#16
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Âû íå îòâåòèëè. Âîïðîñ òî èìåííî ïðî îáúåêòèâèçàöèþ ñóáúåêòèâíîãî èëè êàê ïîñ÷èòàòü íåïîäñ÷èòûâàåìîå. ß òàê ïîíÿë?
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#17
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Äàâàé ïî ññûëêå, ïî ýòîé òåìå òàì îáñóäèì, îê? À âîîáøå òî îáîèì íóæíà àíàëãåçèÿ.
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#18
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ß ïîïðîñèë ìîäåðàòîðîâ ïåðåíåñòè âñå ýòî òóäà. È âñå òàêè ïåðâîãî ÿ áû ñêîðåå íàêîðìèë ôåíàçåïàìîì, ïîìèìî ïëàíîâûõ ÍÏÂÑ èëè ïàðàöåòàìîëà. À âîò âòîðîãî ñ èñïîëüçîâàíèåì íàðêîòè÷åñêèõ àíàëüãåòèêîâ.
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#19
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åñòü, â ãðåöèè âñå åñòü
Öèòàòà:
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#20
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À ñî âòîðûì ÿ áû íå ïîñïåøèë ñ íàðêîòèêàìè. Òàì áîëåå íàñòîðàæèâàþùàÿ êëèíèêà è ÿ áû äîîáñëåäîâàë áîëüíîãî, íå ñòèðàÿ êëèíèêó.
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#21
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Ýòî êëèíèêà áîëè.
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#22
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Áîëè îò ÷åãî? Ìîæåò íà÷èíàþùèé ïåðèòîíèò?
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#23
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Ïðîøó áåç ôëóäà, ñëåäóþùèé ðàç áóäó ñòðàøíî êàðàòü ïîìèäîðàìè è áàíàìè âñåõ ïîäðÿä.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#24
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Öèòàòà:
Subjective assessment of treatment outcome can be obtained by patient interview or by questionnaires completed by the patient at various stages in the treatment process. The two main methods of recording a patient’s response on paper are the visual analogue scale (VAS) and the Likert scale. FACTORS AFFECTING QUESTIONNAIRE COMPLETION: Although self-completion of a questionnaire by the patient maybe seemingly free from any bias, a person’s intelligence will affect his or her ability to complete a questionnaire. Such errors can be minimized by keeping the questions simple. However subtle psychological factors and personality features may affect the accuracy of the response and cannot be avoided. The factors that can affect questionnaire completion are listed in Table 4. Table 4—Factors that affect questionnaire completion. Patient characteristics: Literacy of patient; Language comprehension; Personality; Psychological state; Tick box fatigue. Questionnaire characteristics : Length of questionnaire; Ease of comprehension; Ease of completion; Irrelevant questions. Other factors: Environment; Influence of family members or care-givers; Pending compensation; Secondary gain.” - R. R. BINDRA, J. J. DIAS, C. HERAS-PALAU, P. C. AMADIO, K. C. CHUNG and F. D. BURKE. ASSESSING OUTCOME AFTER HAND SURGERY: THE CURRENT STATE//Journal of Hand Surgery (British and European Volume, 2003) 28B: 4: 289–294 |
#25
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#26
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×àñòü ñîîáùåíèé, íå èìåþùèõ îòíîøåíèÿ ê òåìå îáñóæäåíèÿ ïåðåíåñåíà â íîâóþ òåìó http://forums.rusmedserv.com/showthread.php?t=131927. Æåëàþùèå ìîãóò ïðîäîëæàòü ñïîð îá îáùèõ âîïðîñàõ â íåé.
Íîâûå ñîîáùåíèÿ, íå èìåþùèå îòíîøåíèÿ ê òåìå, áóäóò óäàëÿòüñÿ. |
#27
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#28
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Íå âîëíóéòåñü, ñïîêîåí, êàê íèêîãäà. Ïðîñòî åùå ðàç ñïðàøèâàþ:"×èòàòü-òî óìååòå?" À åñëè âñå-òàêè óìååòå, òî åùå ðàç ïîñìîòðèòå ïðåäëîæåíèå: "Subjective outcomes require interpretation by assessors or patients and may be prone to problems with reliability on repeated measures. These include patient satisfaction,pain, and function after operation." Îöåíêà áîëè ê êàêèì ìåòîäàì îòíîñèòñÿ? Ñïåöèàëüíî äëÿ Âàñ âûäåëèë ñëîâî. Èëè îïÿòü ÷òî-òî íå òî? È åñëè áóäóò êàêèå-òî ïðåòåíçèè, òî ïðåäúÿâëÿéòå èõ àâòîðàì ñòàòüè èëè ïðèâîäèòå ñâîè íàó÷íûå ïå÷àòíûå ðàáîòû, äîêàçûâàþùèå îáðàòíîå. Ýòî ïî ñòàðîé äîáðîé òðàäèöèè.
Öèòàòà:
Âîò ýòî äà! ×òî ýòî çà ïðèáîð òàêîé, "àëãîìåòð"? Íàâåðíîå ñ ïîìîùüþ íåãî èçìåðÿþò âèñöåðàëüíûå èëè çóáíûå áîëè è ïðèáîð âûäàåò óðîâåíü-ñèëó áîëè â êàêèõ-íèáóäü ìåæäóíàðîäíî ïðèçíàííûõ åäèíèöàõ, íó, ê ïðèìåðó, â ÀËÜÃÀÕ. Äà, è êóäà çàñîâûâàþò ýòîò ïðèáîð, â æèâîò èëè â çóá? Êàê îí ðàáîòàåò è êàê âñå-òàêè îïðåäåëÿåò óðîâåíü çóáíîé èëè "æèâîòíîé" áîëè ( ò.å. áîëè â æèâîòå)? Ðàçúÿñíèòå íåñâåäóùèì. |
#29
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Çíàåòå, à ÿ âîò òàê è íå ïîíÿë, î ÷åì ñïîð âîîáùå, ãîñïîäà?
