跨文化研究中量表的跨文化调适

跨文化研究是使用相同的测量方法对来自两个或两个以上文化中的受试者进行心理、行为等方面研究和比较[1].由于国际化趋势愈加明显,跨文化研究也越来越受到关注[2].在跨文化研究中,使用统一的测量工具可以将本土研究结果与其他国家的结果进行比较,从而加强不同文化之间的联系与交流,使知识架构更加完整.在护理研究领域,量表是常用的测量工具.设计量表是一个复杂而严谨的科学过程,研究者也可以通过引进具备良好的信效度的量表来节省人力和时间.尽管在不同的文化中使用同一种量表可以使研究的现象更透彻,但是如果在引进量表的过程中出现错误就可能导致目标量表与源量表之间有差异,从而降低目标量表的信效度.因此,在引进国外量表的过程中,要进行严格的跨文化调适（cross-cultural adaptation）.跨文化调适是指尽量按目标语言的习惯用法,对翻译内容进行适当的修订以使其适合本土文化的特殊性[3],即在保证目标量表所要表达的主要内容和基本结构与源量表等价的基础上,使其更适用于目标人群.     

护理研究中量表研制及测量学特征的评定方法

量表是社会科学研究以及心理学领域中广泛应用的一种测量工具,其主要作用在于测量复杂的概念[1].在护理研究中,常需要对群体或个体的生理、心理、行为和社会现象进行观察和测量,量表也就成为收集资料的一种重要的测量工具[2].近年来,在护理领域,使用量表进行测评的研究较多,但对其使用及测量学特征的评定尚不规范,影响了研究结果的可靠性,而且相关文献也较缺乏.     

基于手机和纸笔调查的中文版乳腺癌自我效能感量表测量等价性研究

目的 检验基于手机调查和纸笔调查的中文版乳腺癌自我效能感量表是否具备测量等价性。方法 通过方便抽样,采用一般资料问卷及中文版乳腺癌自我效能感量表对上海某三级甲等医院乳腺中心就诊的302例乳腺癌患者进行调查,其中145例使用手机调查,157例使用纸笔调查。采用多组验证性因子分析检验量表采用不同测量方式的测量等价性。结果 基线模型、形态等价模型、单位等价模型及尺度等价模型的各项模型拟合指标均达到统计学要求,提示模型拟合良好。结论 乳腺癌自我效能感量表在2种测量方式下具备强测量等价性,研究者可根据需要选择适合的方式进行数据收集并进行数据合并。     

玉树地震灾害医学救援中跨文化护理策略研究

目的探讨跨文化护理在地震医疗救援中的作用及今后的研究方向。方法对玉树地震灾害中跨文化护理的需求进行分析评估，并针对性进行护理干预。结果跨文化护理的介入，提高了伤员的尊医性和医学救援中的护理质量。结论医学救援中跨文化护理是新的医学模式在灾害医学领域的具体应用，是护理学、灾害医学研究的方向。     

混合式科研方法在澳门抑郁老年人生活体验的应用与分析

目的 结合澳门中国文化特点,分析与探讨混合式科研方法在揭示澳门抑郁老年人生活体验方面的应用.方法 采用质性研究与量性研究相结合的混合式科研方法对同一研究现象进行相互印证与解释.质性研究采用Van Manen's演绎性现象学研究方法,量性研究采用精神认知状态问卷(MSQ)、老年抑郁量表(GDS-15)、巴氏日常活动能力评估量表(BI)、Lawton工具性日常活动能力评估量表(IADL)、Lubben社会网络量表(LSNS)、健康调查问卷(SF-36QOL)等一系列量表.研究对象为目的性抽取澳门不同社区的抑郁老年人31名.结果 量性研究结果与质性研究结果互相印证,共同解释澳门抑郁老年人的生活体验,包括负面情绪、生理限制、生活困苦及社交局限、悲惨经历4大领域.负面情绪领域包括没用、无望、悲观、无助主题;生理限制领域包括活动差、依赖别人、关节痛、失眠、胃口差、记性差、药物太多、就医困难主题;生活闲苦及社交局限领域包括穷困、文盲、不公平、鳏寡、独居、与家人吵架、被遗弃、被歧视、社交不足主题;悲惨经历领域包括繁重低廉劳动、父亲去世、婚姻失败、战争动乱冲击主题.结论 混合式科研方法能够成功地应用在探讨澳门抑郁老年人生活体验的研究中,质性研究与量性研究结合可以更全面、更深入的解释该研究现象.     

