12/28 NTUH clinical assessment

五字數值試(Five digit test, FDT):
作者：Manuel Sedo
出版社：TEAEDICIONES
中文翻譯者：Kar Ho Lau, a fantastic High School Senior in Boston, MA.
費用：Booklet-$10
Answer sheet-$25

http://www.sedo.net-a.googlepages.com/home

Non language bound low academic loaded alternative form of the stroop test that has been shown to be sensitive to automatic and controlled attention processes. The FDT test is used in children to measure reading ability and in clinical adults to measure brain damage from various causes.(Ages 6 to adult)

Second review:
I have questions regarding the Chinese version of FDT:
1. I’m confused about the stopping time that showed in the answer sheet at two different time?
2. How do I use the time and the numbers of correct items to interpret the patient’s function?
3. Can patients use their finger to point at each box to help them focus while counting numbers in each box?
4. Is the patient allowed to correct their answer during test?



複本就是類似原始量表的另一個施測版本 使用複本的目的主要是要避免使用原始量表產生的練習效應的影響 (e.g. 受測者可能會記得之前的題目及答案)

12/26 NTUH clinical & review IRB form

申請臨床試驗IRB
台大:要申請證明,則臨床試驗計畫送件核對單多印一張交給林淑芳蓋章後即可領回(需蓋申請者章)

1、臨床試驗計畫送件核對單(置於首頁)
2、臨床試驗計劃申請書--最末頁上需蓋申請者章及單位主管章(醫院-部主任章，醫學院-科主任章)
3、臨床試驗計劃書(首頁右上角需加上計畫申請人及蓋章)
4、臨床試驗快速審查範圍評檢表(背面需蓋申請者章及單位主管章)
5、臨床試驗受試者說明及同意書(首頁需蓋主要主持人章)
6、問卷
7、參考文獻
8、主持人及協同研究人員之學經歷、著作及所受訓練之背景資料(首頁需蓋申請者章)
9、檔案附光碟、隨身碟或email至NTUHRE011@yahoo.com.tw
10、以上申請時訂為一份合計共需2份,送至東址B4(AB棟)研究倫理委員會辦公室(門口有門禁)，分機3155申請
最好全部單面列印(除臨床試驗計劃書可雙面列印)--現沒規定
11、倫委會網頁台大醫院/文件表格/醫學研究部之表格下載
http://intra.mc.ntu.edu.tw/default_Ehospital.asp
e-mail: shuhwai@ha.mc.ntu.edu.tw

計劃時間更改變更
1.變更申請公文-簽一份
2.臨床試驗計畫申請書舊計劃時間第一,二張影本
3.新的臨床試驗計畫申請書,臨床試驗計畫書
高醫倫委會07-3121101-2396
國衛院02-26534401-23322

#因此需要檔案分開,在排版時較容易處理!

12/24 NTUH IRB(attention)

Mission:
1.Find out the prize of the FDT in english version.
2.Redesign the answer sheet in more easy exanmination way.
3.Need to pass up the IRB on Wednesday.

12/21 NTUH's clinical assessment & review article

Mission:
1.Today have finished 2 ADL and 1 BIB.
2.Next week may be will come on Monday 12/24,Wednesday12/26 and Thusday12/27.


FDT's Question:
I have questions regarding the Chinese version of FDT:
1. I’m confused about how to administer the test. In the instruction part, the stopping time isn’t mentioned anywhere. However, in the answer sheet ,stopping time is showed at two different time?
2. What is the instruction of the FDT scoring? How do I use the result (time and the numbers of correct items) to interpret the patient’s function?
3. Can patients use their finger to point at each box to help them focus while counting numbers in each box?
4. Is the patient allowed to correct their answer during test?

12/18 IRB form & NTUH's clinical assessment

Mission:
1.Today finished 2 ADL and1 BIB.
2.Use photoimpact correct the chinese numerals to Arabic Numerals.
3.Review the IRB form and article.
4.Disscuss the question of FDT with angie.(may be need to mail to the author)

12/17 IRB form & NTUH's clinical assessment

Mission:
1.Review IRB form of Wan Fang.
2.Today finished 1BIB and ADL,and 1 FDT.


