助产士核心胜任力量表信度和效度研究

目的:对助产士核心胜任力量表进行信度和效度的检测。方法:采用文献回顾的方法,重点参考国际助产联盟制定的助产士胜任力标准,通过助产专业的专家,形成助产士核心胜任力量表,并对北京市19家医院的300名助产士进行测评,对量表进行信度和效度分析,最终形成量表。结果:有效量表295份。助产士核心胜任力量表共由6个维度,54项条目组成,其内部一致性Cronbach’sα系数为0.978,各分维度的Cronbach’sα系数为0.921～0.938之间,均在0.9以上,总量表的内容效度比为0.95,结构效度6个因子的累计解释变量为70.927%,均在测量学可接受的范围。结论:该助产士核心胜任力量表具有良好的信度和效度,条目设置适用于我国助产士核心胜任力的评价。     

助产士核心胜任力现状调研及影响因素分析

目的 调查连云港地区4所三级甲等医院120名助产士的核心胜任力现状及其影响因素.方法 采用助产士一般情况调查表、助产士核心胜任力量表和自我效能感量表对3所三级甲等医院120名助产士进行调查.结果 助产士核心胜任力总分为(4.04±0.60)分,各维度得分由高到低分别为分娩期保健(4.28±0.65)分、产后保健(4.2...     

湖南省助产士核心胜任力的调查分析

目的了解湖南省助产士核心胜任力现状。方法采用助产士核心胜任力量表对湖南省6所医院102名助产士进行调查。结果助产士核心胜任力总均分为（4．08±O．48）分,其中分娩期保健和产后保健得分较高,而公共卫生保健和孕前保健得分较低;助产士的年龄、工作年限、助产工作年限与助产士核心胜任力得分呈显著正相关,而不同婚姻状况、职称、医院级别、有无助产证和产科进修的助产士核心胜任力水平不同。结论应进一步完善我国助产专业教育体系,建立独立的助产士准入制度和职称体系,充分发挥助产士的角色职能,从而推动助产士队伍核心胜任力的全面提高。     

北京市助产士核心胜任力架构的质性研究

目的 探索助产士核心胜任力的架构.方法 采用国际助产联盟助产士胜任力架构作为模板,通过半结构访谈,收集了14名北京助产实践者和管理者的意见,并用内容模板法进行分析.结果 北京市助产士的核心胜任力架构由5个维度构成.结论 北京助产士核心胜任力的架构和国际助产联盟制定的架构相似,但在孕前保健和社区保健胜任力上存在差异.     

宿迁地区助产士核心胜任力现状及影响因素分析

[目的]了解宿迁地区助产士核心胜任力现状,分析核心胜任力的主要影响因素。[方法]根据方便抽样方法,采用自行设计的一般资料调查问卷、助产士核心胜任力量表对来自宿迁地区二级以上医院从事助产工作的105名助产士进行调查。采用多元回归分析助产士核心胜任力的影响因素。[结果]宿迁地区助产士核心胜任力总均分为(28.99±3.85)分。多元线性回归分析显示,年龄、助产工作年限、婚姻状况、职称、编制、医院等级、学习经历是影响助产士核心胜任力的重要因素(P0.01);学历与核心胜任力无明显相关性(P0.05)。[结论]宿迁地区助产士核心胜任力处于中等水平,管理者应根据不同年资、工作年限等特点,制订合理的措施和培训内容,提高助产士核心胜任力水平,稳定助产士队伍。     

福建省13所医院助产士核心胜任力现状及影响因素研究

目的 了解福建省助产士核心胜任力现状并分析其影响因素。 方法 采用助产士核心胜任力量表对福建省13所二级以上医院的374名助产士进行横断面调查,并进行核心胜任力影响因素的单因素分析和多元线性回归分析。 结果 助产士的核心胜任力总均分为（3.96±0.54）分,职业素养、产后保健技能、妊娠期保健技能得分较高,公共卫生保健知识、公共卫生保健技能、妇女保健知识得分较低。助产士核心胜任力初级、中级、高级能力总均分分别为（4.03±0.55）分、（3.78±0.59）分、（3.54±0.75）分。7个维度中,技能得分均高于知识得分。多元线性逐步回归分析显示,助产工作年限、医院级别、婚姻状况、聘用形式是助产士核心胜任力的影响因素（P<0.05）。 结论 福建省13所医院助产士核心能力总体处于中等水平,初级能力较好,中、高级能力有待提高。应关注新入职、基层、非在编助产士,全面提高助产士队伍的核心胜任力。     

