Transcript Slide 1

KLINIČKE OCJENSKE
LJESTVICE
Ivan Bakran
DOKTORSKI STUDIJ MF, 2006.
POŽELJNA SVOJSTVA OCJENSKIH LJESTVICA
1.
2.
3.
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14.
Jednostavnost
Brzina ispunjavanja
Lakoća ispunjavanja
Jednostavna interpretacija
Brza interpretacija
lakoća interpretacije
Osjetljivost za promjene izazvane određenim
zahvatom
Neosjetljivost na interferiranje
Mala učestalost lažno pozitivnih odgovora
Mala učestalost lažno negativnih odgovora
Opetovano korištenje bez učinka utreniranosti
Reproducibilnost rezultata
Validnost rezultata
Interpretacija korelira sa drugim kliničkim
parametrima
Ocjenske ljestvice moraju biti validirane, tj. točne i precizne
Validacija:
a)
b)
c)
d)
e)
f)
g)
lažno pozitivni/lažno negativni rezultati
usporedba sa zlatnim standardom (idealno)
prihvatljivost
izvodivost
reproducibilnost
konzistentnost
aplikabilnost
Interna validnost = stupanj isključenja drugačijeg
tumačenja rezultata
Eksterna validnost = mogućnost generaliziranja rezultata
(ekstrapoliranje)
PRIMJERI VREDNOVANJA U KLINIČKIM OCJENSKIM LJESTVICAMA
A. 1
2
3
4
5
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7
8
9
B. 0
1
2
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6
7
=
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=
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=
=
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=
Not at all ____
Very little _____
A little ______
Mildly ______
Moderately _____
Quite a bit _____
Distrinctly _____
Markedly _____
D.
Extremely _____
Not assessed
Normal, not at all ____
Borderline ____
Mildly _____
Moderately ____
Markedly _____
Severely ____
Among the most
severely ______
C. 0 = Absent
1 = Slightly present or a suspicion of its
presence
2 = Clearly noticable but mild and occurs
not more than ___per _____
3 = Clearly present and occurs from ____ to
____ times per _____
4 = Definitely present and frequent
5 = Continuous and gross
0 = Absent
1 = Rarely present (occurs less than _____
times per ____)
2 = Occasionally present (occurs ____to ___
times per _____)
3 = Often present (occurs ____ to ___times
per ____)
4 = Always or almost always present (occurs
more than ____ times per ____ or
continually)
ZAVRŠNI CILJEVI U OCJENI
DJELOTVORNOSTI LIJEKA
1. Vrijeme do poboljšanja važnog parametra u dogovorenom
postotku (npr. 75%, 100%)
2. Vrijeme do obnavljanja simptoma nakon prekida liječenja
3. Vrijeme do nove epizode bolesti tijekom liječenja
4. Stupanj obnavljanja simptoma nakon prekida liječenja
5. Trajanje poboljšanja tijekom terapije održavanja
6. Veličina poboljšanja u fiksnom trenutku (npr. nakon 1 tjedna
ili 1 mjeseca) nakon početka terapije
7. Osjetljiv i specifičan dijagnostički parametar (npr. ejekcijska
frakcija, integrirana površina ispod krivulje, dp/dt)
8. Osjetljiv i specifičan subjektivni parametar
9. Kvaliteta života
10. Smrtnost
CILJEVI FARMAKOEKONOMSKIH ISTRAŽIVANJA
1. Cost-benefit (lijek X vs. drugi lijekovi ili 
2. Cost-utility (najjeftiniji lijek; u artificijalnim
jedinicama, npr. kvalitetno trajanje života)
3. Cost-effectiveness (najjeftiniji lijek; u smislenim
jedinicama, npr. spašeni životi)
4. Cost-of-illness (cijena neliječene bolesti)
5. Cost-minimization (najjeftiniji način za isti terapijski
učinak)
6. Quality of life (troškovi i financijska korist za
pojedinca te subjektivna procjena važnosti tog
troška)
BIHEVIORALNE OCJENSKE LJESTVICE U ODRASLIH*
Ljestvica
1. Anxiety Status Inventory (ASI)
2. Beck Depression Inventory (Beck)
3. Brief Psychiatric Rating Scale (BPRS)
4. Carroll Depression Scale
5. Clinical Global Impression (CGI)
6. Clyde Mood Scale
7. Covi Anxiety Scale
8. Crichton Geriatric Rating Scale
9. Depression Status Inventory (DSI)
10. Hamilton Anxiety Scale (HAMA)
11. Hamilton Depression Scale (HAMD)
12. Hopkins Symptom Checklist (HSCL)
13. Inpatient Multidimensional Psychiatric Scale (IMPS)
14. Nurses Observation Scale for Inpatient Evaluation (NOSIE)
15. Plutchik Geriatric Rating Scale (PLUT)