Question about FDT:
1.patient will use their finger to point out the box of the test while answering the number,suitable or not?
2.what is the Criterion of this test?how to mention about the account of corret answer and the time?how to interpret p't ability?
3.patient will corret their answer while they fnd out the wrong answer,in that moment,what should I do ?

12/14 IRB form &NTUH's clinical assessment

萬芳IRB 需求:
1. 收件表單
2. 送審資料清單
3. 快速審查範圍勾選表 ( 視需要 )
4. 人體試驗計畫申請書
5. 審查意見表---一般
6. 主持人 / 共同主持人資料 ( 個人簡歷、臨床試驗 GCP 訓練資料等 )
7. 計畫書摘要 ( 若為查驗登記之試驗請另檢附衛生署之計畫書摘要格式 )
8. 計畫書 ( 計畫書參考範例 )
9. 受試者同意書 ( 一般試驗、基因、檢體 )、寫作建議
10. 醫療資源使用表
IRB 計畫
萬芳醫院 教研部
Tel: 02-29307930--轉機1467 or 1465陳嘉宏先生(IRB)
==>if get any question about IRB,can ask him.
寄件到此信箱96315@wanfang.gov.tw
相關表格，請至 http://www.wanfang.gov.tw/edu/06_irb/download.htm

if get any question about IRB,can ask him.
Mission:
1.Review the data of the IRB form
2.Today just finished 1 paper of BIB and ADL.
3.Next week will come on Monday, Tuesday and Fiday.

12/13 IRB form & NTUH's clinical assessment

Mission:
1.fill in all the form of Wan Fang.
2.Today i finished 1 ADL & BIB, and 2 FDT with stroke p't.

Tomorrow Mission:
1.call the 林嘉皇老師 about the plan will delay after Chinese New Year.
2.change the chinese number of FDT to Arab number e.g四-->4.
3.conclude the question about the FDT and article, tomorrow afternoon will discuss with sir.

寫作要點

1. 撰寫主題句：明確的主詞，完整明確的句意。若有可能，再精簡之！
(不是原句翻譯,而是擷取句子重點,然後以本身的句子表達出來)

2. 段落或章節內容，可先具體體會其意義，闔上書本後，再將段落或章節之重點，以自己的詞彙撰寫下來。（然而若有不懂或模糊不清之處，務必跟老師討論及澄清之！）

3.效率提問題:有任何問題,或者不明白的句子,應先釐清不明白的地方或者將問題以文字表達出來,再經由本身的思考,經過沉澱後再提出!

名詞解釋-網路篇 for 統計相關詞彙
「統計相關詞彙」可參考：http://ccms.ntu.edu.tw/~clhsieh/spss2003.htm 個人彙整。
研究方法及心理計量相關詞彙解釋：http://www.smithsrisca.demon.co.uk/research-methods-glossary.html
統計及心理計量詞彙：http://www.sportsci.org/resource/stats/ 2005-07-11
Logical Validity（邏輯效度）
Essentially the same as content validity, but, for a motor skills test. If the test assesses performance of what was taught without being confounded with other variables the test is logically valid. For further details, please take a visit at: http://www.geolog.com/msmnt/mval.htm

Future Plan:
資料庫查詢與彙整

學習 Endnote 軟體之使用 （詳：http://ccms.ntu.edu.tw/~clhsieh/EndNote/）
學習查詢 PubMed 資料庫建立簡易的 bibliography 於 Endnote以上

12/12 Reading & Revision

Mission:
Some questions about FDT:
1.why the answer beed to separate 2 stop timing,what is the meaning?
2.Figure out the instruction of evaluation and scoring !
3.If the tester said a wrong answer while having the examination,how to scoring or need to remind them that they couldn't change the answer?
4. The guidance of the assessment need to more profession,clear and understanding,or not they will spend much time to understanding and finish it.
5.some examination protocol need to figure out!
such like ,
指導語的目的是讓個案明白測驗作答方式，故在陳述指導語時，應隨時與個案保持視線接觸，並且視個案的反應而調整解釋的速度。而非將指導語通通唸完後，才看受試者。

一開始詢問個案是否有無老花或近視，若個案回答有，則應進一步主動詢問是否有帶來，若無，就拿出我們備用的眼鏡(如果我們自己有準備,目前還沒有)。而不是在個案測驗已經進行一半時，等到個案反應才拿出來。
6.是否應該先探討文字和算數這兩者對受試者那一者影響較多?為何要探討呢?

