PICC专科护士临床相关能力评估量表的编制及信效度分析

目的编制PICC专科护士临床相关能力评估量表,并对该量表进行信效度检验。方法基于查阅国内外相关文献及PICC门诊专家讨论,形成条目池。应用德尔菲邀请19名PICC领域相关专家对PICC专科护士临床相关能力评估量表分别进行2轮专家咨询,完成初始量表编制。然后选取某三级甲等医院106名PICC专科护士进行调查,利用收集数据对量表的Cronbach’sα信度系数、分半信度、重测信度、内容效度、结构效度进行检验。结果PICC专科护士临床相关能力评估量表包括人际交流、教育科研、法律伦理、文书记录4个维度,共25个条目。该量表的Cronbach’sα信度系数为0.998,分半信度为0.904,重测信度为0.963。该量表的条目水平内容效度指数为0.947~1.000,全体一致性内容效度指数为0.920。结构效度,探索性因子分析中4个因子可解释的变异为80.14%。内部一致性信度,各维度与量表总分的相关系数均0.800,呈密切相关,各维度与量表总分相关性分析结果均具有统计学意义(P0.01)。结论 PICC专科护士临床相关能力评估量表具有良好的信度、效度,适合作为PICC专科护士临床相关能力的测评工具。     

改良Loewenstein认知评定量表的效度及信度研究

目的:检验改良Loewenstein认知评定量表(MLOTCA)的效度及信度,为其在国内临床应用提供客观依据。方法:对74例脑血管意外后的患者进行测试,2周后由同一评定者进行复测。对该量表内容效度和结构效度,以及内部一致性信度、重测信度进行检测。结果:量表21个项目与总分之间的相关系数为0.496—0.841,P<0.01,具有较好的内容效度;提取3个主成分,这3个主成分的累计贡献率为69.032%,各项目在相应因子上的因子载荷均大于0.5,可以认为该量表有较好的结构效度。MLOTCA Cronbachα系数0.9379,量表内部一致性信度较好;MLOTCA重测信度相关系数0.718—0.967,重测信度较好。结论:改良Loewenstein认知评定量表有较好的效度和信度,可用于临床脑血管意外后认知功能的评定。     

中文版14项尿毒症皮肤瘙痒量表的信效度分析

目的引进透析患者14项尿毒症皮肤痛痒量表(14-item uremic pruritus in dialysis patients scale,14-Item UP-Dial Scale),翻译成中文版,分析其信效度,评估该量表在我国患者中的适用性。方法将英文版量表进行翻译和回译,确定中文版量表,并在270例尿毒症皮肤瘙痒患者中进行信效度分析。通过Cronbachα系数、重测信度、各项目与量表总分的相关性分析检验量表信度。使用内容效度指数评价量表内容效度,Pearson相关分析检验量表效标效度,探索性因子分析检验量表结构效度。结果量表由14项问题组成,分为症状和体征(瘙痒时间、瘙痒程度、瘙痒部位和面积、皮肤抓痕、麻木感、蚁行感、皮肤干燥)、睡眠(入睡困难、夜间醒来、睡眠质量)和社会心理(工作/学习、社交、情绪、性生活)3个维度。3个维度分量表和总量表的Cronbachα系数分别为0.749、0.710、0.845、0.894。3个维度分量表和总量表的重测信度系数r分别为0.968、0.951、0.977、0.976(均P0.001)。各项目与分量表以及总量表的相关系数r为0.413～0.892(均P0.001)。麻木感和性生活的内容效度指数均为0.83,余各题项的内容效度指数均为1.00。量表的平均内容效度指数为0.98。校标效度r=0.809(P0.001)。量表KMO检验值为0.907,Bartlett球形检验χ~2=1837. 141(v=91,P0.001),共提取出3个公因子,其累积解释方差为61.81%。结论中文版透析患者14项尿毒症皮肤瘙痒量表具有较好的信度与效度,可作为我国尿毒症皮肤瘙痒患者的测量工具。     