16. Profile of Mood States (POMS)
17. Sandoz Clinical Assessment – Geriatric
18. Self-Report Symptom Inventory (SCL-90)
19. Wittenborn Psychiatric Rating Scale (WITT)
20. Zung Self-Rating Anxiety Scale (SAS)
21. Zung Self-Rating Depression Scale (SDS)
* ECDEV Assessment Manual for Psychopharmacology, Guy, 1976
Ispunjava
Liječnik
Bolesnik
X
X
X
X
or
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
POMS (Profile of Mood States)
Dolje su navedene riječi koje opisuju ljudske osjećaje. Molimo Vas da svaku od njih pažljivo
pročitate. Zatim križićem ispunite odgovarajuću kućicu ispod odgovora na desnoj strani koji najbolje
opisuje KAKO STE SE OSJEĆALI PROTEKLOG TJEDNA UKLJUČUJUĆI DANAŠNJI DAN.
nimalo
malo
umjereno
poprilično
izrazito
Simptomi
(0)
(1)
(2)
(3)
(4)
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1. Prijazno
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2. Napeto
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3. Ljutito
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4. Iznošeno
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5. Nesretno
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6. Bistre glave
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7. Živahno
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8. Zbunjeno
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9. Žalim zbog učinjenog
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10. Potreseno
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11. Ravnodušno
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12. Zlovoljno
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13. Uviđavno
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14. Tužno
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15. Aktivno
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16. Na rubu
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17. Čangrizavo
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18. Potišteno
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19. Energično
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20. Uspaničeno
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21. Beznadno
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22. Opušteno
LARS (Line Analogue Rating Scale)
Molim Vas da okomitom crticom () na skali označite kako se osjećate ovog
trenutka za navedene simptome:
Više tjeskobno
Manje tjeskobno
Manje umorno
Više umorno
Manje sretno
Više sretno
Više opušteno
Manje opušteno
Manje pospano
Više pospano
Manje ošamućeno
Više ošamućeno
Manje nespretno
Više nespretno
Više na oprezu
Manje na oprezu
Manje energično
Više energično
Više tužno
Manje tužno
Više depresivno
Manje depresivno
IZVRŠENJE SVAKODNEVNIH ZADATAKA (182 starije osobe)*
1. Priprema lakih obroka
2. Oblačenje i svlačenje
3. Pranje posuđa
4. Kupanje ili tuširanje
5. Pospremanje kreveta
6. Uobičajena kupovina
7. Pranje veša
8. Kuhanje
9. Ustajanje iz stolca
10.Čišćenje sa
usisivačem prašine
11.Rezanje nokta na
nožnom palcu
12.Uspinjanje i silaženje
stepenicama
Lako
(1)
%
93
87
89
79
73
75
78
76
64
Poteško
(2)
%
5
13
7
19
20
15
12
14
26
Jako teško Ne radim/ne mogu
(3)
(4)
X
%
%
2
0
1,08
1
0
1,14
2
2
1,18
2
1
1,24
2
6
1,40
4
6
1,40
2
9
1,41
2
8
1,42
9
1
1,47
59
21
7
12
1,72
46
35
7
13
1,87
40
32
13
15
2,03
* Kempen GIJM et al. Hierarchical structure in ADL and IADL: analytical assumptions
and applications for clinicians and researchers. J Clin Epidemiol 1995;48:1299.
COPD
Variable
0
Breathlessness
Cough
No cough
Sputum
production
Sputum colour
None
Colourless
1
2
3
4
5
Not breathless
at rest or on
exertion
Not breathless
at rest, but
breathless on
moderate
exertion (eg,
walking
quickly)
Not breathless
at rest but
breathless on
mild exertion
(eg, walking
on the level)
Not breathless
at rest but
breathless on
minimal
exertion (eg,
getting
washed)
Breathless
at rest
Mild cough (ie,
some, mostly
morning)
Moderate
cough (ei,
some morning
and evening)
Severe cough
..