Five digit test(FDT):五字數值試

五字數值試(Five digit test, FDT):
作者：Manuel Sedo
出版社：TEAEDICIONES
中文翻譯者：Kar Ho Lau, a fantastic High School Senior in Boston, MA.
費用：booklet-$10
Answer sheet-$25

※2種不同評估方式：讀取或者數一數排列在圖卡上的一組數字或星星符號；或者不同數目和數字組合(1個4、2個5及3個1等等)。
※為中性語言，不要求讀出，可施測於無法在Stroop色字測驗回應的個案，比如年幼個案、文盲和色盲(無法分辨顏色的個案)。
※由於不同社會和文化背景下，最少為5個字句為最適合讓個案理解測驗的題目；及可跨文化和語言比較。(部分個案需要使用語音答案卷來回答以便能更清晰理解測驗的題目內容)
※分為4部分(閱讀一頁有50個項目)：
◎Rate of production(生理回應) of the subject反應：
=>檢測功能：言語速度（speeded verbal production）、流暢度（fluency）
＃Part1:Reading閱讀：讀出卡片上的數字
＃Part 2:Couting算數：數一數卡片上星星的數目
◎Cognitive controls of the subject適應：
=>檢測功能：認知結果（conscious effort）、計畫能力（planning）、適應性（flexibility）
【選擇性注意力和轉移性注意力】
＃Part 3:Selecting焦點：數一數卡片上數字的數目(選擇有矛盾的項目而不是讀取數
字)。比如數字為5但只有一個，答案為1。
＃Part 4:switching適應：在黑框中，所有項目之間從數數和讀取施測方式的轉移。
※嘗試用於和Stroop色字測驗(Stroop Color Word Test)比較直覺概念上的不一致(perceptual-conceptual conflict)
Stroop色字測驗為需個案讀出或命名出字的顏色，有時字的顏色會不一樣。

在非臨床狀況下，SCWT和FDT的相關為.71，.64，.66和.65（顯著水平p=.001）。
與較年老的中風患者比較，FDT能準確辨別97.5%的個案（隨意分類與測驗”沒有顯著差異”），但無法提供功能化。
FDT較少強調項目內容；但卻注重過程：控制順序結果和自我認知導向。
在臨床個案上，FDT為一般、控制、快速施測；分數無法與教育程度和受傷前能力呈現相關，及個案神經狀況表現負重。
FDT 為無特殊非閱讀測驗卻具有敏感的分辨腦部是否受損，尤其在多種文化個案上卻有著語言優勢或者不同教育程度、文盲或者色盲。

12/10 Reading article

Q&A
1.一旦在文章中得証信效度,有沒有一套方法或者其他方式可以知道這篇論文是否值得我們去參考或應用!
Ans:對於論文--價值==>研究設計或研究主題(多層面的,因有不同的issues需要確定)能不能夠回答探討的問題.因此我們才需要去懷疑這篇文章內容,將此篇的論文使用的方法和其他之前看過有類似ㄧ樣的做比較(comparison);也可以藉由文章內的討論,研究上的限制,介紹自己的優缺點以及前言對其他文章的討論來作為indicator.

2.另一個面向,則是如何知道工具是否可以證明這篇論文或如何去驗證?
Ans:就要看其研究的項目是那一種,如再測信度,施測者間信度等等,從它們的定義,統計指標,判讀標準以及臨床涵義或價值去推斷此篇論文的核心在告訴我們什麼事情!作者為何要以如此的研究工具去探討什麼議題?為何要利用某個項目來研究此目的的關係?

