脑卒中后失能综合评估量表的汉化与信效度检验

目的 对脑卒中后失能综合评估量表进行汉化及信效度检验,探索该量表在国内的临床适用性。方法 采用Brislin双人直译-回译法、专家评议、预调查对量表进行文化调适,便利抽取203名脑卒中患者进行调查,对中文版量表进行项目分析,并验证其重测信度、评定者间信度、内容效度、效标关联效度。结果 脑卒中后失能综合评估量表重测信度相关性分析结果显示相关系数为0.988;评定者间信度Kappa系数为0.846（95%置信区间为0.793~0.899）,P<0.001;各条目内容效度指数均在0.833~1.000之间,量表内容效度指数为0.935;以改良Rankin量表为标准,效标关联效度系数为0.896。结论 中文版脑卒中后失能综合评估量表具有良好的信效度,可作为我国临床脑卒中失能评估工具。     

肢残儿童生存质量测量量表的信度和效度分析

目的:对已建立的肢残儿童生存质量测量量表进行信度和效度分析。方法:采用分半信度、重测信度、内部一致性度及内容效度、维度相关性、结构效度等指标分析量表的信度和效度。结果:量表的分半信度R为0.765;各领域以及总得分的重测信度相关系数均在0.732—0.901之间;各领域以及总得分的Cronbachɑ系数除残疾儿童共性模块均在0.7以上;各领域以及总条目的Pearson相关系数均在0.6以上;采用验证性因子分析法的结果显示量表的结构效度较高,整体模型拟合好。结论:量表的信度和效度较好,具有较强的可行性和有效性;量表中社会支持、独立能力、个人情感等影响因素需要进一步研究。     

中文版护士对老年患者营养护理态度量表的信效度研究

目的 汉化护士对老年患者营养护理态度量表（ The Staff Attitudes to Nutritional Nursing Care Geriatricsca,SANN-G ,并对 196 名老年相关科室的护士进行现况调查,检测其信效度。 结果 中文版 SANN-G 共有 18 个条目,因子分析提取 5 个公因子,累计贡献率为 59.956% ;量表总 Cronbach,s α 系数为 0.806 ,重测信度为0.769 ,折半信度为 0.735 ;各条目内容效度为 0.83～1.00 ,量表内容效度为 0.97 。 维度间的相关系数为 0.387～0.619 ,各维度得分与总分的相关系数为0.645～0.791 ,差异均有统计学意义（ P＜0.01 ）。 量表总分已知组别效度显示,不同性别、工作年限、岗位编制、职称、月收入、是否有老年亲友患者及是否参加过老年营养培训课程比较,差异有统计学意义（ P＜0.05 ）。 结论 中文版 SANN鄄G具有良好的信效度,可作为我国护士对老年患者营养护理态度的评估工具。     

老年住院患者安全危险因素评估量表的初步研制

目的：初步研制老年住院患者安全危险因素评估量表。方法：在文献研究、问卷调查的基础上拟定量表条目池,通过两轮专家函询对条目进行评定形成预测量表,选取217名老年住院患者进行调查,筛选预测量表条目并检验其信度、效度,进一步完善量表。结果：该量表由5个维度、27个条目构成。各维度内部一致性Cronbach’sα系数为0.677～0.805,量表总体Cronbach’sα系数为0.799,重测信度Pearson相关系数为0.857～0.933,量表总体重测信度系数为0.938。各维度的内容效度为0.78～0.95,量表总体内容效度为0.90。结论：该量表具有良好的信度与效度,为正式量表的形成奠定了基础。     

重庆市医院－养老机构－社区通用老年健康综合评估量表的编制和信效度检验

目的：编制适用于重庆市医院、养老机构及社区的老年健康综合评估量表并检验其信效度。方法采用文献回顾、专家咨询、对老年人和护士访谈,拟定初始量表。选取300例老年人进行预调查,量表条目的筛选采用项目区分度、相关性分析、探索性因素分析和内部一致性检验。选取1080例老年人进行正式调查,量表信度采用重测信度、克朗巴赫系数、分半信度进行评价,效度采用内容效度、准则效度和结构效度进行综合评价。结果正式量表包含4个维度（躯体、自理能力、社会功能和精神心理）、37个条目。该量表的总分重测信度为0．959;克朗巴赫系数为0．952,Spearman-Brown系数和Guttman分半系数均大于0．7;内容效度指标为0．78;各维度累积贡献率为65．968％,因子分析显示该量表具有较好的结构效度。结论 BGA量表具有良好的信效度,适用于医院、社区、养老机构进行老年基本综合健康评估。     

