CCU护理干预分级量表的编制及信效度检测

目的制定及研究CCU护理干预分级量表的信效度。方法成立量表编制专家小组,制定量表条目、结构及评分方法,并用其对CCU住院的406例患者进行临床试验性应用,评价量表的内部一致性信度、重测信度、内容效度和结果效度。结果该量表的Cronbach’s α系数为0．909,分半信度为0．838,重测信度为0．704,信度较高,各条目分值与总分值Pearson相关系数为0．210—0．818,内容效度较好,主成分因子分析,提取3个公因子,解释61．77％的总方差变异,结构效度较好,与量表设计初衷基本符合。结论CCU护理干预分级量表具有较好的信度和效度,适用于辅助CCU护理干预分级。     

简明版骨质疏松国际功能、残疾和健康分类核心分类组合的信效度研究

目的:探讨简明版骨质疏松国际功能、残疾和健康(ICF)核心分类组合的信度和效度。方法:122例骨质疏松症患者进行简明版骨质疏松ICF核心分类组合和欧洲骨质疏松症基金会生活质量问卷(QUALEFFO-41)评定。信度研究采用重测信度、观察者间信度和内部一致性信度,效度研究采用效标效度、结构效度和内容效度。重测信度和观察者间信度检验采用组内相关系数(ICC);内部一致性检验采用Cronbachα值分析;效标效度用Spearman相关;内容效度应用德尔菲法;结构效度采用因子分析法。结果:(1)信度:重测信度ICC 0.762—0.921;观察者间信度ICC 0.781—0.941;内部一致性信度Cronbachα系数0.953。(2)效度:校标效度:简明版骨质疏松ICF核心分类组合中功能和残疾部分总分与QUALEFFO-41总分呈中度相关(r=0.654);内容效度:经德尔菲法确定内容效度好;结构效度:公因子1包括条目d430、d450和d920,公因子2包括条目b710、b730、s750、s760,公因子3包括条目e110、e355、e580,公因子4包括条目b152、b280。结论:简明版骨质疏松ICF核心分类组合的信度、校标效度和内容效度较好。除b710和b730、s750和s760归为同一维度外,其余条目的结构效度与目前ICF成分结构一致。     

功能综合评定量表的研究(二)信度研究

目的 :探讨功能综合评定量表 (functionalcomprehensiveassessment ,FCA)在评测脑血管意外患者中的可信性。方法 :对已明确诊断的 2 0例脑血管意外患者进行评测者内部和评测者之间的信度分析 ,并对FCA的内部一致性进行分析。结果 :FCA评测员内部和评测员之间的信度较好 ,各选项组内相关系数 (ICC)范围在 0 .78— 0 .99(ICC总分 >0 .90 0 )。FCA的内部一致性较好 ,(运动功能α=0 .93 ,认知功能α=0 .98,FCA总分α =0 .96)。结论 :FCA具有很好的重测信度和内部一致性 ,是脑血管意外患者综合功能评定一项可信的评测量表     

女性压力性尿失禁患者健康信念量表的编制

目的编制用于评价女性压力性尿失禁患者的健康信念量表,并检验其信效度。方法以健康信念模式为理论框架,通过文献回顾和专家咨询设计初始量表。经专家内容效度评定、预调查和统计学分析等过程对量表条目进行修订和筛选,形成正式量表,然后对量表的信度和效度进行评价。结果正式量表包括4个维度:罹患性认知(3个条目)、严重性认知(12个条目)、障碍性认知(8个条目)和利益性认知(7个条目),共30个条目。量表中每个条目均具有较好的鉴别度,量表的内部一致性信度Cronbach'sα系数为0.97,重测信度为0.95。量表的内容效度为0.97,其4个维度用主成分分析均抽取了特征值大于1的公因子1个,每个公因子的贡献率均大于50%,每个条目在各自公因子上的载荷值均大于0.4。结论编制的女性压力性尿失禁患者健康信念量表具有良好的信度和效度,可用于评价女性压力性尿失禁患者的健康信念水平。     

康复护理日常生活活动评定量表的信度和效度研究

背景在康复医学中有许多种日常生活活动(ADL)能力评定量表,但符合康复护理程序的评定量表甚少.为此,浙江省康复中心从2000年开始研究设计了康复护理ADL(rehabilitative nursing ADL,RNADL)评定量表,并制定了评定内容和评定标准.目的探讨康复护理ADL评定量表在患者日常生活活动功能评测中的重测信度、内部一致性及量表的有效信度.设计重复测量设计.单位浙江省望江山疗养院,浙江省康复中心.对象2001-04/2003-04浙江省望江山疗养院康复医学科进行康复治疗的ADL功能障碍的40例患者.方法对40例住院康复患者用RNADL量表进行评测者内部、评测者之间的信度分析;内部一致性用Cronbach α计算;并分别用RNADL和改良的Barthel指数(MBI)进行出、入院各项目评定,用Pearson分析入院、出院及出入院之间的相关性.主要观察指标RNADL评定量表的信度和效度检测结果.结果RNADL评测者内部和评测者之间的信度良好,各项组内相关系数(ICC)范围为0.966～0.998,r=0.996～0.997;内部一致性信度系数α=0.822,各项之间α=0.925,RNADL内部一致性较好.RNADL和MBI的比较研究得出出、入院RNADL与MBI改变值间相关性良好(r=0.89,P＜0.001).结论RNADL具有很高的重测信度,内部一致性较好,与MBI有良好的关联效度,是康复护理日常生活活动能力可信、有效的评测量表.     