护士人文关怀品质测评量表的研制

目的初步研制护士人文关怀品质测评量表,为评价护士人文关怀品质现状提供评价指标。方法通过专家访谈、相关文献的提取和现有测评工具条目的遴选建立量表条目池,经两轮Delphi专家咨询和临床调查对量表条目进行筛选和信效度检验,建立初始量表。结果量表包括4个维度(人文关怀理念、人文关怀知识、人文关怀能力、人文关怀感知)共29个条目,其内容效度(内容效度指数为0.986)、结构效度(4个因子的累积贡献率为55.009%)、内部一致性信度(Cronbachα系数为0.932)、分半信度(分半系数为0.801)均在量表研制的理论允许范围之内。结论该量表具有较好的信、效度,可用于护士人文关怀品质的测评。     

身体约束认知量表的汉化及信效度检验

[目的]对身体约束认知量表(Perceptions of Restraint Use Qustionnaire,PRUQ)进行汉化并验证其信效度。[方法]对英文版PRUQ进行前译、综合、回译、专家委员会审查及预试验形成中文版PRUQ,并选取石家庄市某三级甲等医院临床护士294人进行调查,评价其重测信度、内部一致性、折半信度、内容效度、结构效度和聚集区分效度。[结果]中文版PRUQ条目与总分相关系数为0.451～0.745,且P0.05;各条目决断值(CR)为5.886～19.365,均大于3,且P0.001;量表的重测信度为0.956,内部一致性Cronbach′sα系数为0.888,折半信度为0.848,内容效度指数为0.94;采用探索性因子分析提取了3个公因子,累积方差贡献率为63.238%。[结论]中文版PRUQ具有良好的信效度,可以作为评估护士对老年病人身体约束认知的有效工具。     

女大学生原发性痛经自我管理行为量表的编制

目的编制适合评价我国女大学生原发性痛经自我管理行为的量表。方法以格林健康教育模式为理论基础,通过查阅国内外文献和对10名痛经女大学生进行半结构化访谈,形成包含40个条目的条目池;结合5名专家意见,并经过预测试,形成包含20个条目的女大学生原发性痛经原始量表;通过对100名痛经女大学生进行调查,采用条目分析法对原始量表的条目进行筛选,最终形成含有19个条目的暂定量表;选取500名痛经女大学生进行调查,采用因子分析、相关分析等方法对量表的信度和效度进行检验,形成量表。结果女大学生原发性痛经量表确立为4个维度,19个条目。量表的内部一致性Cronbach’sα系数为0.91,其中日常行为、获取知识、遵医行为和寻求帮助4个维度Cronbach’sα系数分别为0.77,0.88,0.86,0.84;量表重测信度为0.92,各维度分别为0.76,0.84,0.83,0.77;量表总内容效度指数(scale content validity index,S-CVI)为0.93,各维度的条目内容效度指数I-CVI(item content validity index,I-CVI)分别为0.93,0.92,0.92,0.94;采用探索性因子分析法和碎石图,抽取4个因子,累计贡献率达62.90%;各维度的相关系数为0.12~0.35,各维度与量表总分的相关系数为0.49~0.78,均具有统计学意义(均P0.05)。结论女大学生原发性痛经自我管理行为量表具有较好的信度和效度,可以作为评价我国女大学生自我管理行为的参考工具。     