中文版吞咽生命质量量表信度和效度的研究

目的通过对吞咽生命质量量表翻译和编制,进行心理测量学考评,建立适合中国人群使用的吞咽障碍患者生命质量评估专表。 方法参考国内外推荐的量表汉化程序,将英文版吞咽生命质量量表（SWAL-QOL）编译成中文。选取吞咽障碍患者103例为受试者,并采用编译后的中文版SWAL-QOL进行评估。对其测量者间信度、重测信度、同质性信度及内容效度和结构效度进行检测。 结果中文版SWAL-QOL的测量者间信度相关系数范围为0.945～0.990（P<0.01）;重测信度相关系数范围为0.965～0.992（P<0.01）;同质性信度,量表内部一致性指标Cronbachα系数范围为0.708～0.933（P<0.01）;每一个条目与其所在领域的相关系数范围为0.723～0.982（P<0.01）,且每一个条目与其所在维度的相关系数均高于与其他维度的相关系数;在10个维度各个条目的因子分析中提取出10个公因子,累计贡献率为79.029%;10个维度总分的因子分析中提取出2个公因子（吞咽相关生命质量领域和普通生命质量领域）,累计贡献率为54.718%。 结论中文版SWAL-QOL量表具有良好的信度和效度,可以作为一种有效的测量工具对吞咽障碍患者的生命质量进行评估。     

中文版患者便秘状况评估量表在应用评价中的信效度研究

目的 评价中文版患者便秘状况评估量表(PAC-QOL)在慢性便秘患者生活质量评价中的信度、效度和反应度.方法 采用中文版PAC-QOL量表和汉化版简明健康调查问卷(SF-36),对门诊152例慢性便秘患者进行问卷调查,其中28例慢性便秘患者两周后重测,同时纳入接受生物反馈治疗的34例慢性便秘患者,采用治疗前后自身对照进行反应度评价.结果 ①可行性:量表的回收率为100%,有效率为98.03%,患者容易理解,平均完成时间为10.7min.②信度:PAC-QOL量表Cronbach's α系数为0.69-0.93;重测信度组内相关系数(ICC)为0.68-0.89.③效度:该量表适合患者理解和填写,代表性好,专家评定内容效度指数(CVI)为0.84;与SF-36总分相关性好(r=0.560),与各维度相关系数为0.271-0.604;验证性因子分析提取4个公因子,4个公因子对方差的累积贡献率迭57.30%,各条目在相应公因子上的因子负荷在0.4以上;该量表能区分量度组与非重度组患者生活质量.④反应度:生物反馈治疗后,PAC-QOL量表各堆度得分及总分均较治疗前下降.结论 中文版PAC-QOL量表具有较好的可行性、信度、效度和反应度,可以应用于慢性便秘患者生活质量的评价.     

护患关系量表的汉化及信效度检验

目的:对基于老年病人视角编制的护患关系量表（Interpersonal Geriatric Care Relationship Tool,InteGer）进行汉化，并检验其信效度。方法:对英文版InteGer进行翻译、回译，通过跨文化调试及预试验形成中文版InteGer。选取武汉市某三级甲等医院436例老年病人进行问卷调查，检验量表的信效度。结果:中文版InteGer包括人性化、注意性、兴趣、可及性4个维度，共29个条目。量表总体Cronbach’s α系数为0.942，各维度的Cronbach’s α系数为0.822～0.958；量表总体重测信度为0.935，各维度重测信度为0.857～0.941；量表总体折半信度为0.862，各维度折半信度为0.779～0.969。量表条目水平的内容效度（I-CVI）为0.830～1.000，量表水平的内容效度（S-CVI）为0.967。以护患关系信任度量表为标准，效标关联效度系数为-0.712(P<0.001)。探索性因子分析提取了4个公因子，累计方差贡献率为71.321%。结论:中文版InteGer具有较好的信效度，可用于评估我国老年病人...     

脊髓独立测量量表Ⅱ中文版的开发及信度和效度研究

目的：脊髓独立测量量表第2版（Spinal Cord Independence MeasureⅡ,SCIM-Ⅱ）是由劳温斯坦康复医院研制并用于脊髓损伤患者的功能评估的专用量表。研制脊髓独立测量量表Ⅱ中文版并检验其信度和效度。方法：完成量表的汉化,对87例脊髓损伤的患者进行测试,评价SCIM-Ⅱ中文版内部一致性信度、重测信度和测量者间的信度,检验量表的标准效度、内容效度和结构效度。其中标准效度以功能独立测量（FIM）为效标。结果：量表的4个领域中Cronbach′s系数为0.829-0.943;重测信度和测量者间的信度系数均大于0.9。因子分析显示4个公共因子累计方差贡献率为86.1%;各领域与总量表得分的相关系数0.728-0.871;与FIM中文版相比,各领域间有着高度的相关性（r〉0.808;P〈0.01）。结论：SCIM-Ⅱ中文版具有较好的信度和效度,适用于脊髓损伤患者的功能评估。     

心理承受力量表在临床护理人员中应用的信效度分析

目的 检验心理承受力量表在临床护理人员中应用的信效度,为下一步临床护理人员心理承受力状况的评估提供科学的测评工具.方法 采用一般资料问卷、心理承受力量表对485名护士进行问卷调查,并采用分半信度、内部一致性信度、重测信度进行信度检验,内容效度、结构效度进行效度检验.结果 心理承受力量表总分半信度系数为0.859,Cronbach's α系数为0.939,重测信度系数为0.797,量表各条目与所属维度相关系数r均在0.6以上,除掩饰因子外,量表各维度得分与量表总分之间相关系数均在0.75以上,探索性因子分析结果与问卷结构基本吻合,验证性因子最终模型拟合优度良好.结论 经验证,心理承受力量表具有较好的信度和效度,结构合理,可作为临床护理人员心理承受力状况的测评工具.     

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.