Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Differences in parents of pediatric liver transplantation and chronic liver disease patients

BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.

Does Liuzijue Qigong affect anxiety in patients with chronic obstructive pulmonary disease,even during the COVID-19 outbreak?a randomized,controlled trial

Background:Anxiety is a common comorbidity associated with chronic obstructive pulmonary disease(COPD),but no well-recognized method can provide effective relief.Liuzijue Qigong(LQG)is a traditional Chinese fitness method,based on breath pronunciation.This study aimed to examine the efficacy of LQG to relieve anxiety in COPD patients and to explore the factors that influence anxiety,including whether LQG is effective during the coronavirus disease 2019(COVID-19)outbreak.Methods:We conducted an open-label,randomized,controlled,clinical trial.A total of 60 patients with stable COPD were randomly assigned to two groups.Both groups were given routine medical treatment,and the patients in the pulmonary rehabilitation(PR)group were given an extra intervention in the form of LQG,performed for 30 minutes each day for 12 weeks.Data collection was performed at baseline and 12 weeks(during the COVID-19 epidemic).The primary outcomes were the self-rating anxiety scale(SAS)scores,and the secondary outcomes were relevant information during the epidemic and analyses of the related factors that influenced SAS scores during the COVID-19 outbreak.Results:Compared with baseline,patients in both groups demonstrated varying degrees of improvements in their SAS scores(all P<0.01).An analysis of covariance,adjusted for baseline scores,indicated that the SAS scores improved more dramatically in the PR group than in the control group(F=9.539,P=0.004).During the outbreak,the SAS scores for sleep disorder were higher than all other factors,reaching 1.38±0.67,and the scores for“I can breathe in and out easily”for the PR group were lower than the scores for the control group(Z=−2.108,P=0.035).Significant differences were identified between the two groups for the categories“How much has the outbreak affected your life”,“Do you practice LQG during the epidemic”and“Do you practice other exercises during the epidemic”(all P<0.05).Compared with current reports,LQG had a relatively high adherence rate(80.95%).A multiple linear regression analysis revealed multiple predictors for SAS scores during the outbreak:group(b=−3.907,t=−3.824,P<0.001),COPD assessment test score(b=0.309,t=2.876,P=0.006),SAS score at baseline(b=0.189,t=3.074,P=0.004),and living in a village(b=4.886,t=2.085,P=0.043).Conclusion:LQG could effectively reduce the risks of anxiety among COPD patients,even during the COVID-19 outbreak.For those COPD patients with high COPD assessment test and high baseline SAS scores or who live in villages,we should reinforce the management and intervention of psychological factors during the epidemic.

Prevalence of Depression in Pre-Dialytic Chronic Kidney Disease Patients Attending at a Tertiary Care Hospital in Bangladesh

Background: Depression is a common and serious medical illness around the world. It occurs more frequently in patients with chronic illness than in the general population. It is a common psychiatric problem in patients with chronic kidney disease (CKD). Objective: To assess the level of depression in pre-dialytic CKD patients attending at a tertiary care hospital in Bangladesh. Methodology: This cross sectional study was conducted at Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2020 to June 2020. A total of 100 pre-dialytic CKD patients were selected by convenience sampling technique and their level of depression was assessed by Zung Self-Rating Depression Scale (ZSDS). Data were collected by existing questionnaire with face to face interview and analyzed by statistical test. Results: The mean age of the participants was 49.70 ± 11.80 years. Among them 64% were male, 95% were muslim, 98% were married, 65% were completed secondary/above higher secondary level education, 65% were unemployed and 55% were lived in urban area. It was observed that 65% participants were economically dependent to their family, only 6% were engaged in regular exercise, 14% had family history of depression, 8% were smoker and 12% were alcohol/drug abuser. According to the Zung Self-Rating Depression Scale (ZSDS) we found 29% participants were mildly depressed, 39% participants were moderately depressed and 18% participants were severely depressed. Prevalence of depression was 86% in pre-dialytic CKD patients. Of them, 7% was in CKD stage-I, 17.4% was in CKD stage-II, 19.8% was in CKD stage-III, 22.1% was in CKD stage-IV and 33.7% was in CKD stage-V. Conclusion: Depression is highly prevalent in pre-dialytic CKD patients and more frequent in the advanced stages of CKD.

