我国医学生医患沟通能力住院患者评价量表的编制及信效度检验

背景　目前我国对医学生医患沟通能力的评价研究甚少且存在较大的局限性,不能客观、准确、全面地检测医学生的医患沟通能力并及时给予反馈。目的　编制医学生医患沟通能力住院患者评价量表,并对其进行信效度检验。方法　采用整群抽样的方法选择南华大学附属第一医院2018年10月和11月参加出科考试的448名住院医师规范化培训生（住培生）为调查对象,通过文献查阅、研究小组讨论、专家论证及小样本预调查形成医学生医患沟通能力住院患者评价量表初稿,模拟住院患者入院至出院情景,以住院患者为评价者,对住培生的医患沟通能力进行测评。运用决断值（CR值）、相关系数、克朗巴赫α系数及探索性因子分析进行条目筛选,形成医学生医患沟通能力住院患者评价量表,并检验量表的同质信度、分半信度、组合信度、同时效度、结构效度,采用验证性因子分析〔近似均方根残差（RMSEA）、拟合优度指数（GFI）、标准拟合指数（NFI）、相比较拟合指数（CFI）、对拟合指数（RFI）〕检验量表的结构合理性。结果　本次研究共发放量表448份,回收有效量表395份,其中10月份176份,11月份219份。通过条目筛选和探索性因子分析,形成了含沟通态度、疾病了解、病情告知、沟通效果、病史采集、诊治解释6个维度24个条目的医学生医患沟通能力住院患者评价量表,其克朗巴赫α系数为0.863,分半信度为0.716,各维度的组合信度为0.766~0.837;6个维度与量表总分的相关系数为0.639~0.791。验证性因子分析结果显示,RMSEA为0.050,GFI为0.837、NFI为0.872、CFI为0.835、RFI为0.819。结论　医学生医患沟通能力住院患者评价量表具有良好的信效度,值得进一步推广。     

门诊医生接诊态度评价量表的开发

研究使用文献法和德尔菲法开发量表条目,并使用多元线性回归分析、克朗巴赫系数、相关系数法等方法评价量表的信度和效度,进行修订,形成最终版量表。《门诊医生接诊态度量表》包含19个条目,沟通技巧、尊重、关心、责任感四个维度。该量表条目间一致性高,量表维度设置合理,总分较好地反映了医生接诊态度,可以作为研究医生态度的测量工具。     

从评分者角度看医患沟通技能评价量表在医学生中的应用

目的：探讨医患沟通技能评价量表的应用。方法：采用中文版SEGUE量表对某医学院校18名医学生进行评价。结果：（1）SEGUE量表评分与主观总体评价显著相关（P〈0．01．0．05）。（2）信息收集、信息给予、沟通结束和总分因子上,3位评分者间ICC系数0．7185、0．7041、0．7870和0．6634;但Kendall系数较低。2位评分者间仅沟通启动因子信度较好（ICC=0．8298,r=0．741）。（3）5位评分者中位数分别为14、8、13．5、22和22．05。结论：中文版SEGUE量表评分者信度不很理想,可能与条目内容、评分标准以及样本量大小等有关。     

中文版老年患者家庭照护能力量表的信效度研究

目的 检验中文版老年患者家庭照护能力量表的信度和效度。方法 选取于2014年1-3月入住宁夏回族自治区某三级甲等医院的高龄患者316例,并以1∶1的比例纳入其家庭照护者。采用修订的中文版老年患者家庭照护能力量表对纳入患者及其家庭照护者进行调查,并进行量表的信度和效度检验。结果 修订的中文版老年患者家庭照护能力量表包括家庭照护认知能力、家庭凝聚力、家庭支援能力共3个维度,10个条目。量表的内容效度指数（CVI）为0.83,条目的内容效度指数（I-CVI）为0.84;共析出3个公因子,总贡献率为76.01%,各条目对相应公因子的载荷值为0.501～0.803;量表中家庭照护认知能力维度与家庭凝聚力维度（r=0.348,P＜0.01）、家庭照护认知能力维度与家庭支援能力维度（r=0.236,P＜0.01）、家庭凝聚力维度与家庭支援能力维度（r=0.222,P＜0.01）均呈正相关,且3个维度与量表总分间均呈正相关（r值分别为0.789、0.686、0.654,P＜0.01）。量表的Cronbach′s α系数为0.780,各维度Cronbach′s α系数为0.780～0.804;重测信度为0.665～0.768;分半信度为0.745～0.890。结论 中文版老年患者家庭照护能力量表具有良好的信效度,可用于对老年患者家庭照护能力的测评。     