..
Mild sputum
production (ie,
normal
amount)
Moderate
sputum
production (ie,
>normal,
≤twice normal
amount)
Severe sputum
production (ie
>twice normal
amount)
..
..
White/grey
Light yellow
Dark
yellow/green
..
..
Symptom scores recorded in daily record cards
COMMUNITY – ACQUIRED PNEUMONIA
PATIENT-RISK ASSESMENT
(N Engl J Med 1997;336:243-250)
SCORING SYSTEM
Patient Characteristics
Points Assigned
Demographic Factors
Age: Males.........................................................Age (in years)
Age: Females...............................................Age (in years) -10
Nursing-home resident......................................................+10
Comorbid Diseases
Neoplastic disease............................................................+30
Liver disease....................................................................+20
Congestive heart failure....................................................+10
Cerebrovascular disease....................................................+10
Renal disease...................................................................+10
COMMUNITY – ACQUIRED PNEUMONIA
PATIENT-RISK ASSESMENT
(N Engl J Med 1997;336:243-250)
Physical Examination Findings
Altered mental status........................................................+20
Pulse ≥ 125/BPM..............................................................+10
Respiratory rate ≥ 30/min.................................................+20
Systolic blood pressure < 90 mmHg...................................+20
Temperature <35°C (95°F) or ≥ 40°C (104°F)...................+15
Laboratory Findings
Hematocrit < 30%............................................................+30
pH <7.35.........................................................................+30
Blood urea nitrogen >10.7 mmol/L....................................+20
Sodium <130 mEq/L.........................................................+20
Glucose >13.9 mmol/L......................................................+10
PO2 <60 mmHg................................................................+10
Pleural effusion.................................................................+10
STRATIFICATION OF RISK SCORE
Risk
Low
Moderate
High
Risk Class
I
II
III
IV
V
Based On
Algorithm
≤ 70 total points
71-90 total points
91-130 total points
> 130 total points
Tablica 2. Anketa o nastavi*
Sadržaj mora biti “važan”
po stručnoj ocjeni
1----2----3----4----5
x=3.15
Sadržaj mora biti
“potreban” po ocjeni
slušatelja
Bolja je općenita i
temeljna tematika
1----2----3----4----5
x=4.21
Bolja je primjenjena i
konkretna tematika
Jednosmjerna nastava
1----2----3----4----5
x=4.46
Interaktivna nastava
Predavanja i pokazi
1----2----3----4----5
x=4.26
Seminari i vježbe,
rješavanje problema
Brojno slušateljstvo
1----2----3----4----5
x=4.79
Male grupe
Prisilno sudjelovanje
1----2----3----4----5
x=4.22
Dobrovoljno sudjelovanje
Provjera prisutnosti
1----2----3----4----5
x=3.87
Ispit stečenog znanja
“Lagodna” atmosfera bez
1----2----3----4----5
“Ugodna” atmosfera zbog
obveza
x=3.27
novih iskustava
* studenti medicine, 7. semestar, zadnji dan turnusa (14.1.2000.)
Programme Evaluation
2 / 7 Room Tejo: Plenary Session 1 “Advances in Immunopathology”
Activity endorsed by
EAACI CME Accreditation Council
5
Excellent
Good
Average
Poor
Very
Poor
Unsatis
-factory
1. Organisational and logical level of the
presentations
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2. Ability of speakers to keep my interest
during the session
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3. Relevance of the lectures to my
clinical practice and/or research
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4. The ability of speakers to provoke
critical thoughts on the subject
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5. Contribution to my current knowledge
in the subject by the lectures
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6. The novelty of the contents
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7. Possible impact on my daily practice
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8. The quality of handouts, slides and/or
other material
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9. Meeting room facilities
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10.The overall value of this session as a
learning experience
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SVEUČILIŠTE U ZAGREBU
STUDENTSKA ANKETA
- Ovim upitnikom možete utjecati na poboljšanje i unapređenje nastave, na uočavanje eventualnih problema i
slabosti koje se javljaju u njenoj izvedbi.
- Molimo Vas da na navedena pitanja odgovorite u cijelosti, iskreno, objektivno, samostalno i dobronamjerno.
- Kako bi anketni listić bio važeći molimo da ga ispunite ispravno: x DOBRO, .