IRB 計畫
萬芳醫院 教研部 Tel: 02-29307930--1467(IRB)--96315@wanfang.gov.tw 1465陳嘉宏先生
相關表格，請至 http://www.wanfang.gov.tw/edu/06_irb/download.htm

12/7 Reading Article

P(probability):Inferential statistic =>estimate population 推母群體
=>characteristic of population
用sample 的特性去推population
@CI=confidence Interval 信賴區間
99%CI(α=0.05)={mean-2.57SD,mean+2.57SD}99%左右的樣本的平均值會落入U±2.58SE
95%CI(α=0.05)={mean-1.96SD,mean+1.96SD}95%左右的樣本的平均值會落入U±1.96SE
90%CI(α=0.05)={mean-1.645SD,mean+1.645SD} 90%左右的樣本的平均值會落入U±1.64 SE


當數值超過CI範圍==>表示不屬於此sample

Hypothesis testing: intervention 之後,看進步是因為by chance or sampling error
費雪爾（R.A.Fisher），把假設分為虛無假設（null hypothesis）與對立假設（alternative hypothesis）
兩種，且分別以符號Ho及H1表示之。
費雪爾建議：將實驗者心目中盼望得到的研究結果當作是對立假設H1 ；而將與對立假設完全相反的結果當作是虛無假設Ho。在兩種假設當中，只有虛無假設是直接受到統計檢定。費雪爾希望藉由統計測驗推翻虛無假設，從而間接的為對立假設的可信性提供支持。
1-4steps:
1.state null hypothesis: intervention 無效
Ho=Ua=Ub=Ua-Ub=0
#拒絕 虛無假設
#接受 虛無假設(介入無效)
evidence is too weak to support the effect (intervention 不一定無效)
2.state the alternative hypothesis:intervention 有效
H1=Ua≠Ub or Ua-Ub≠0 (nondirectional hypothesis)
H1=Ua>Ub(directional hypothesis)較常用
3.select level of significance (α)
error:decision to reject
Type 1 error(α)α=0.05(p<0.05)
type 2 error(β)β=0.2(power=0.8)

p=0.05 有5%的機率效果是by chance,有5%是Type 1error
p values: p<0.001 or p=0.001 在統計的意義=>都小於0.05,reject Ho
可以看出有進步或改變的差異
要看效果則要看effect size(ES)

null hypothesis(虛無假設）
「虛無假設」是母群體的變數。假設驗證是要根據實驗資料測試虛無假設的可行性，它可能被推翻或不被推翻。The null hypothesis is an hypothesis about a population parameter. The purpose of hypothesis testing is to test the viability of the null hypothesis in the light of experimental data. Depending on the data, the null hypothesis either will or will not be rejected as a viable possibility.
研究者想研究酒精和人對音調反應的影響。當µ1 表示喝酒者的平均反應時間，而µ2表未喝酒者的平均反應時間，則此虛無假設為µ1 - µ2 = 0。
Consider a researcher interested in whether the time to respond to a tone is affected by the consumption of alcohol. The null hypothesis is that µ1 - µ2 = 0 where µ1 is the mean time to respond after consuming alcohol and µ2 is the mean time to respond otherwise.
虛無假設通常和實驗者的預測結果相反，為的是要讓實驗資料將之推翻。此實驗中，實驗者認為酒精對反應力有不良的影響，若實驗資料亦顯示如此，則可以將虛無假設推翻。
The null hypothesis is often the reverse of what the experimenter actually believes; it is put forward to allow the data to contradict it. In the experiment on the effect of alcohol, the experimenter probably expects alcohol to have a harmful effect. If the experimental data show a sufficiently large effect of alcohol, then the null hypothesis that alcohol has no effect can be rejected.
http://www.ruf.rice.edu/~lane/hyperstat/A29337.html

null hypothesis：先假設和原本假設相反的假設，也就是「虛無假設」，再推翻它，進而證明原假設成立。（這麼做的原因是因為要直接證明一個假設成立很難，因為它可能在各種狀況下都成立，而只要所有情況中有任一個可以證明假設不成立，即可推翻此假設，但我們又不能保證已經找出所有的情況故最好的方法就是先假設和預期相反的虛無假設，再進一步推翻它，此方法較容易，且可間接證明原先預期成立。

12/6 NTUH's assessment & visit OT at Wan Fang Hospital

Mission:
1.2p't were out of croterion,one p't stroke because of falling floor,and the others' balance too poor to assessment his performance ,the score almost was zero.

