癌症患者参与能力对其感知医患共同决策水平的影响

目的 探讨癌症患者参与能力对其感知医患共同决策水平的作用，以期为促进患者参与治疗决策提供参考。方法 选取广州市4所三甲医院住院的458例癌症患者作为研究对象，采用患者参与能力量表、中文版医患共同决策量表患者版评估患者的参与能力和感知医患共同决策水平。采用分层回归方法，探讨在控制患者的社会人口学特征和疾病资料时患者的参与能力对其感知医患共同决策水平的影响。结果 患者医患共同决策水平总分为65.67(44.44,79.00)分,参与能力量表总得分为(96.80±21.02)分。控制患者的社会人口学特征和疾病资料后，患者参与能力量表的3个维度（信息获取能力、沟通交流能力、自主决策能力）能解释患者感知的医患共同决策水平37.5%的变异(均P<0.05)。结论 医护人员应重视评估患者的参与能力，并采取措施来提升患者的信息获取能力、沟通交流能力、自主决策能力，以推动医患共同决策在临床上实施。     

卵巢癌患者医患共同决策现状及影响因素分析

目的 了解卵巢癌患者医患共同决策现状，分析影响因素，为针对性干预提供参考。方法 采用一般资料调查问卷、中文版患者参与治疗决策态度问卷和决策困境量表对205例卵巢癌患者进行调查。结果 卵巢癌患者参与治疗决策态度总均分为2.39±0.57,决策困境总分为34.23±5.79;logistic回归分析显示，年龄、首次治疗、决策困境是参与治疗决策态度的主要影响因素(均P<0.05)。结论 卵巢癌患者参与医患共同决策态度积极，决策困境呈中等偏上水平；医护人员应针对影响因素提供个体化指导，以降低患者决策困境，提高患者共同决策参与度。     

中文版特异性用药信念量表应用于2型糖尿病患者的信效度检验

目的汉化适用于2型糖尿病患者的特异性用药信念量表,并在2型糖尿病患者中检测其信效度。方法对特异性用药信念量表进行翻译、回译等,采用便利抽样法抽取118例2型糖尿病患者进行调查,检验量表的内部一致性信度、重测信度、内容效度、结构效度和判别效度。结果中文版特异性用药信念量表2个维度的Cronbach′sα系数分别为0.749和0.796;重测信度分别为0.809和0.751。量表各条目的内容效度指数为0.857～1.000,量表的平均内容效度指数为0.980。探索性因子分析提取2个公因子,分别为用药顾虑和用药必要性,解释总方差的62.25%。高分组患者的得分显著高于低分组患者(P0.01)。结论中文版特异性用药信念量表运用于我国2型糖尿病患者具有良好的信效度,可用于测量2型糖尿病患者用药信念。     

老年人老化期望量表的汉化及信效度检验

目的 对老年人老化期望量表进行汉化和信效度检验。方法 采用Beaton法对英文版老年人老化期望量表进行正译、综合、回译、专家委员会讨论及预试验形成中文版老化期望量表初始版本;采用便利抽样法选取378名社区老年人进行横断面调查,评价量表的信效度。结果 项目分析删除11个条目;探索性因子分析删除6个条目,提取4个公因子（身体健康、精神健康、认知功能、功能独立性）,累积方差贡献率为68.635%,形成的中文版老化期望量表包含4个维度、21个条目;量表的内容效度指数为0.97;量表总的Cronbach′s α系数、折半信度、重测信度分别为0.944、0.952、0.936。结论 中文版老化期望量表具有良好的信效度,可作为老年人老化期望的测评工具。     

中文版决策冲突量表在直肠癌患者术式决策中应用的信效度检验

目的对决策冲突量表(Decision Conflict Scale,DCS)进行跨文化调适和信效度检验。方法遵循美国矫形外科医师学会循证医学委员会推荐指南进行问卷的翻译、回译以及跨文化调适,抽取胃肠外科250例直肠癌患者进行问卷调查,检验中文版决策冲突量表的信效度。结果中文版DCS共16个条目,因子分析共提取3个公因子,累计贡献率达65. 481%。量表水平的内容效度指数为0. 989; Cronbach'sα系数为0. 886,各维度Cronbach'sα系数为0. 706～0. 911; Guttman折半系数为0. 869。结论中文版DCS具有良好的信效度,符合问卷心理学测量要求,适用于评估直肠癌患者的决策冲突水平。     

分娩恐惧量表的汉化及信效度检测

目的对分娩恐惧量表进行汉化,并对其进行信度、效度检测。方法遵循量表引进对等性模型,根据Brislin翻译与回译原则,将英文版分娩恐惧量表翻译成中文,应用专家咨询法进行文化调适,形成中文版分娩恐惧量表。对351例孕妇进行调查评价其信度与效度。结果中文版分娩恐惧量表共有16个条目,因子分析共提取4个因子,累积贡献率为63.217%。该量表Cronbach′sα系数为0.910,各因子Cronbach′sα系数为0.678~0.853;重测信度为0.803,各因子重测信度为0.812~0.921。中文版分娩恐惧量表的内容效度(CVI)为0.924,结构效度、效标关联效度良好。结论中文版分娩恐惧量表具有良好的信效度,可作为测量孕妇分娩恐惧的有效工具。     