Prevalence and Clinical Characteristics of Chronic Constipation in Senegalese Children

Introduction: Constipation is the infrequent emission of hard stools. It is common, most often of functional origin, with a prevalence ranging from 0.7% to 29.6%. The aim of our study was to investigate the prevalence of constipation in children undergoing paediatric gastroenterology. Methodology: This was a bi-centric retrospective study carried out at the Albert Royer Children’s Hospital and the Dalal Jamm Hospital Pediatrics Department. Children followed in the pediatric gastroenterology consultation during the period from January 1, 2013 to February 29, 2020 were included. Results: A total of 337 children (205 boys;60.83%) were included, representing a prevalence of 25%. The median age was 3 years 6 months. The 13 - 24 months age group was the most frequent (27.6%). Rare stools were the main reason for consultation (92.8%). Rare stools were noted in 92.88% of cases. Bristol types 1 and 2 accounted for 6.53% and 54.60% respectively. The main associated signs were abdominal pain (29.4%), followed by abdominal bloating (20.96%). Abdominal pain was functional in 73.58% of cases. Under treatment, 90.19% of children had a favorable outcome. Conclusion: Constipation is common in Senegalese children with a prevalence close to that reported in Western countries. In most case, it is functional with good prognostic.

慢性阻塞性肺疾病急性加重期患者报告结局测评工具研究现状

慢性阻塞性肺疾病(COPD)是常见呼吸系统疾病之一,其急性加重作为一种急性事件,严重影响COPD患者生存质量。本研究检索PubMed、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库,经纳排标准共筛出69篇代表性文献,发现目前国内外应用于COPD急性加重期患者报告结局的测评工具共23个,除COPD急性加重自我报告结局(EXACT-PRO)外均直接采用稳定期患者报告结局测评工具,可分为普适性、疾病特异性及症状特异性测评工具,主要涉及症状、生理领域、社会领域、心理情绪、日常活动等领域。建议未来COPD急性加重期患者生存质量研究重点关注以下几方面:加强特异性测评工具研究,重视经典测量理论、项目反应理论及概化理论联合应用,重视测评工具最小临床重要差值研究,合理选择测评工具。

简版患者延续性护理评估问卷的汉化及其在慢性病患者中的信效度检验

目的汉化简版患者延续性护理评估问卷(patient continuity of care questionnaire,PCCQ-12),并在慢性病患者中检验其信效度,以期为慢性病住院患者出院后延续性护理的评估提供可靠工具。方法按照Brislin翻译模型进行问卷的正译、回译及文化调适,形成中文版PCCQ-12。2023年12月至2024年3月,于河南省郑州市某三级甲等医院招募202例调查对象,对问卷的信效度进行检验。结果中文版PCCQ-12共12个条目,条目内容效度指数为0.833~1.000,问卷内容效度指数为0.917;问卷总分与简式健康相关生活质量问卷的生理健康总评分、心理健康总评分的相关系数分别为0.197、0.583(均P<0.01);方差分析结果显示不同性别、文化程度的得分差异有统计学意义(均P<0.05)。中文版PCCQ-12的Cronbach’sα系数为0.853,重测信度为0.912。结论中文版PCCQ-12具有良好的信效度,可作为评估慢性病住院患者出院后延续性护理看法的可靠工具。