ICU护理工作量的研究

我国护理人力资源短缺以及因此引起的护理质量问题正受到国家卫生管理部门和医院管理者的关注[1],护理工作量的测量及护理人力资源的配置方法应运而生[2～3],但关于ICU的护理工作量计算和人力配置尚缺乏一个有效具有公信力的工具提供适当的测量。为了尽可能客观地评估ICU的护理工作量,引进了国外测量ICU护理工作量的ICNSS(the in-tensive critical nursingscore system,ICNSS)量表,本量表的形成来自多种成人重症护理单位,并有很好的信、效度[4～5]。在取得此量表后,先后对其进行了翻译、修订和信、效度评价,形成适合我国国情的中文版量表。本研究应用此量表对一综合ICU的护理工作量做调查,现报道如下。     

基于Web of Science数据库的跨文化护理文献计量学分析

目的 :分析跨文化护理研究领域的经典文献、重要作者和研究活跃地带,挖掘出该领域的研究热点和未来趋势。方法 :基于Web of Science数据库,应用Hist Cite分析工具及文献计量学方法,检索1950-2015年有关跨文化护理的研究论文进行文献计量研究。结果 :共检索到3455篇文献;跨文化护理论文量总体呈增长趋势;以美国为首的发达国家在该领域研究成果显著;文章类型以论著数量居第一位;热门关键词集中在文化背景的差异与交融、文化能力和护理质量、跨文化护理评估工具的开发及相关研究方法等方面。结论 :发达国家在本领域研究中居于领先地位,在某些专题上已经取得突破性进展。我国在该领域的研究上仍有较大的上升空间。     

CCU护理分级评分量表的设计及临床应用

目的 探讨自行设计的CCU分级护理评分量表在临床应用中的可行性及效果.方法 选择在CCU住院的患者400例,由责任护士在每位患者入院时按照评分细则进行评分,病情有变化随时评分,根据分值确定所需的护理等级.结果 量表评分结果提示：16分提供预防性护理,17～21分提供支持性护理,22～26分提供补偿、缓解性护理,≥27分提供代偿、救助性护理.结论 CCU护理分级评分量表是以护理问题为依据,以护理干预措施为指导的护理分级的测量工具,评分方法简便,有较强的原则性和操作性,对护理工作可起到一定的指导作用,值得临床推广及应用.     

跨文化护理理论的应用现状

综述了跨文化护理理论在护理教育、护理研究、临床实践及护理管理4个方面的应用,为我国更好地应用和发展这一理论提供依据.     

ICU护理工作量的研究

我国护理人力资源短缺以及因此引起的护理质量问题正受到国家卫生管理部门和医院管理者的关注，护理工作量的测量及护理人力资源的配置方法应运而生，但关于ICU的护理工作量计算和人力配置尚缺乏一个有效具有公信力的工具提供适当的测量。为了尽可能客观地评估ICU的护理工作量，引进了国外测量ICU护理工作量的ICNSS（the intensive critical nursing score system，ICNSS）量表，本量表的形成来自多种成人重症护理单位，并有很好的信、效度。在取得此量表后，先后对其进行了翻译、修订和信、效度评价，形成适合我国国情的中文版量表。本研究应用此量表对一综合ICU的护理工作量做调查，现报道如下。     

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.     

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.     

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.     

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.     

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.