中文版科研动机量表应用于护理硕士生的信效度分析

目的测评中文版科研动机量表的信效度,为护理硕士生科研动机测量提供工具。方法对科研动机量表严格遵循"翻译-逆向翻译-文化调适-预试验"程序进行修订、翻译形成中文版科研动机量表,选取249名护理硕士生评估检测其信效度。结果量表经主成分分析共抽取3个因子(内在动机、避免失败动机、外在动机)19个条目,解释变异量的54.62%。各条目与对应维度的相关系数为0.62～0.83;各维度与护理人员科研能力自评量表的相关系数分别为0.25、-0.20、0.17;量表总的Cronbach′sα系数为0.83,各维度Cronbach′sα系数分别为0.89、0.76、0.74,Spearman-Brown分半信度系数分别为0.86、0.75、0.79,重测信度系数分别为0.76、0.67、0.61。结论中文版科研动机量表信度和效度较好,可用于测量我国内地护理硕士生的科研动机。     

产妇参与分娩决策期望量表的编制及信效度检验

目的编制适合我国文化背景的产妇参与分娩决策期望评估量表,为评估产妇参与决策期望提供参考。方法通过文献分析、参考国内外相关期望量表及指南构建量表框架,并结合质性研究结果发展条目池。后经专家函询、小样本预调查形成预试量表。应用预试量表对236例产妇进行调查,评价量表的信效度。结果经探索性因子分析,共得到3个公因子(信息需求、沟通需求和决策需求)15个条目,累积方差贡献率为68.055%;总量表Cronbach′sα系数为0.902,折半信度系数为0.864,量表水平内容效度指数为0.941。结论产妇参与分娩决策期望量表具有良好的信度和效度,可以作为产妇参与分娩决策期望水平的测评工具。     

STEADI老年人跌倒风险自评量表的汉化及信效度检验

目的 汉化及验证STEADI老年人跌倒风险自我评估量表,为我国老年人提供适用性自评工具。方法 选取STEADI工具包中的“Stay Independent Brochure Questionnaire”,按翻译、回译和文化调适,形成“中文版老年人跌倒风险自我评估量表”,分别选取医护人员10名、住院老年人197例、门诊老年人196例、社区老年人232例进行效度信度检验。结果 中文版老年人跌倒风险自我评估量表在住院、门诊、社区老年人群中的Cronbach′s α信度系数分别为0.716、0.674、0.608;重测信度r值分别为0.992、0.996、0.998;量表的内容效度指数S-CVI/UA为0.920,S-CVI/AVE为0.980,各条目内容效度指数I-CVI为0.800～1.000;因子分析共提取4个公因子,住院、门诊、社区的公因子对应的条目不同,其累积方差贡献率分别为54.096%、52.730%、51.180%。结论 中文版老年人跌倒风险自我评估量表具有良好的信度与效度,可用于中国老年人跌倒风险自我评估。在使用过程中,注意结合老年人生活场景和健康状况进行最终跌倒风险判定。     

癌症患者照护评估量表的汉化与信效度评价

目的汉化癌症患者照护评估量表(the Care Evaluation Scale 2.0,CES 2.0),检验中文版量表的适用性。方法经原作者同意获取CES 2.0,进行翻译、回译和文化调适,形成中文版癌症患者照护评估量表,再行项目分析、信度和效度检验。结果中文版癌症患者照护评估量表为10个维度共28个条目,累积方差贡献率为68.351%。量表的内容效度指数(CVI)为0.925;量表总的Cronbach'sα系数为0.819,10个维度Cronbach'sα系数为0.631～0.795,奇偶折半信度r为0.870;重测信度相关系数r为0.886。结论中文版癌症患者照护评估量表具有良好的信效度,可用于评价我国癌症患者临终关怀服务质量的结构和过程。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

三角韧带损伤的手术治疗

[目的]探讨踝关节三角韧带损伤的手术治疗及效果。[方法]2002年4月-2005年4月治疗伴有三角韧带损伤的踝关节骨折40例，均采用切开复位和坚强内固定，并修复重建三角韧带，恢复踝关节内外侧结构的稳定性。下胫腓联合分离仍不稳定者，给予皮质骨螺钉横向内固定。[结果]全部病例得到16个月-3a随访，平均1．5a。按齐氏疗效评定标准：优良30例，可8例，差2例，优良率75％。[结论]强调踝关节骨折切开解剖复位，坚强内固定的同时，应充分重视修复重建三角韧带。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.