慢性病患者云随访服务体验量表的研制及其信效度检验

背景随访是慢性病患者疾病管理的必要步骤,云随访作为新型的随访形式可能有助于提高随访质量,但目前缺乏从患者角度出发的云随访服务质量评价工具。目的研制慢性病患者云随访服务体验量表,并检验其信效度,旨在为云随访服务质量的评价提供工具。方法以服务质量评价模型为指导,通过文献回顾、半结构式访谈、专家函询及预调查形成量表;于2022年8—10月在杭州市某三甲医院和某社区卫生服务中心选取慢性病患者(n=480)进行调查,对量表进行项目分析和信效度检验。结果形成的慢性病患者云随访服务体验量表包含5个维度、37个条目,从患者的感受和期望两个方面进行评定。量表总的Cronbach’sα系数为0.962,折半信度为0.732,重测信度为0.844。量表内容效度指数为0.980;量表和满意度评分相关系数为0.754(P<0.01);验证性因子分析显示量表拟合度良好;量表各条目的载荷系数为0.514~0.988(P<0.001),各维度组合信度为0.947~0.987,平均提取方差值(AVE)为0.693~0.947;维度之间相关系数均小于所对应的AVE平方根。结论本研究研制的慢性病患者云随访服务体验量表具有良好的信效度,可用于慢性病患者云随访服务体验的评估。

老年非恶性肿瘤慢性病患者终末期生存质量量表编制及信效度检验

目的编制老年非恶性肿瘤慢性病患者终末期生存质量评估量表,并评价其信效度。方法以马斯洛需要层次论的XYZ理论为基础,通过文献回顾、半结构式访谈构建量表条目框架;通过专家函询、预调查对量表条目内容进行调整优化,形成量表施测稿;采用便利抽样法,选取2022年5—12月在四川大学华西医院就诊的568例老年非恶性肿瘤慢性病终末期患者为研究对象,进行量表项目分析及信效度检验。结果老年非恶性肿瘤慢性病患者终末期生存质量量表包含4个维度共35个条目。量表总体内容效度指数(S-CVI)为0.96,各条目内容效度指数(I-CVI)为0.83~1.00,与简明健康测量量表简表的关联效度为-0.528,探索性因子分析提取4个公因子,共解释总变异量的50.674%。量表整体Cronbach’sα系数为0.927,重测信度为0.968。结论老年非恶性肿瘤慢性病患者终末期生存质量量表信效度良好,可作为该类人群生存质量的评估工具。

慢性病患者限制饮食负担量表的汉化和信效度检验

目的汉化慢性病患者限制饮食负担量表(BIRD),并检验其信效度。方法采用Brislin翻译模式对BIRD量表进行翻译、回译,再进行文化调试和预试验后形成中文版BIRD量表。采用便利抽样法选取2023年4-6月邵阳市多所三级甲等医院的343例慢性心力衰竭患者进行信效度检验。结果中文版BIRD量表共1个维度,11个条目,量表每个条目的内容效度指数(CVI)均处于0.82~1.00,问卷平均CVI值为0.983;量表的效标关联效度r=-0.323(P<0.001);验证性因子分析χ^(2)/df=2.797,RMSEA=0.073,整体模型拟合度较好;量表的折半信度为0.79;总量表的Cronbach′sα系数为0.870。结论中文版BIRD量表具有良好的信度和效度,可作为我国慢性病患者限制饮食负担的测评工具。

新型腹膜透析引流液记录秤研究

研制一种新型持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)引流液袋称重专用秤,该装置集称重、语音播报、数据共享、智能预警于一体,可以解决患者的称重难、读数难、分析难、记录难、共享难等问题.该装置包括秤盘及秤体两部分,秤盘采用PVC材质(聚氯乙烯),秤体表面以ABS材质覆盖,秤盘及秤体底部有TPE材质的防滑装置.秤体前面设有防水功能按键,右侧方设有便携式铝合金材质合页拉环,左侧方设有USB充电接口和电量提示灯、后面设有扬声器和音量调节旋钮.电子秤的内部构造核心在于STC51单片机和蓝牙/LPWAN模块.采用STC51单片机和蓝牙/LPWAN模块,可实现称重、语音播报、数据共享、智能预警功能,解决患者实际应用的问题.该装置能够精确称重并通过语音播报数值,同时上传共享数据,对数据进行分析,智能预警,使患者更准确、方便地获取、记录引流液信息,可改善患者预后,值得临床推广.