基于奥马哈系统慢性阻塞性肺疾病患者社区卫生服务需求调查问卷编制及信效度检验

目的　编制具有良好信效度且能全面评价慢性阻塞性肺疾病（COPD）患者社区卫生服务需求的调查问卷。方法　以奥马哈问题分类系统为理论框架,在文献回顾、小组讨论和德尔菲法的基础上得到初始问卷。于2016年12月—2017年4月采取方便抽样法,选取天津市4所综合性三级甲等医院呼吸科的COPD患者。对患者进行问卷调查,采用临界比值（CR）法、相关性分析、内容效度指数（CVI）、探索性因子分析、重测信度、Cronbach's α系数进行信效度检验,形成正式问卷。结果　通过文献回顾、小组讨论、专家咨询形成4个维度34个条目的初始问卷。共发放问卷187份,回收有效问卷177份,问卷的有效回收率为94.7%。项目分析结果表明,各条目临界比值（CR值）为2.64~9.21（P均<0.05）,除A1（降低社区医院COPD治疗相关的医疗服务价格）、A3（增加COPD药品报销比例）、A4（增加社区医院COPD常用药物种类）外,各条目与总分Pearson相关系数（r值）均>0.4。条目水平的内容效度指数（I-CVI）为0.93~1.00,平均量表水平的内容效度指数（S-CVI/Ave）=0.99。因子分析删除1个条目后共提取4个公因子,累积方差贡献率为55.76%。最终确定COPD患者社区卫生服务需求调查问卷共计33个条目,分为4个维度,分别为环境需求（9个条目）、心理社会需求（6个条目）、生理需求（6个条目）、健康相关行为需求（12个条目）。问卷总重测信度为0.88,各维度重测信度为0.76~0.90。问卷总Cronbach's α系数为0.91,各维度Cronbach's α系数为0.75~0.90。结论　基于奥马哈系统编制的COPD患者社区卫生服务需求调查问卷具有良好的信度及效度,可以作为COPD患者社区卫生服务需求的评价工具。     

SF-12v2量表评价社区居家养老模式下老年人健康状况的信度和效度分析

目的　探讨应用健康调查12条简表第2版（SF-12v2量表）评价社区居家养老模式下老年人健康状况的信度和效度。方法　2017年7—11月采用两阶段抽样法抽取广州市451名社区居家养老的老年人为研究对象,应用SF-12v2量表对其健康状况进行调查,同时采用欧洲五维健康量表5个维度（EQ-5D-5L）的定序数据作为效标。SF-12v2量表信度分析采用Cronbach's α系数和Spearman-Brown分半信度系数,效度分析采用内容效度（集合效度与区分效度）、结构效度和效标效度。结果　信度方面,SF-12v2量表总的Cronbach's α系数为0.876,两个分半量表的Spearman-Brown分半信度为0.873。效度方面,8个维度的集合效度和区分效度均为100.0%,因子分析提取公因子共2个,累计解释65.94%的总变异,SF-12v2生理健康子量表总分与EQ-5D-5L量表行动能力、自我照顾、日常活动、疼痛/不舒服维度中度相关（r值分别为0.591、0.436、0.606、0.590,P<0.01）,SF-12v2心理健康子量表总分与EQ-5D-5L量表焦虑/沮丧维度中度相关（r=0.517,P<0.01）。结论　SF-12v2量表应用于社区居家养老模式下老年人健康状况评价时,具有较好的信度和效度,能够客观反映老年人的健康状况。     

第二版临终关怀家庭照顾者满意度量表的汉化及信效度检验

背景　满意度是临终关怀质量评价体系中的重要指标之一,及时、准确的满意度评估,对了解和提高我国临终关怀的发展水平有重要意义。目的　汉化第二版临终关怀家庭照顾者满意度量表（FAMCARE-2）,并检验其信效度。方法　采用Brislin翻译模型进行翻译、回译,并通过专家函询和预调查对翻译初稿进行文化调适。采用便利抽样法选取2018年9—12月在天津医科大学肿瘤医院中西医结合科接受临终关怀服务的晚期癌症家庭照顾者206例,采用一般资料调查表和中文版FAMCARE-2进行调查,1周后随机便利抽取其中30例进行重测。对中文版FAMCARE-2进行项目分析、信度分析和效度分析。结果　中文版FAMCARE-2包括症状控制、信息支持、家庭支持和患者心理支持4个维度,17个条目。项目分析结果显示,量表17个条目的决断值（CR）为13.463~20.324;各条目与总分均呈正相关（r值为0.763~0.925）;删除各条目后量表的Cronbach'sα系数为0.972~0.975。验证性因子分析结果显示,χ2自由度比（CMIN/DF）为2.045,拟合优度指数（GFI）为0.903,规范拟合指数（NFI）为0.949,相对拟合指数（RFI）为0.929,残差均方和平方根（RMR）为0.011,近似误差均方根（RMSEA）为0.071;量表的条目水平的内容效度指数（I-CVI）为0.857~1.000,量表水平的内容效度指数（S-CVI）为0.958。量表的Cronbach'sα系数为0.975,各维度Cronbach'sα系数分别为0.922、0.903、0.908、0.924;量表的重测信度相关系数r值为0.837;折半信度系数r值为0.947。结论　中文版FAMCARE-2具有良好的信效度,适用于我国临终关怀家庭照顾者满意度的评估。     

