ABSTRACT
BACKGROUND: The Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) is a standard instrument to measure pediatric inpatients' experience of care. Currently, no Chinese version of the Child HCAHPS exists for Chinese patients. Therefore, this study aimed to create a Chinese version of the Child HCAHPS and investigate its validity and reliability in a Chinese setting. METHODS: Using the approach recommended in guidelines from the Agency for Healthcare Research and Quality for translating HCAHPS surveys, we produced a Chinese version of the Child HCAHPS. A two-month field test with seven hospitals across five provinces in China was performed to assess its validity. Construct validity was assessed using confirmatory factor analysis. We evaluated convergent validity by factor loading, average variance extracted (AVE), and construct reliability (CR). Cronbach's alpha and corrected item-total correlation (CITC) were used to reflect hospital-level unit reliabilities for the survey's item composites. The correlation of the measure score with the overall rating was calculated to evaluate criterion validity. RESULTS: An overall response rate of 63% was achieved, and 2,258 respondents completed the questionnaire. Confirmatory factor analysis showed a comparative fit index (CFI) of 0.905, a non-normed fix index of 0.886, and a root mean square error of approximation (RMSEA) of 0.089. Most items had factor loadings over 0.7. Cronbach's alpha coefficient on the overall level was 0.981, and all measures' CITC exceeded 0.6, demonstrating good to excellent hospital-level reliability of the composite and single-item measures. All composite measures had good to excellent internal consistency reliability (0.716 to 0.994). Item-to-composite correlation ranged from 0.510 to 0.997. Composite-to-composite correlations ranged from 0.488 to 0.997. According to the survey result, for all the 18 composite or single-item measures, mean top-box scores ranged from 56% ("Involving teens in care") to 87% ("Informed in Emergency Room"). CONCLUSIONS: The Chinese version of the Child HCAHPS demonstrated acceptable validity and reliability. The application of this tool can help benchmark ongoing healthcare improvement initiatives in China.
ABSTRACT
UNLABELLED: To investigate value of amplitude-integrated electroencephalograph (aEEG) in early diagnosis and prediction of long-term prognosis of neonatal hypoxic-ischemic encephalopathy (HIE), 120 HIE Children were randomly assigned into aEEG group and control group (n = 60 per group). Children in each group were sub-divided into mild, moderate and severe HIE groups (n = 20 per group). 1, 3, 14 and 28 days after birth, aEEG was performed in aEEG group; 3, 14 and 28 days after birth, neonatal behavioral neurological assessment (NBNA) was done in both groups. Children who discharged were followed up at adjusted gestational age of 12 months with Denver Developmental Screening Test (DDST) and prognosis evaluation. RESULTS: aEEG manifestation was positively related to clinical severityb of HIE (r = 0.843, P < 0.01). On day 3 and 14, NBNA score was comparable between two groups (P > 0.05), but significant difference in NBNA score was noted on day 28 (P < 0.05). On day 3, 14 and 28, aEEG manifestation was positively associated with prognosis at adjusted gestational age of 12 months (r = 0.832, 0.857, 0.778, 0.743, P < 0.01). In aEEG group, disability rate was 13.8%, which was significantly lower than that in control group (23.2%); cure rate in aEEG group (60%) was significantly higher than that in control group (40%). Moreover, long-term prognosis was also dramatically different between aEEG group and control group (χ(2) = 4.107, P < 0.05). CONCLUSION: aEEG manifestation is significantly associated with clinical severity of HIE and may be helpful for early diagnosis of HIE. aEEG may be used to predict long term prognosis of HIE children.
ABSTRACT
OBJECTIVE: To determine whether early application of Duo positive airway pressure (DuoPAP), in comparison with nasal continuous positive airway pressure (NCPAP), can reduce the need for endotracheal intubation and mechanical ventilation and decrease the incidence of bronchopulmonary dysplasia (BPD) in preterm neonates with respiratory distress syndrome (RDS). METHODS: In a single-center, randomized controlled trial, preterm neonates (gestational ages 30-35 weeks) with RDS were randomly assigned to receive DuoPAP (n=34) or NCPAP (n=33) within 6 hours of birth. If the two noninvasive ventilations were not effective, endotracheal intubation and mechanical ventilation were used, and pulmonary surfactant was administered as rescue therapy. The total invasive respiratory support rate and incidence of BPD within 24, 48 and 72 hours of birth were observed. The two groups were compared in terms of PaCO2, PaO2 and oxygenation index (OI) at 1, 12, 24, 48 and 72 hours after using the noninvasive respiratory support. RESULTS: The total invasive respiratory support rates within 48 and 72 hours after birth were significantly lower in the DuoPAP group than in the NCPAP group (P<0.05). There was no difference in the incidence of BPD between the two groups (P>0.05). The OI in the DuoPAP group was significantly higher than in the NCPAP group at 1, 12, 24, 48 and 72 hours after noninlasive respiratory support (P<0.05). The DuoPAP group showed significantly lower PaCO2 than the NCPAP group at 1, 12, and 24 hours after noninvasive respiratory support (P<0.05). PaO2 was significantly higher in the DuoPAP group than in the NCPAP group at 1 and 12 hours after noninvasive respiratory support (P<0.05). CONCLUSIONS: Compared with NCPAP, early application of DuoPAP can decrease the need for endotracheal intubation and mechanical ventilation in preterm neonates with RDS, showing promise for broad use.