社区老年多重慢性病患者健康相关生命质量及其影响因素分析

目的:探讨社区老年多重慢性病患者健康相关生命质量(HRQoL)状况及其影响因素。方法:采用多阶段分层整群抽样方法,选取青岛、广州和苏州3个城市辖区内6个街道社区老年多重慢性病患者(≥60岁),对其社会人口学特征、行为生活方式、慢性病患病情况和HRQoL等进行调查。对不同特征老年多重慢性病患者健康效用值进行单因素分析,采用Tobit回归对健康效用值影响因素进行分析。结果:老年多重慢性病患者总体健康效用值为0.847(0.569,0.939)。EQ-5D量表中疼痛/不适维度存在健康问题的比例(45.8%)最高。已婚(β=0.049,95%CI为0.000~0.098)、子女或孙辈每天探望(β=0.074,95%CI为0.022~0.126)的老年多重慢性病患者健康效用值较高;年龄≥80岁(β=-0.067,95%CI为-0.119~-0.016)、患3种慢性病(β=-0.045,95%CI为-0.087~-0.004)和4种及以上慢性病(β=-0.092,95%CI为-0.137~-0.047)、每天睡眠时间≥8 h(β=-0.098,95%CI为-0.149~-0.046)、居住方式为福利院/养老机构/保姆/护工(β=-0.086,95%CI为-0.148~-0.023)、主要经济来源为家人提供(β=-0.116,95%CI为-0.229~-0.002)、子女或孙辈1 a及以上探望1次(β=-0.122,95%CI为-0.234~-0.009)的老年多重慢性病患者健康效用值较低。结论:老年多重慢性病患者HRQoL较差,疼痛/不适是主要健康问题,需探索更有效的慢性病管理模式,以更好地改善老年多重慢性病患者HRQoL。

中文版全球疼痛量表在减轻CKD患者肾穿刺活检术后疼痛体验中的应用效果分析

目的探讨中文版全球疼痛量表在减轻慢性肾脏病(CKD)患者肾穿刺活检术后疼痛体验中的应用效果。方法选取80例CKD患者,均实施肾穿刺活检术,按信封随机法分成试验组(40例)、对照组(40例)。对照组于术后施行常规疼痛护理,试验组根据中文版全球疼痛量表评估结果进行疼痛护理。对比两组心理痛苦程度、临床指标、疼痛情况和生活质量。结果试验组心理痛苦程度轻于对照组,差异有统计学意义(P<0.05)。试验组疼痛缓解用时(4.43±0.75)d和住院时长(6.48±1.21)d短于对照组的(6.27±1.32)、(8.24±1.46)d,差异有统计学意义(P<0.05)。护理后,两组数字评定量表(NRS)评分低于护理前,且试验组NRS评分(1.54±0.32)分低于对照组的(2.68±0.50)分,差异有统计学意义(P<0.05)。护理后,两组角色、躯体、情绪及认知功能评分高于护理前,且试验组角色、躯体、情绪和认知功能评分高于对照组,差异有统计学意义(P<0.05)。结论中文版全球疼痛量表在减轻CKD患者肾穿刺活检术后疼痛体验中的效果显著,有助于缩短疼痛缓解时长和住院时长,减轻其疼痛程度,并促进生活质量改善。