河北省教学医院助产士的核心胜任力及影响因素研究

目的:了解河北省三级甲等教学医院的助产士核心胜任力现状,分析其影响因素.方法:根据目的抽样法,采用助产士核心胜任力量表对河北省5所三级甲等教学医院的131名助产士进行问卷调查.结果:助产士的核心胜任力总分为(220.78±33.22)分,其中分娩保健维度得分较高,条目均分为(4.30±0.70)分,孕前保健的得分较低,条目均分为(3.62±0.90)分.助产士核心胜任力与年龄、婚育状况、初始学历、工作时间、助产工作时间以及是否参与带教工作等呈正相关.多元线性逐步回归分析显示,助产工作时间是助产士核心胜任力的影响因素(P<0.01).是否参与科室/医院带教工作的助产士核心胜任力总分比较差异有统计学意义(P<0.05).结论:河北省教学医院助产士的核心胜任力水平较高,教学医院应根据不同的助产工作时间和是否参与科室/医院的带教工作等特点,制定合理的培训措施与内容,提高助产士核心胜任力水平.同时通过进一步加强临床带教师资的培养,完善我国助产专业教育体系,为助产教育奠定基础.     

助产士核心能力培养及影响因素分析

目的 探讨助产士核心能力培养与影响因素的分析.方法 使用助产士核心胜任力量表对200名助产士进行问卷调查,收回有效问卷统计分析.结果 助产士核心胜任力量表总平均分和各细目得分与助产士核心力相关的影响因素对比如下:年龄＜30岁和>30岁差异有统计学意义(P＜0.05);中级以下职称和中级以上职称差异有统计学意义(P＜0.05);未婚和已婚差异有统计学意义(P＜0.05);中专以下学历和中专以上学历差异无统计学意义(P>0.05);在编人员和人事代理差异无统计学意义(P>0.05);二级以下医院和二级以上医院差异无统计学意义(P>0.05).结论 助产管理部门和教育管理者应根据我国的实际情况从相关影响因素中制定提高助产士核心力的制度,对助产士核心力的培养做到目标明确,逐步推动助产事业健康发展.     

护理组织信任量表的信效度评价

目的评价组织信任量表在护理领域的适用性。方法使用量表对北京市3所三级医院313名护士进行测试，评价量表信度和效度。结果量表总体内部一致性信度为0．953，各维度内部一致性信度为0．906～0．923，重测信度为0．799，折半信度为0．941。量表具有较好的内容效度，结构效度的累积方差贡献率为77．273％，提取的2个公因子与原量表稍有不同。结论组织信任量表具有良好的信度和效度，可为该量表在护理领域应用提供参考。     

胜任力表现测验体系中文版的信度和效度研究

目的检测胜任力表现测验体系(Competency Performance Examination,CPE)中文版的信度和效度,为胜任力本位教育的效果评价提供可靠的评价工具。方法通过专家效度法评价CPE中文版的表面效度和内容效度。使用CPE中文版对20名护理本科实习生胜任力表现进行评价,检测CPE中文版的内部一致性及评定者间信度。结果 CPE中文版各个条目的 CVI在0.6～1.0,全部条目的平均CVI为0.965。7项核心胜任力的KR-20值在0.730～0.921,整个测验体系的KR-20值为0.855。7项核心胜任力判定的一致Kappa系数在0.685～0.823(P均<0.05)。结论 CPE中文版具有良好的信度和效度,可作为评价胜任力本位教育临床教学效果的评价工具。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.