fa بررسی پایایی مقیاس FOUR اصلی و اصلاح شده بر بیماران بستری شده در بخش مراقبت های ویژه بیهوشی Anesthesiology پژوهشي Research <font face="Times New Roman" size="3">&nbsp;</font> <p class="MsoNormal" dir="rtl" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: inter-ideograph"><b><span 10pt="" 9.0pt="" b="" font-size:="" lang="AR-SA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-hansi-font-family:="" new="" span="" style="font-family: " times="">: </span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">ارزیابی بیماران کمایی یکی از مهم ترین بخش از مراقبت ویژه است. تعدادی از ابزارهای در دسترس بررسی کما به صورت عمومی و گسترده به کار می روند. از بهترین آن ها که شناخته شده و مورد مقبول عموم واقع شده است </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">GCS</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> می باشد. به تازگی ابزاری به نام </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> (نمای کلی از عدم پاسخ) به عنوان مقیاس مناسب جهت بررسی بیماران دچار تغییر سطح هوشیاری معرفی شده است که در حال گذراندن مراحل تکمیلی خود می باشد. این پژوهش بخشی از مطالعه بزرگ تر اصلاح و اعتباریابی مقیاس </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> بوده و هدف از این مطالعه بررسی پایایی مقیاس </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلی و اصلاح شده در بیماران بستری در بخش مراقبت های ویژه بود.<!--stripped--><!--stripped--></span></b></p> <b><font face="Times New Roman" size="3">&nbsp;</font></b> <p class="MsoNormal" dir="rtl" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%"><b><b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">روش کار</span></b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">: این پژوهش از نوع تحقیق روش‌شناسی می باشد. جهت تعیین پایایی از توافق نظر بین مشاهده کنندگان استفاده شد. نرم افزار به کار گرفته شده</span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">SPSS </span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span><font size="2"><font face="B Mitra"><span style="mso-spacerun: yes">&nbsp;</span>نسخه 21 بود. پانزده بیمار بستری در بخش مراقبت های ویژه توسط 40 پرستار آموزش دیده با ابزار </font></font></span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلی و اصلاح شده امتیاز دهی شدند و در مجموع 104 بار مشاهده توسط مشاهده کنندگان انجام شد.<!--stripped--><!--stripped--></span></b></p> <b><font face="Times New Roman" size="3">&nbsp;</font></b> <p class="MsoNormal" dir="rtl" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%"><b><b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">یافته ها</span></b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">: توافق نظر بین مشاهده کنندگان در امتیازدهی </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلی 28/0 (12/0</span><span dir="ltr"></span><span dir="ltr"></span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times=""><span dir="ltr"></span><span dir="ltr"></span> p=</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span>) با احتمال 95/0 درصد دارای سطح معناداری نبود و در </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلاح شده توافق نظر بین مشاهده کنندگان 63/0 (001/0</span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">p=</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span>) با احتمال 9/99/0 درصد محاسبه شد، که دارای توافق معناداری بود.<!--stripped--><!--stripped--></span></b></p> <b><font face="Times New Roman" size="3">&nbsp;</font></b> <p class="MsoNormal" dir="rtl" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: inter-ideograph"><b><b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times="">نتیجه گیری:</span></b><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""> مقیاس </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلاح شده پایاتر از </span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">FOUR</span><span dir="rtl"></span><span dir="rtl"></span><span 10pt="" 9.0pt="" b="" font-size:="" lang="FA" mso-ansi-font-size:="" mso-ascii-font-family:="" mso-bidi-language:="" mso-hansi-font-family:="" new="" style="font-family: " times=""><span dir="rtl"></span><span dir="rtl"></span> اصلی بود.</span><span 10.0pt="" 9pt="" b="" dir="ltr" fa="" font-size:="" mso-bidi-font-family:="" mso-bidi-font-size:="" mso-bidi-language:="" new="" style="font-family: " times=""><!--stripped--><!--stripped--></span></b></p> <b><font face="Times New Roman" size="3">&nbsp;</font></b> <font face="Times New Roman" size="3">&nbsp;</font> <p class="MsoNormal" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal text-justify: inter-ideograph tab-stops: 357.1pt"><b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">Background</span></b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">: The assessment of comatose patients is an important part of critical care. Few of the many available coma scales have gained wide spread approval and popularity. The best known and widely accepted scale is the Glasgow Coma Scale (GCS). The newer FOUR score (Full Outline of Un Responsiveness) provides an attractive replacement for all patients with fluctuating levels of consciousness and is gradually gaining wide acceptance. This study is part of the larger study of Modification and validation of FOUR coma scale. The aim of this study was to compare the inter-rater reliability of the Modified and original FOUR coma scale among patients hospitalized in Critical Care Unit. </span><span b="" mso-bidi-font-family:="" new="" style="font-family: " times=""><!--stripped--><!--stripped--></span></p> <font face="Times New Roman" size="3">&nbsp;</font> <p class="MsoNormal" style="margin: 0cm 0cm 0pt line-height: normal"><b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">Methods</span></b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">:</span><font size="3"><span b="" mso-bidi-font-family:="" new="" style="font-family: " times="">&nbsp;</span><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">This is methodological research. For inter-rater reliability 15 patients admitted in ICU were scored by 40 nurses with the original and modified FOUR Coma score and a total of 104 pair-wise rating was done.<!--stripped--><!--stripped--></span></font></p> <font face="Times New Roman" size="3">&nbsp;</font> <p class="MsoNormal" style="margin: 0cm 0cm 0pt text-align: justify line-height: normal text-justify: inter-ideograph"><b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">Results</span></b><span 12pt="" font-size:="" mso-bidi-language:="" new="" style="font-family: " times="">: The inter-rater agreement among raters (P=0/12) was 0.28 (unacceptable level) for original and (P= 0/001) was 0.63 for modified FOUR Scale (good level).<!--stripped--><!--stripped--></span></p> <font size="3"><font face="Times New Roman"> <b><span 12pt="" en-us="" fa="" font-size:="" minor-fareast="" mso-ansi-language:="" mso-bidi-language:="" mso-fareast-font-family:="" mso-fareast-language:="" mso-fareast-theme-font:="" new="" style="line-height: 115% font-family: " times="">Conclusion</span></b><span 12pt="" en-us="" fa="" font-size:="" minor-fareast="" mso-ansi-language:="" mso-bidi-language:="" mso-fareast-font-family:="" mso-fareast-language:="" mso-fareast-theme-font:="" new="" style="line-height: 115% font-family: " times="">: Modified FOUR Coma scale performs better than the original FOUR Scale for good inter-rater agreement</span></font></font> مقیاس چهار نمره‌ای, تعیین سطح هوشیاری, مقیاس گلاسکو کما, پایایی. FOUR Scale, Level of consciousness, Glasgow coma Scale, Reliability 85 90 http://rjms.iums.ac.ir/browse.php?a_code=A-10-1-1641&slc_lang=fa&sid=1 Zahra sadat Moosavi sani زهرا سادات موسوی ثانی 3900319475328460043505 3900319475328460043505 No AJA University of Medical Sciences, Tehran, Iran ، دانشگاه علوم پزشکی ارتش، تهران، ایران Seyed Amirhosein Pishgooie سید امیر حسین پیشگویی 3900319475328460043506 3900319475328460043506 Yes AJA University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ارتش، تهران، ایران Armin Zareiyan آرمین زارعیان 3900319475328460043507 3900319475328460043507 No AJA University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ارتش، تهران، ایران Seyed Davood Tadrisi سید داود تدریسی 3900319475328460043508 3900319475328460043508 No , Baqiyatallah University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی بقیه الله، تهران، ایران