糖尿病联络护士专科护理管理行为量表信度、效度分析

目的评价德尔菲法形成的“糖尿病联络护士专科护理管理行为量表”的信度和效度。方法在426名基本样本、21名重测样本中检验量表的结构效度、克朗巴哈系数和重测信度,专家评价法检验量表的内容效度。结果量表总的Spearman相关系数为0．822,总的Cronbach’a系数为0．851;量表总的内容效度指数为0．96,特征根大于1的4个因子被旋转,其累积贡献率为69．928％,大部分条目的因子载荷在0．6以上。结论量表的内容效度、结构效度和重测信度、Cronbach’a系数均比较理想,量表具有较好的稳定性和内在一致性。     

癫自我管理行为量表汉化及其信效度评价

目的翻译癫自我管理行为量表,并评价其信度和效度。方法采用双人翻译-回译模型翻译癫自我管理行为量表中文版,并用于评估194例住院癫患者的自我管理行为,评价其内容效度、结构效度、内部一致性信度和重测信度。结果中文版癫自我管理行为量表保留了源量表20个条目,总内容效度为0.990,各条目的内容效度指数为0.920～1.000。采用探索性因子分析,共提取5个公因子,累计方差贡献率为58.787%。修订后中文版癫自我管理行为量表总Cronbachα系数为0.829,各维度Cronbachα系数为0.661～0.721。重测信度系数为0.743。结论修订后的中文版癫患者自我管理行为量表,具有较好的信度和效度,可用于临床评定我国癫患者的自我管理行为的状况。     

上肢功能评定量表对脑卒中偏瘫患者上肢功能评价的信效度研究

目的 探讨上肢功能评定量表评定脑卒中偏瘫患者上肢功能的信度和效度.方法 采用上肢功能评定量表、Fugl-Meyer量表上肢部分和Barthel指数,对35例脑卒中偏瘫患者相隔2周进行2次评定,分析上肢功能评定量表、Fugl-Meyer量表上肢部分、Barthel指数评定结果,并验证上肢功能评定量表的标准效度;采用探索性因子分析方法,验证上肢功能评定量表的结构效度;分析2次上肢功能评定量表的评定结果,验证上肢功能评定量表的重测信度和评价者间信度.结果 上肢功能评定量表的重测结果和组间结果高度相关,其重测组内相关系数在0.884以上,组间相关系数在0.965以上.两位评价者上肢功能评定量表评定结果与Fugl-Meyer量表上肢部分和Barthel指数总分具有高度相关性,r值分别在-0.918和-0.771以上.通过条目筛选和探索性因子分析,共得出4个公因子.结论 上肢功能评定量表具有较好的信度和效度,可以用于脑卒中偏瘫患者上肢功能的评定.     

中文版成套神经心理测验的信度和效度研究

目的评估中文版成套神经心理测验(NTB)的信度和效度。方法为横断面研究,对118例被试者进行简易智力状况检查(MMSE)、阿尔茨海默病评定量表认知分量表(ADAS-cog)与NTB测验,其中30例在4周后进行NTB重测。从同质信度、重测信度和分测验内部一致性进行信度检验;从结构效度和效标关联效度进行效度检验,结构效度包括因素分析和因素结构,效标关联效度包括基线MMSE、ADAS-cog与NTBz分的相关性。结果 NTB测验的Cronbachα系数为0.824。除分类流畅性测验的重测相关系数为0.504外,其余各分测验的重测相关系数为0.590～0.856。NTB各分测验z分与合成z分的相关系数为0.693～0.872;各分测验之间的相关系数为0.297～0.848。主成分分析显示2个特征根≥1的因子可解释方差的71.198%。NTBz分与MMSE、ADAS-cog总分之间的相关系数分别为0.874、-0.799。结论 NTB的同质信度、重测信度、结构效度、效标效度均较理想,符合心理测验的要求。     

SF-36量表应用于下肢深静脉血栓形成患者的信度和效度研究

目的评价SF-36量表用于测量下肢深静脉血栓形成患者生存质量的信度和效度。方法采用SF-36生存质量量表,对130例下肢深静脉血栓患者进行调查,对测量结果进行信度和效度分析。信度指标包括内部一致性、折半信度、重测信度,效度指标包括内容效度和结构效度。结果整个量表的Cronbach’sα系数以及去掉一项内容后得到的Cronbach’sα系数均高于0．8;总量表和各个维度的折半信度均高于0．8;各个维度的组内相关系数高于0．6;总量表及各维度的Pearson相关系数均高于0．6;因子分析所产生的2个主成分可解释总变异的65．704％;经最大方差旋转后产生2个公共因子与量表的理论结构假设基本一致。结论SF-36量表具有较好的信度和效度,适用于下肢深静脉血栓形成患者的生存质量评价。     

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.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。