临床护患沟通知信行调查问卷的编制及信效度检验

目的:编制临床护患沟通知信行问卷调查并进行信效度检验。方法:以知信行理论为框架，通过文献分析法、半结构化访谈和专家咨询法，编制临床护患沟通知信行问卷，选择江苏省多所三级甲等医院200名临床护士进行问卷调查，检测问卷的信效度。结果:临床护患沟通知信行问卷包括知识、态度、行为3个维度，共25个条目。问卷的Cronbach’s α系数为0.864，各维度的Cronbach’s α系数为0.817,0.917,0.943。条目水平的内容效度指数（I-CVI）为0.82～1.00，量表水平的内容效度指数（S-CVI）为0.95。探索性因子分析共提取出3个公因子，累计方差贡献率为62.308%。结论:临床护患沟通知信行问卷具有较好的信度和效度，可以作为调查临床护患沟通知识、态度、行为的有效工具。     

护士死亡态度量表的编制及信效度检验

目的 初步编制我国护士死亡态度的评估量表并对其进行信效度检验.方法 查阅相关文献初步拟定量表条目,经专家商询及20例小样本访谈调查修正后确定量表内容,对120名临床护士进行调查,采用项目分析、因子分析、相关分析及信效度分析等统计方法评价该量表的信效度.结果 护士死亡态度量表包括25个条目,因子分析产生7个因子,可解释总方差的63.732％,且各条目在其相应维度上均有较高的因子负荷;各条目与所属维度的Pearson相关系数在0.498 ～0.808;各维度的Cronbach′s α系数在0.595～0.774,总量表的Cronbach′s α系数和分半信度系数分别为0.824和0.868.结论 护士死亡态度量表的信效度指标较好,可作为我国护士死亡态度的有效测评工具.     

临床护士静脉血标本采集知信行问卷的编制及信效度检验

目的:编制静脉血标本采集知信行问卷，并检验其信效度。方法:回顾国内外相关文献，参考《静脉血液标本采集指南》，在小组讨论的基础上初步构建问卷，结合德尔菲专家函询、临床护士认知性访谈结果形成问卷。选取太原市某三级甲等医院的249名临床护士填写问卷，对其进行信效度检验。结果:最终形成的临床护士静脉血标本采集知信行问卷包括知识、态度、实践3个维度，共25个条目。2轮专家函询问卷有效回收率分别为100%、94%；专家权威系数分别为0.866,0.868；专家协调系数为0.156,0.508（均P<0.05）。问卷的Cronbach’s α系数为0.912。条目水平的内容效度指数（I-CVI）为0.87～1.00，量表水平的内容效度指数（S-CVI）为0.97。探索性因子分析共提取了6个公因子，累计方差贡献率为62.280%；验证性因子分析结果显示模型拟合较好。结论:编制的临床护士静脉血标本采集知信行问卷具有一定的可靠性与科学性，可作为评价临床护士静脉血标本采集知识、态度、行为的工具。     

护士用老年糖尿病患者口腔保健知信行问卷的编制及信效度评价

目的：以知信行理论为基础,编制护士用老年糖尿病患者口腔保健知信行问卷并对其信效度进行检验。方法在实地调研、文献回顾、专家咨询的基础上编制初问卷,运用6种筛选条目的方法进行问卷条目筛选并对问卷进行信效度检测。结果最终形成42个条目的问卷,包括3个维度,知识维度16个条目,信念维度6个条目,行为维度20个条目。问卷的Cronbach’ sα系数为0.909,内容效度为0.955,折半信度为0.789,相关系数为0.400~0.763。结论编制的护士用老年糖尿病患者口腔保健知信行问卷具有良好的代表性、敏感性及独立性,符合初步设计的理论构想。     

护士调节焦点量表的修订及信效度检验

目的:基于护理工作特点及组织情景修订调节焦点量表，检验其信效度，为护士调节焦点的研究提供可靠的测量工具。方法:在中文版调节焦点量表基础上，通过查阅文献、小组讨论、德尔菲专家函询、预调查，形成护士调节焦点量表。选取某三级甲等医院的1 456名临床护士进行问卷调查，测量其信效度。结果:修订后的护士调节焦点量表条目水平内容效度指数（I-CVI）为0.800～1.000，量表平均水平内容效度指数（S-CVI/Ave）为0.917。量表总体Cronbach’s α系数为0.962，各维度Cronbach’s α系数为0.929,0.970。探索性因子分析结果显示2个公因子的累积方差贡献率为83.259%，验证性因子分析结果显示各项拟合指标均在可接受范围内。结论:护士调节焦点量表具有较好的信效度，适用于医院护士调节焦点的现状调查。     