2.Wan Fang Hospital:
林嘉皇老師 : 02-29307930轉1612, H.phone:09-26155910
Rush time :Mon,Wed,Fri---> 9-10a.m & 2-3p.m
Space: Have one bobath bed for us to assessment BIB,but if we have any interview or assessment in rush hour that the environment are crowed for us to do it.So ,we can use the corridor (the space of outside therapy room,still need time to observation).
Next Friday will go to contact with the 林嘉皇老師 for the next arrangement.

12/5 NTUH's assessment

Mission:
1.Today i finished 3ADL& BIB.
2.Tomorrow i will go to Wan Fang hospital for figure out the situation at there,such as how many CVA p't(name list),environment(bed,a room for cognition),how i reach the p't,and the detail of our plan need to interpretation!
3.Tomorrow morning plan to have meeting with sir!

Responsiveness（反應性）

1.反應性決定一工具是否夠敏感及可以偵測出臨床重要的變化。指評估工具可偵測出具臨床意義之改變的能力。(Responsiveness determines whether an instrument is sensitive to and can detect clinically important change.) (Hobart, 1996)

2.反應性是指一測量工具能在改變確實發生的情況下所檢測出表現改變的能力。(Responsiveness is the ability of an assessment to measure change in performance over time in situations where change truly occurs.) (Deusen. & Brunt, 1997)
【〝Assessment in Occupational Therapy and Physical Therapy〞by J.V. Deusen. & D. Brunt. (1997) p.432 、 Hobart, J.C. (1996). J. Neurol Neurosurg & Psychiatry, 60, 127-130. 】

3.指此量表偵測欲測量特質些微變化的能力。一個良好的量表，應能適當地反應病患或治療師所感受到或觀察到之功能變化。

effect size（效應值）

Effect size(ES)效應值：效應值是一群能測量治療成效大小的指標，而它們與樣本大小並不相關。效應值普遍使用在 "變化分析"的研究上，並從一特定的研究範圍內歸納出結果。例如Lipsey and Wilson(1993)中寫到，用於心理、教育和行為治療上。Effect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. ES measures are the common currency of meta-analysis studies that summarize the findings from a specific area of research. See, for example, the influential meta-analysis of psychological, educational, and behavioral treatments by Lipsey and Wilson (1993).d = M1 - M2 / swheres = Ö[å(X - M)² / N] (X為原始分數；M表平均)(Ö表開根號；å表sigma加總)Cohen(1988)定義d為兩次測量平均差/兩者測量中任一個的標準差。(前提是兩者的變異數的數值相近)Cohen (1988) defined d as the difference between the means, M1 - M2, divided by standard deviation, s, of either group. Cohen argued that the standard deviation of either group could be used when the variances of the two groups are homogeneous. 若兩次測量的標準差數值相差很大，則用 s pooled = Ö[(s1²+ s2²) / 2] 代替。M1 - M2的值若為正，則表個案經過治療後有進步；M1 - M2若為負，則表退步。By convention the subtraction, M1 - M2, is done so that the difference is positive if it is in the direction of improvement or in the predicted direction and negative if in the direction of deterioration or opposite to the predicted direction.effect size d Percentage of Overlap ----------------------------------------------------- Small 0.20 85Medium 0.50 67Large 0.80 53David C. Howell (2001) Statistical methods for psychology 效應值可被解釋為兩次樣本分佈中(有接受治療和沒接受治療的個案族群)未重疊的部分。所以ES等於0就表示兩者全完重疊。(即治療前後沒有改變)Effect sizes can also be interpreted in terms of the percent of nonoverlap of the treated group's scores with those of the untreated group, see Cohen (1988, pp. 21-23) . An ES of 0.0 indicates that the distribution of scores for the treated group overlaps completely with the distribution of scores for the untreated group, there is 0% of nonoverlap.

12/4 NTUH's assessment

Mission:
1.i went to Renai branch Hospital for collecting the data of P't.
2.Recently only increased the number of CVA p't, today finished one BIB
3.Arrange a plan go to 萬芳Hospital for collecting data.

