空间,只有充分了解使用者需求,才能为推进人行道和自行车专用道建设提供决策依据。基于问卷调查统计数据,从用户视角明确公众对慢行道的使用感受和景观偏好,并借助关联规则分析并揭示公众实际需求和潜在需求,研究结果既为后续政策出台提供支撑,又为规划设计者和管理者提供参考。

关节镜肘关节有限清理及松解术对风湿性关节炎肘关节僵直DAS28-CRP、HAQ等评分的影响及安全性分析

目的探究分析风湿性关节炎肘关节僵直患者接受关节镜肘关节有限清理并配以松解术联合治疗方案对其DAS 28-C反应蛋白检验结果、健康评估问卷(HAQ)评分结果的影响情况以及安全性。方法选取2022年1月-12月收治风湿性关节炎肘关节僵直患者33例,均在局部浸润麻醉下接受关节镜有限清理术,且对挛缩的关节囊与侧副韧带实施松解术,术后2周行随访调查,评价分析疾病活动评分(DAS 28-CRP检测结果、HAQ评分、Mayo肘关节功能评分、ROM屈伸功能评分)以及安全性情况。结果⑴相较于术前,术后2周DAS 28-CRP检测结果、HAQ结果改善效果明显,差异有统计学意义(P<0.05);⑵相较于术前,术后2周Mayo肘关节评分功能改善效果明显,日常活动能力明显升高,差异有统计学意义(P<0.05);⑶相较于术前,术后2周肘关节屈伸功能改善明显,差异有统计学意义(P<0.05)。肘关节僵直时间≥12个月的患者术后关节屈伸功能恢复程度,相较于<12个月患者明显较差,差异有统计学意义(P<0.05);⑷术后情况恢复良好,并发症发生率为0.00%。结论在风湿性关节炎肘关节僵直治疗中,运用关节镜肘关节有限清理并配以松解术联合治疗方案,能够有效改善患者的疼痛感,提高患者肘关节屈伸活动度,治疗安全性比较高,不会对患者自身带来极大伤害,使患者早日回归生活。

肺康复联合无创通气治疗重度慢性阻塞性肺疾病的临床分析

目的 探究肺康复联合无创通气对重度慢性阻塞性肺疾病血气、肺功能、运动耐力及生活质量的影响。方法 选取2022年6月—2023年10月北京燕化医院呼吸与危重症医学科收治的稳定期重度慢性阻塞性肺疾病患者80例,采用随机数表法分为观察组40例、对照组40例。观察组实施肺康复联合无创通气治疗,对照组实施无创通气治疗。比较两组患者治疗前后血气指标,肺功能,运动耐力及生活质量指标变化。结果 观察组治疗后动脉二氧化碳分压(38.63±2.01)mmHg低于对照组、动脉血氧分压(73.63±3.85)mmHg高于对照组,差异有统计学意义(t=15.547、9.684,P均<0.05)。观察组治疗后肺功能第1秒钟用力呼吸容积(1.68±0.22)L、最大呼气中期流速(1.69±0.41)L/s、第1秒钟用力呼吸容积/用力肺活量(70.96±4.42)%均高于对照组,差异有统计学意义(t=5.979、5.276、12.501,P均<0.05)。观察组6 min步行距离、慢性阻塞性肺疾病评估测试评分均优于干预前,且优于对照组,差异有统计学意义(P均<0.05)。结论 肺康复联合无创通气治疗效果显著,改善患者肺功能。