À ñàìîå ãëàâíîå ê ÷åìó? Òûñÿ÷è ëåò ñóùåñòâóåò òî, ÷òî ìû íàçûâàåì ìåäèöèíîé, äåñÿòêè òûñÿ÷ âðà÷åé ïî âñåìó ìèðó ðàáîòàþò è êàê òî ñïðàâëÿþòñÿ ñ òåì, ÷òî ìíîãèå ïàðàìåòðû âîîáùå íåèçìåðèìû. Íó, âîò âçÿòü ìåíÿ - ÿ ïñèõèàòð. Ìîãó ÿ êàê-íèáóäü èçìåðèòü ãàëëþöèíàöèè èëè áðåä? Õóäî áåäíî ìîãó â öèôèðÿõ âûðàçèòü äåïðåññèþ, èíòåëëåêò. Íî, âû óæ ïðîñòèòå, è áåç âñåãî ýòîãî ìíå ïîíÿòíî - ïñèõîç, èëè íåò, åñòü äåïðåññèÿ èëè íåò. Äàâàéòå ïîìíèòü, ÷òî ÊËÈÍÈÊÀ èìååò ãëàâåíñòâóþùåå ïîëîæåíèå, à âñå ò.í. îáúåêòèâíûå ìåòîäû (êàêèìè áû ñóáúåêòèâíûìè îíè íå áûëè!) ëèøü âñïîìîãàòåëüíûå. Ïðèìåð! Òåìïåðàòóðà òåëà, èçìåðåííàÿ ðòóòíûì òåðìîìåòðîì â ïîäìûøå÷íîé âïàäèíå - îáúåêòèâíî? Óâåðåí, áîëüøèíñòâî ñêàæåò ÷òî äà. à òåïåðü äàâàéòå âñïîìíèì, êàê ýòîò "îáúåêòèâíûé ïîêàçàòåëü" áûë âûâåäåí. Ïðîâåëè ìíîæåñòâî è ìíîæåñòâî èçìåðåíèé, çàòåì îòêèíóëè 5% ñ òîé è ñ äðóãîé ñòîðîíû è ïîëó÷èëè "íîðìàëüíûå" ïîêàçàòåëè. Òàê ÷òî, äàâàéòå ïîìíèòü î êëèíèêå è íå óâëåêàòüñÿ èçìåðåíèÿìè! Âðà÷ äëÿ òîãî è íóæåí, ÷òîáû äóìàòü è îöåíèâàòü.  ïðîòèâíîì ñëó÷àå, ìîæíî ïåðåäàòü ïðèíÿòèå ðåøåíèÿ ñèñàäìèíó Âàñå, êîòîðûé áûñòðî ïðîñêàíèò áîëüíîãî êó÷åé àïïàðàòîâ, âîáúåò â "âîëøåáíóþ" ïðîãðàììó, ïî÷èòàåò îòâåò è îòäàñò ðàñïå÷àòêó ôåëüäøåðó Âàíå. |
#30
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Äåëî â òîì, ÷òî Âû ïðîñòî ïðèâåëè öèòàòó è íå ñîâñåì ïîíÿòíî, ïîääåðæèâàåòå ëè Âû ìíåíèå àâòîðîâ èëè íàîáîðîò.
Ò.å. õîòåëîñü áû ïîíÿòü Âàøó ïîçèöèþ ïî ñëåäóþùèì àñïåêòàì (âàðèàíòû ñóæäåíèé): 1) Áîëü ÿâëÿåòñÿ ñóáúåêòèâíîé îöåíêîé, êîòîðàÿ íå ìîæåò áûòü îáúåêòèâèçèðîâàíà íèêîèì îáðàçîì 2) Ñóáúåêòèâíàÿ îöåíêà áîëè íå íóæäàåòñÿ â îáúåêòèâèçàöèè 3) Ïîñêîëüêó áîëü ñóáúåêòèâíà, êëèíè÷åñêàÿ îöåíêà áîëè íåòî÷íà è íå òðåáóåòñÿ 4) Âîñïðîèçâîäèìîñòü îöåíîê áîëè ôîðìàëüíûìè ìåòîäàìè õðîìàåò, ïîýòîìó íå ñëåäóåò íà ýòó îöåíêó îðèåíòèðîâàòüñÿ â äèíàìèêå 5) Ñóáúåêòèâíàÿ îöåíêà áîëè íåíàäåæíà è íå äîëæíà èñïîëüçîâàòüñÿ â êà÷åñòâå ìåðû èñõîäîâ â êëèíè÷åñêèõ èñïûòàíèÿõ 6) Ïîñêîëüêó îöåíêà áîëè ñóáúåêòèâíà, òî âêëþ÷åíèå ýòîãî ïàðàìåòðà â êîìïëåêñíûå èíñòðóìåíòû îöåíêè (èíäåêñû è øêàëû) äåëàåò òàêèå èíñòðóìåíòû íåîáúåêòèâíûìè è, çà÷àñòóþ, áåñïîëåçíûìè 7) ... äðóãèå âñåâîçìîæíûå âàðèàíòû ... Ïîëüçóåòåñü ëè Âû ñàìè ñóáúåêòèâíîé îöåíêîé áîëè ïàöèåíòîì êàê ìåðîé óñïåõà/íåóñïåõà ëå÷åíèÿ? Åñëè äà - òî â êàêîì âèäå, åñëè íåò - òî ÷òî èñïîëüçóåòå? |