LOŠE
Naziv kolegija_____________________Akad.god._____________Semestar______Broj kredita1______________
Nastavnik_______________________________________________
Broj studenata (kolegij upisalo)______Broj studenata (anketu ispunilo)______ Ovaj red ispunjava administracija!
1. Vaša prisutnost predavanjima2
 75-100%
 50-75%
 25-50%
 0-25%
2. Molimo ocijenite nastavnika prema predloženim značajkama:
Pitanja
a) Pripremljenost predavanja
b) Sposobnost jasnog izlaganja gradiva
c) Sustavnost izlaganja
d) Zanimljivost i suvremenost predavanja
e) Spremnost na raspravu
f) Poticanje studenata na raspravu i rad
g) Povezivanje teorije i prakse
h) Odnos nastavnika prema studentu
i) Usklađenost svih oblika nastave
(predavanja, seminari, vježbe)
j) Ocjena rada nastavnika u cjelini
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SVEUČILIŠTE U ZAGREBU
STUDENTSKA ANKETA (nastavak)
3. Jesu li predavanja bila redovita i točno prema rasporedu?
 Redovito i točno
 Redovito sa zadašnjenjem
 Neredovito
 Izrazito neredovito
4. Pokrivenost gradiva literaturom:
 odlična
 dovoljna
 nedovoljna
5. Biste li ovaj kolegij i ovog nastavnika preporučili i drugim studentima?
 Da u svakom slučaju
 Vjerojatno da
 Vjerojatno ne
 Ne, ni u kom slučaju
6. Molimo, navedite Vaše dodatne primjedbe, zapažanja i prijedloge na poleđini ovog listića.
Hvala na vremenu koje ste posvetili ovoj anket, te na iskazanoj pomoći i suradnji.
1
Prije uvođenja kreditnog sustava molimo da navedete broj nastavnih sati prema prihvaćenom planu.
2
Anketni list za predavanja ispunjava se izdvojeno od anketnog listića za seminare i vježbe.
Za seminar i vježbe upisuje se i asistent.
ASTHMA CONTROL QUESTIONNAIRE
PATIENT ID _______________
DATE ____________________
Page 1 of 2
Please answer questions
Circle the number of the response that best describes how you have been
during the past week
1. On average, during the past
week, how often were you
woken by your asthma during
the night?
0
1
2
3
4
5
6
Never
Hardly ever
A few times
Several times
Many times
A great many times
Unable to sleep because of asthma
2. On average, during the past
week, how bad were your
asthma symptoms when you
wake up in the morning?
0
1
2
3
4
5
6
No symptoms
Very mild symptoms
Mild symptoms
Moderate symptoms
Quite severe symptoms
Severe symptoms
Very severe symptoms
3. In general, during the past week
how limited were you in your
daily activities because of your
asthma?
0
1
2
3
4
5
6
Not limited at all
Very slightly limited
Slightly limited
Moderately limited
Very limited
Extremely limited
Totaly limited
4. In general, during the past
week, how much shortness of
breath did you experience
because of your asthma?
0
1
2
3
4
5
6
None
A very little
A little
A moderate amount
Quite a lot
A great deal
A very great deal
ASTHMA CONTROL QUESTIONNAIRE
PATIENT ID _______________
DATE ____________________
Page 2 of 2
5. In general, during the past
week, how much of the time did
you wheeze?
0
1
2
3
4
5
6
Not at all
Hardly any of the time
A little of the time
A moderate amount of the time
A lot of the time
Most of the time
All the time
6. On average, during the past
week, how many
pufs/inhalations of short-acting
bronchodilator (eg.
Ventolin/Bricanyl) have you used
each day)
0
1
2
3
4
5
6
None
1-2 puffs/inhalations most days
3-4 puffs/inhalations most days
5-8 puffs/inhalations most days
9-12 puffs/inhalations most days
13-18 puffs/inhalations most days
More than 18 puffs/inhalations
most days
If you are not sure how to answer
this question, please ask for help)
7. FEV1 pre-bronchodilator:
FEV1 predicted:
FEV1 % predicted: ........................
(Record actual values on the dotted
lines and score the FEV1 %
predicted in the next column)
0
1
2
3
4
5
6
> 85% predicted
95 – 90%
89 – 80%
79 – 70%
69 – 60%
59 – 50%
< 50% predicted