12/3 P> 5% or < 5%

P值指的是比較的兩者的差別是由機遇所致的可能性大小。
P值越小，越有理由認為對比事物間存在差異。
例如，P<0.05,就是說結果顯示的差別是由機遇所致的可能性不足5%，或者說，別人在同樣的條件下重複同樣的研究，得出相反結論的可能性不足5%。
P>0.05稱“不顯著”；P<=0.05稱“顯著”，P<=0.01稱“非常顯著”。
由於常用“顯著”來表示P值大小，所以P值最常見的誤用是把統計學上的顯著與臨床或實際中的顯著差異相混淆，即混淆“差異具有顯著性”和“具有顯著差異”二者的意思。其實，前者指的是p<=0.05，即說明有充分的理由認為比較的二者來自同一總體的可能性不足5%，因而認為二者確實有差異，下這個結論出錯的可能性<=5%。而後者的意思是二者的差別確實很大。舉例來說，4和40的差別很大，因而可以說是“有顯著差異”，而4和4.2差別不大，但如果計算得到的P值<=0.05，則認為二者“差別有顯著性”，但是不能說“有顯著差異”。

由於“有顯著差異”和“差異具有顯著性”容易混淆，因而現在有些期刊提倡用“差異有統計意義”來代替“差異有顯著性”，用“差異無統計意義”、“差異有高度統計意義”來代替“差異不顯著”和“差異有高度顯著性”。
如果P>5%，是否我們就可以下結論說比較的二者沒有差別呢？
不能。P>5%只能說明沒有充分的證據說明二者確有差別，但是也不能說二者沒有差別或差別很小。在這兩個極端之間還有一個過渡區間，即無論下有差別還是沒有差別或差別很小的證據都不足。要推斷二者沒有差別或差別很小，需要採用等效檢驗的統計推斷方法。
虛無假設（null　hypothesis)通常是表示沒有差異的假設，也叫原假設。
discussing the p-value related to the correlation coefficient. Of course, the p-value represents the probability of incorrectly rejecting the null hypothesis. If the p-value is less than some significance level, alpha, (typically practitioners use an alpha of 0.05) then we say that the result is statistically significant (at the 5% level) - i.e. the probability of incorrectly rejecting the null hypothesis is less than 5%.
"For the test I think you're alluding to, it would indicate that we would reject the null hypothesis that rho (the true correlation coeff) is equal to zero, hence there may be some evidence to suggest that a linear relation is present. Don't ignore a scatter diagram though, of course!"
...If the p-value for a correlation coefficient test is less than 0.05, it indicates that the correlation coefficient IS significantly different from zero (either positive or negative) at the alpha = 0.05 level. This means that there is some significant amount of linear relationship between your two variables of interest.
Imagine that there is a universe of points from the process you are studying. You take a sample of those to see if you can prove or disprove correlation. The truth that you are assuming is that there is no or null correlation.

"Now you develop some test or way to mathematically relate the sample to some statistic, in this case rho. You then compare it to some reference distribution. The probability (p) that you selected the sample in such a way that you got a sample that shows there is some correlation, i.e. that rho is not zero, when in fact it is zero, the truth you assumed; is the p value. In other words it is the probability that your sample indicates that the state of nature in the universe is different than the truth you assumed when your assumption was the correct one. In this case it is the probability that the rho or correlation is zero when your sample indicates that it is not zero.

"Usually if we have a one in twenty (0.05) chance of making the wrong decision, we are satisfied that there is a difference , i.e. statistical significence, and we reject the null hypothesis that there is no difference. You can set this level based on your need to be right. In drug testing work for instance, a p= 0.01 is often used since the consequences of being wrong are much more severe than being wrong about a knob for a radio."
referenced :http://www.isixsigma.com/library/content/c011119a.asp

做出是否拒絕虛無假設的決定，有四種拒絕虛無假設的方法
　（１）如果最終統計量落入拒絕域之內，則拒絕虛無假設
　（２）如果最終統計量大於臨界值，則拒絕虛無假設
　（３）如果ｐ－ｖａｌｕｅ值小於顯著水準，則拒絕虛無假設
　（４）如果虛無假設的值落在信賴區間之外，則拒絕虛無假設

如果減小了顯著水準α，那麼在檢驗一個實際上是真實的假設時，我們就減小了拒絕該假設的可能性；但是在另一方面，減小顯著水準卻可能增加了接受不真實的假設的可能性