动机访谈健康教育在老年慢性阻塞性肺疾病患者中的应用效果

目的:观察动机访谈健康教育在老年慢性阻塞性肺疾病患者中的应用效果。方法:选取2021—2022年该院收治的150例老年慢性阻塞性肺疾病患者进行前瞻性研究,按照随机数字表法将其分为观察组与对照组各75例。对照组采用常规健康教育,观察组在对照组基础上采用动机访谈健康教育,比较两组肺功能指标[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC]水平、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分和知信行量表评分。结果:教育1个月后,两组FEV_(1)、FVC、FEV_(1)/FVC水平和WHOQOL-BREF评分、知信行量表评分均高于教育前,且观察组高于对照组,差异均有统计学意义(P<0.05)。结论:在常规健康教育基础上采用动机访谈健康教育可提高老年慢性阻塞性肺疾病患者FEV_(1)、FVC、FEV_(1)/FVC水平以及WHOQOL-BREF、知信行量表评分,效果优于单纯常规健康教育。

浅析尿毒症瘙痒评估量表

瘙痒是很多皮肤疾病共有的自觉症状,也是尿毒症患者发病率最高的并发症之一,具有发病部位广泛、夜间症状加重、程度轻重不一等特点。目前,临床上所使用的皮肤瘙痒评估量表种类繁多,但多数为精神科或皮肤科医师所研发,再经肾病科医师汉化或借用,专门用于评估尿毒症瘙痒病情的量表相对较少,且对尿毒症瘙痒的评估标准也尚未统一,临床医生在量表的选择上存在一定困难。本文整理归纳了目前临床常用的尿毒症瘙痒评估量表,并浅析各自的优缺点,以期为临床医师在不同应用场景下选择合适的评估量表提供参考。

慢性阻塞性肺疾病稳定期证候疗效评价量表条目权重的确定

目的 确定慢性阻塞性肺疾病稳定期证候疗效评价量表(Syndrome therapeutic evaluation scale of chronic obstructive pulmonary disease, COPD-STES)条目权重,为COPD-STES的形成提供依据。方法 基于568例COPD患者临床调查数据,首先利用Python 3.8编程语言,采用Anaconda Navigator软件中的Spyder集成开发环境,调用Sklearn包中“Random Forest Classifier”建立初始随机森林模型,计算条目权重;其次采用主成分分析法及最大方差正交旋转,提取累计方差贡献度>80%的公因子,根据公因子的累计方差贡献度及成分得分系数,计算条目权重;然后基于专家问卷每位专家对每一条目的重要性评分,计算条目权重。最后将以上三种方法分别赋予40%、30%、30%比重,相加得出条目最终权重。专家问卷未涉及到的个别条目,将前两种方法分别赋以60%、40%比重,再做归一化处理,作为条目的最终权重。结果 基于三种条目赋权方法,寒饮证各条目权重范围为0.082-0.154,痰湿证为0.043-0.215、血瘀证为0.128-0.202、肺气虚证为0.054-0.256、脾气虚证为0.043-0.188、肾气虚证为0.051-0.127、肺阴虚证为0.088-0.150、肾阴虚证为0.074-0.202、肾阳虚证为0.073-0.166。结论 本研究通过计算COPD-STES各条目的权重,可为证候积分的计算提供依据,也为证候疗效评价量表条目赋权提供方法。