医院提供者视角下过渡期护理协调性量表的汉化及信效度检验

目的:对医院提供者视角下过渡期护理协调性量表（CTCS）进行汉化，并进行信效度检验。方法:采用Brislin翻译模型对CTCS进行翻译、整合、回译，经专家咨询和预调查后形成中文版CTCS，选取郑州市3所三级甲等医院222名参与协调过渡期护理服务的医院提供者进行问卷调查，对其进行信效度检验。结果:中文版CTCS包括4个维度、23个条目，量表的Cronbach’s α系数为0.924，各维度的Cronbach’s α系数为0.777～0.954，重测信度为0.878。量表水平的内容效度指数为0.925，通过探索性因子分析提取4个公因子，累积方差贡献率为70.320%。结论:中文版CTCS具有良好的信效度，可作为评估过渡期护理质量的工具。     

临床护士糖尿病知识评估量表的研制及信效度检验

[目的]研制临床护士糖尿病知识评估量表,并检验其信度和效度。[方法]结合访谈法结果和已有文献编制临床护士糖尿病知识评估初始量表,经2轮专家咨询后形成临床护士糖尿病知识评估量表,并对量表的信效度进行评价。[结果]临床护士糖尿病评估量表由糖尿病基本知识、糖尿病并发症、血糖监测、药物治疗、运动治疗、饮食治疗、注射技能7个维度100个条目组成,量表的条目内容效度为1,量表平均内容效度指数为1;总量表的重测信度系数为0.898,各维度的重测信度系数为0.578~0.802;总量表的Cronbach’sα系数为0.945,各维度的Cronbach’sα系数为0.727~0.890。[结论]编制的临床护士糖尿病知识评估量表信效度良好,能够用于评估临床护士对糖尿病知识的掌握水平。     

家属决策冲突量表在神经内科ICU患者家属中应用的信效度检验

目的：编制家属决策冲突量表,并在神经内科ICU患者家属中对其进行信效度检验。方法：基于患者 决策冲突量表（DCS）,编制家属决策冲突量表,抽取神经内科ICU 191例患者家属进行问卷调查,检验其信 效度。结果：家属决策冲突量表共16个条目,因子分析共提取3个公因子,累计贡献率达到68.024%。量表 水平的内容效度为 0.990,Cronbach’s α系数为 0.885,各维度 Cronbach’s α系数分别为 0.802、0.861、0.924, Guttman折半系数为0.727。结论：家属决策冲突量表具有良好的信效度,适用于评估神经内科ICU患者家 属的决策冲突水平。     

公共服务动机量表的修订及信效度检验北大核心

目的:修订公共服务动机量表并验证其效信度。方法:在专家会议基础上修订条目内容,形成修订版公共服务动机量表。选取南宁市某三级甲等医院护士435人进行调查,验证其信效度。结果:修订版公共服务动机量表条目水平的内容效度(I-CVI)为0.857~1.000,平均量表水平的内容效度(S-CVI/Ave)为0.984。探索性因子分析提取4个公因子,累计解释71.616%变异量。验证性因子分析显示模型拟合较好。量表Cronbach’s α系数为0.933,各维度Cronbach’s α系数为0.868~0.904;格特曼折半系数为0.868,各维度格特曼折半系数为0.728~0.894;重测信度为0.844,各维度重测信度为0.778~0.879。结论:修订版公共服务动机量表在护士群体中应用的信效度良好,适合测量护士人群公共服务动机。     

麻醉恢复室护士对全麻术后患者低体温管理知信行问卷的编制与信效度检验

目的 编制麻醉恢复室(PACU)护士对全麻术后患者低体温管理知信行(KAP)问卷,并检验其信效度。方法 基于循证总结PACU全麻术后患者低体温管理最佳证据,以知信行理论为指导提取证据,构建问卷条目池,通过小组讨论、德尔菲专家函询、预调查修订问卷条目。采用便利抽样法选取全国110所医院465名PACU护士进行问卷调查,以检验问卷信效度。结果 最终问卷含知识、态度和行为3个维度,共43个条目,其中知识维度含15条客观题,信念和行为维度分别含13和15个条目,采用Likert 5级评分法作答。信念维度和行为维度Cronbach′s α系数分别为0.989和0.926,总Cronbach′s α系数0.956;重测信度0.879;条目水平的内容效度指数(I-CVI)为0.800～1.000,平均内容效度指数(S-CVI)0.985;探索性因子分析萃取3个公因子,累计方差贡献率为74.22%。结论 PACU护士对全麻术后患者低体温管理的KAP问卷信度和效度良好,适用于PACU护士对全麻术后患者低体温知识、态度和行为现状的调查。     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。     

Literature and poetry: Pleasure and practice

The value of a humanities perspective in the initial and continuing education of practising nurses and midwives is discussed briefly. It is suggested that nursing requires a blend of both science and sensitivity and that empirical knowledge alone is insufficient for one who cares for others. The value of literature in relation to the notions of catharsis, vicarious experience and insight into the lives of patients will be discussed. Some examples of literature that may be used to help nurses gain insight into aspects of death and dying, midwifery, physical disability and mental illness are presented.