心肌梗死多维度评估量表的信效度研究

目的翻译“心肌梗死多维度评估量表”(Myocardial Infarction Di mensional Assessment Scale,MIDAS),评价其效度、信度及文化相关性,提供一种有效评估心肌梗死患者生活质量的中文版问卷。方法应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对88例心肌梗死患者应用问卷对其内部一致性、效标关联效度及结构效度进行评价,对其中30例心梗患者在2周内重新应用问卷收集资料,进行重测信度的评价。结果问卷中所有条目均具有较好的文化相关性,其中2个条目被重新修订。中文版“心肌梗死多维度评估量表”具有较好的表面和内容效度,内容效度指数(CVI)为0.94,其内部一致性及重测信度均可接受,问卷7个亚量表的Cronbach'sα为0.73~0.91,重测信度系数为0.74~0.94,总体Cronbach'sα为0.93,重测信度系数为0.85。中文版MIDAS中的各亚量表与中文版“36条目简明量表”(Short Form36,SF-36)中的相关亚量表具有显著相关性(P<0.05)。因子分析结果提示中文版MIDAS具有与原英文量表一致的结构效度。结论中文版“心肌梗死多维度评估量表”是一种具有较高效度和信度的疾病专用量表,可为医护人员量化评估心肌梗死患者生活质量提供可靠的依据。     

中文版Barthel指数的信度与效度研究

目的 研究脑卒中患者中文版Barthel指数(Barthel Index,BI)的信度和效度.方法 147例急性脑卒中患者分别由不同评定者对同一脑卒中患者于入院当天、入院第15天、发病后第90天进行BI的评定.用Kappa值表示重测信度与评定者间信度,用Cronbach α值表示分半信度、内部一致性信度.采用Spearman相关分析预测效度,采用因子分析方法评定结构效度.结果 所有重测信度、评定者间信度的Kappa值差异均有统计学意义(P＜0.01);分半信度:BI奇偶项两部分的Cronbach α值分别为0.837、0.824,两部分的rs为0.903;内部一致信度:Cronbach α值为0.916;效度研究中患者的KMO统计量为0.854,Bartlett球形检验拒绝相关阵是单位阵(P＜0.01);入院时、发病15天的BI评分结果与发病90天后BI呈正相关(rs=0.614,0.583,均P＜0.01);与斯堪的那维亚卒中量表(Scandinavian Stroke Scale,SSS)结果呈正相关(rs=0.619,0.704,0.882,均P＜0.01),与美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)呈负相关(rs=-0.587,-0.705,-0.790,均P＜0.01).结论 中文版的BI重测信度和评定者间信度佳,内部一致性好;具有结构效度、预测效度;使用方便,易于掌握,可广泛应用于脑卒中的评定中.     

养老需求评估量表的编制

[目的]编制老年人养老需求评估量表。[方法]通过查阅文献和开放访谈形成初始量表,采用德尔菲法对量表进行修改,采用内在一致信度、重测信度对量表进行信度检测,采用内容效度和结构效度进行效度检测,形成正式量表。[结果]老年人养老需求评估量表包含自理能力、认知能力、情感行为、社会功能和健康养生5个维度27个条目。总量表的内在一致性信度(Cronbach′sα)为0. 951,各维度Cronbach′sα值为0. 821～0. 989;总量表的重测信度为0. 935,各维度的重测信度值为0. 848～0. 956;量表内容效度(S-CVI)为0. 918,条目内容效度(I-CVI)为0. 893～0. 942;各条目因子载荷均在0. 48及以上。[结论]老年人养老需求评估量表具有良好的信效度,可以用来评估老年人养老需求。     

中文版护理依赖量表在恶性肿瘤患者中应用的信度效度评价

目的 :检验中文版护理依赖量表在恶性肿瘤患者中应用的信度、效度。方法 :应用中文版护理依赖量表(Care Dependency Scale,CDS)对329例恶性肿瘤患者进行问卷调查,通过探索性因子分析提取因子,通过计算Cronbach’sα系数和重测相关系数,检验问卷的内在一致性和重测信度。结果 :中文版CDS量表经因子分析提取2个公因子,共14个条目,累积方差贡献率达69.8%;量表与ADL评分呈高度正相关(r=0.91,P0.001),量表的内容效度指数(CVI)为0.833;Cronbach’sα系数是0.944,2个因子Cronbach’sα系数均为0.924;重测相关系数为0.667。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.