慢性阻塞性肺疾病稳定期证候疗效评价量表条目的赋权研究——以肺气虚证为例

目的以慢性阻塞性肺疾病稳定期证候疗效评价量表(COPD-STES)肺气虚证为例,联合采用随机森林法、因子分析法及百分权重法确定条目权重,为证候疗效评价量表的形成提供方法学支持。方法基于568例COPD患者的临床调查数据,首先利用Python 3.8编程语言,采用Anaconda Navigator软件中的Spyder集成开发环境,调用Sklearn包中“随机森林分类器”建立初始随机森林模型,计算条目权重;其次采用主成分分析法及最大方差正交旋转,提取累计方差贡献度>80%的公因子,根据公因子的累计方差贡献度及成分得分系数,计算条目权重。然后基于专家问卷中每位专家对各条目的重要性评分,计算条目权重。最后将以上3种方法分别赋以40%、30%、30%的比重,相加得出条目最终权重。结果基于前期已初步形成的COPD-STES,包含9个基础证候、46个条目,其中肺气虚证10个条目。通过随机森林法,计算出肺气虚证各条目的权重系数范围为0.019~0.473;通过因子分析法,计算出各条目权重系数范围为0.042~0.152;通过百分权重法,计算出各条目权重系数范围为0.083~0.110。综合3种方法,计算出条目最终权重系数,分别为咳嗽0.188、喘息0.073、胸闷0.082、气短0.256、乏力0.054、恶风0.061、自汗0.073、少气懒言0.064、易感冒0.077、脉弱或脉沉细0.073。结论基于随机森林法、因子分析法、百分权重法的证候疗效评价量表条目赋权法具有可行性,可为中医证候疗效评价量表条目赋权提供新思路。

慢性阻塞性肺疾病中生活质量量表的临床应用及其特点

慢性阻塞性肺疾病(COPD)具有高患病率、高致残率、高死亡率的特点。COPD严重影响患者的生活质量,生活质量量表是对COPD患者心理情绪、社会适应和躯体功能的一个综合测量,被广泛用于病情及疗效评估。本文对COPD中生活质量量表的临床应用及其特点进行综述。

公众健康积极指数量表汉化及在慢性病患者中的信效度研究

目的汉化英文版公众健康积极指数量表,对其信度和效度进行检验。方法遵循Brislin翻译模式,经过翻译、回译、跨文化调适和预调查,采用便利抽样法对江苏省6所社区医疗卫生机构的182例慢性病患者进行测试。结果中文版量表的总体Cronbach′sα系数为0.812,重测信度系数为0.979;量表水平的平均内容效度指数(S-CVI/Ave)为0.960,条目水平的内容效度指数(I-CVI)为0.800~1.000;探索性因子分析共提取知识、自我效能及行动3个公因子,累积方差贡献率为68.784%。结论中文版量表在慢性病患者中具有良好的信效度,可作为慢性病患者健康积极度的测量工具。

GMAS、MMAS-8和SEAMS评估慢性病病人用药依从性效能的比较

目的:比较普适性药物依从性量表(GMAS)、Morisky服药依从性测量量表(MMAS-8)、合理用药自我效能量表(SEAMS)在慢性病病人中的应用效果,为临床选择有价值的慢性病用药依从性评估工具提供参考。方法:于2021年10月—2022年2月选取在天津市3所医疗机构就诊的270例成年慢性病病人为研究对象,采用一般资料调查表、GMAS、MMAS-8、SEAMS进行用药依从性评估,并以MAQ作为效度评价标准,采用受试者工作特征(ROC)曲线、Bayes判别分析、Kappa一致性检验和阳性似然比对3种慢性病用药依从性评估工具进行比较。结果:以MAQ为评价标准,270例病人中用药依从性差者122例(45.2%)。GMAS、MMAS-8、SEAMS评分的ROC曲线下面积(AUC)分别为0.981,0.984,0.917,灵敏度分别为0.987,0.993,0.676,特异度分别为0.926,0.943,0.951,约登指数分别为0.913,0.936,0.627(P<0.001)。GMAS、MMAS-8和SEAMS对评估慢性病病人用药依从性的交叉检验准确率分别为89.6%、97.0%和80.7%,与MAQ评估结果的一致性检验Kappa值分别为0.917,0.940,0.608(P<0.001),阳性似然比分别为13.367,17.303,13.734。结论:3种量表在评估慢性病病人是否存在用药依从性不佳风险时均有较高价值,其中MMAS-8评估慢性病病人用药依从性的效能最高,GMAS量表次之,最后是SEAMS,提示研究人员可根据研究对象个性化特点和研究目的针对性地选择评估工具,有助于准确识别用药依从性不佳的慢性病病人并早期开展干预。