巴林特小组活动在内科住院医师规范化培训中的应用

目的　探讨巴林特小组活动在内科住院医师规范化培训医患沟通技能培养中的应用。方法　选取武汉大学人民医院2018级及部分2019级内科专业规培医师为研究对象。采用SPSS 22.0配对t检验以自身培训前后为对照,应用医患沟通技能评价量表（set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter,SEGUE）对巴林特小组培训活动前后规培医师的医患沟通能力进行评估,采用问卷调查方式了解其对医患沟通现状的认识并对培训活动进行评价。结果　规培医师均认识到医患沟通的重要性和医患沟通产生的主要原因。在接受以巴林特小组活动为主的医患沟通培训后,SEGUE量表总分由（15.40±5.65）分上升至（19.84±1.92）分,在准备启动、信息收集、信息给予、理解病人及结束问诊5个维度均有明显提高（P<0.001）,规培医师对培训方式及内容满意度为92.00%（69/75）。结论　内科专业规培医师医患沟通能力需进一步提高,巴林特小组活动丰富了医患沟通培训形式,有助于规培医师增强职业自信、构建和谐医患关系。     

一种成年人营养素养测量量表的编制及信效度评价

目的筛选成年人营养素养测评量表条目,并验证其信效度,为评价成年人的营养素养水平提供一个测量工具。方法通过文献综述法形成量表条目池,通过Delphi专家咨询对量表进行初步筛选后形成营养素养初始调查问卷,线上调查1 718名成年人后收集结果,结合临界比值法、校正题项-总相关系数法和因子分析法进一步筛选条目,并使用Cronbach's α系数和折半信度系数来检验量表的信度,从内容效度和结构效度两方面检验量表的效度。结果本研究成年人营养素养量表包括功能性营养素养（包括知识储备、知识理解、获取技能和应用技能4个领域）、互动性营养素养（互动技能领域）和评判性营养素养（评判技能领域）3个方面,总共43项条目。总量表的Cronbach's α系数为0.971,折半信度系数为0.855;量表水平的内容效度指数为0.982,条目水平的内容效度指数为0.846~1.000;验证性因子分析结果显示6个维度的标准化因子载荷0.463~0.938,平均方差萃取值0.552~0.807,组合信度值0.860~0.961。结论该量表具有良好的信度和效度,可用于成年人营养素养水平的测量。     

维和官兵创伤压力暴露量表的初步编制及信效度检验

目的 初步编制维和官兵创伤及压力暴露量表,评价其信度及效度。 方法 基于文献回顾和访谈法确定量表的理论模型和结构模型,建立条目池,编制测试条目,经专家修订形成基本条目。对维和步兵营733名官兵进行测试,通过项目分析等进行条目筛选,应用探索性因素分析等形成基本量表。运用量表对维和步兵595名官兵进行验证性测试,通过相关分析、验证性因素分析等验证量表的效度,以克朗巴赫系数和分半信度检验量表的信度,以PCL-M量表作为研究校标。结果 经统计学分析结合专业知识,量表最终保留5个维度,分别为创伤性事件、个人生活应激源、人际关系应激源、任务评价、过去创伤性事件,共25个条目,累计贡献率达62.909%。验证性因子分析结果显示各检验量均处于标准范围,χ2/df=2.438,RMR =0.042, RMSEA=0.082;总量表同质信度克朗巴赫系数为0.909,分半信度为0.806,各维度与量表总分相关系数为0.411～0.727(P<0.01),量表总分与PCL-M量表总分的校标关联效度为0.623(P<0.01),显示该量表信效度良好。以5%为划分点,计算量表的预测效度,AUC（曲线下面积）为0.937,说明该量表在5%的划分点预测价值较高。结论 经过严格的条目筛选后,保留的条目符合代表性好、敏感性高、区分性好的原则,达到了编制的要求。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.