社区老年人口腔健康知信行问卷的编制及信效度检验

目的编制社区老年人口腔健康知识、信念及行为问卷,并检测其信效度。方法以"知信行"理论和"健康信念模式"为指导,通过与老年人接触、文献查阅、2轮专家咨询、预试验形成正式施测问卷。对23名老年人间隔2周进行2次测试,检验问卷重测信度;对412名社区老年人进行正式施测,检验问卷信效度,形成最终版问卷。结果经因子分析提取10个因子,共47个条目。知信行3个层面累计解释变异量分别为53.24%、62.30%、48.72%。问卷内容效度分别为0.930、0.880、0.824,条目内容效度为0.800~1.000;Cronbach′sα分别为0.827、0.816、0.856;折半信度为0.676、0.727、0.762;3个层面的重测信度0.814~0.930。结论问卷具有良好的信效度,可以用于社区老年人口腔健康知识、信念及行为评估。     

社区老年人跌倒风险感知量表的编制及信效度检验

目的 编制社区老年人跌倒风险感知量表并检验信效度,为跌倒自我防范提供评估工具。方法 通过文献分析、专家函询、预调查、小组讨论等方式构建量表,选取浙江省某社区卫生服务中心259名老年人进行调查,检验量表信效度。结果 社区老年人跌倒风险感知量表包括跌倒生物行为易感性感知（8个条目）、跌倒社会环境易感性感知（4个条目）、跌倒严重性感知（5个条目）3个维度,共17个条目。探索性因子分析3个公因子累计方差贡献率为60.266%。量表内容效度指数为0.940,条目内容效度指数为0.800~1.000。量表的Cronbach′s α系数为0.913,各维度Cronbach′s α系数为0.814~0.858,重测信度为0.907。结论 社区老年人跌倒风险感知量表信效度良好,可用于老年人跌倒风险感知的评估。     

消毒供应中心工作人员职业暴露风险感知量表的编制及信效度检验

目的 编制消毒供应中心工作人员职业暴露风险感知量表并检验其信效度。 方法 通过风险感知理论、健康行为变化的多理论模型确定量表结构,通过文献分析及质性访谈法编制量表条目池,通过德尔菲专家咨询法形成量表初稿,通过问卷调查法检验量表信效度。 结果 消毒供应中心工作人员职业暴露风险感知量表共包括发生职业暴露的可能性、职业暴露后果的严重性、参与性对话、行为信心、环境的改变5个维度共33个条目。探索性因子分析提取5个公因子累积方差贡献率为65.098%。内容效度分析I-CVI为0.867~1.000,S-CVI/UA为0.864,S-CVI/Ave为0.983。量表总分与效标工具（护理人员风险感知问卷） 总分呈正相关（r=0.674,P＜0.05）。总量表Cronbach′s α系数和重测信度分别为0.869和0.919。 结论 消毒供应中心工作人员职业暴露风险感知量表具有良好的信效度,可用于相关人员职业暴露风险感知的评估。     

终末期癌症患者自我报告安宁疗护照护质量问卷的编制及信效度检验

目的 编制、检验终末期癌症患者自我报告安宁疗护照护质量问卷，为评价照护质量提供适用性工具。方法 通过文献分析、小组讨论、德尔菲法、预调查形成问卷初稿；先后选取终末期癌症患者238例、254例进行问卷信效度检验与验证分析。结果 问卷包括5个维度共39个条目，探索性因子分析提取5个因子，累积方差贡献率为74.433%;验证性因子分析显示χ²/df=1.721,GFI=0.921,NFI=0.925,CFI=0.963,TLI=0.943,RMSEA=0.054。问卷总Cronbach′s α系数为0.950,折半信度为0.927,重测信度为0.830,内容效度指数为0.950。结论 该问卷具有良好的信效度，可用于评估终末期癌症患者安宁疗护照护质量。     

肿瘤患者跌倒风险感知量表的编制及信效度检验

目的 编制肿瘤患者跌倒风险感知量表并检验信效度,为肿瘤患者跌倒防范提供自评工具。方法 通过文献回顾、专家函询、小组讨论等方式构建量表,选取407例肿瘤患者进行调查,检验量表信效度。结果 肿瘤患者跌倒风险感知量表包括跌倒认知易感知性(5个条目)、生理状况易感知性(12个条目)、个人活动易感知性(5个条目)、环境因素易感知性(5个条目)、跌倒严重性感知(3个条目)5个维度共30个条目。探索性因子分析提取5个公因子,累计方差贡献率66.746%。量表总的Cronbach′s α系数为0.926,折半信度为0.672,各维度Cronbach′s α系数为0.914～0.970,折半信度为0.877～0.963。量表水平的内容效度指数为0.867,条目水平的内容效度指数为0.813～1.000。验证性因子分析结果显示,χ²/df=1.845,RMSEA=0.059,GFI=0.840,CFI=0.971,NFI=0.939,AGFI=0.811,模型适配良好;AVE平方根均显著大于相关系数,各维度之间有显著相关性(均P<0.05)。结论 肿瘤患者跌倒风险感知量表信效度...     

照顾者预防儿童哮喘发作健康信念问卷的编制与检验

目的 为评估照顾者预防儿童哮喘发作健康信念提供可靠工具。方法 以健康信念模型为理论基础，采用文献回顾、专家咨询法、预调查法形成正式调查问卷。选取2所妇幼保健院253名哮喘患儿照顾者进行调查。结果 最终形成的问卷包含感知易感性、感知严重性、自我效能、感知障碍、感知益处5个维度共41个条目。总问卷的Cronbach′s α系数为0.947，各维度的Cronbach′s α系数0.814~0.963。探索性因子分析提取5个因子，累积方差贡献率为62.951%。问卷平均内容效度指数为0.917。结论 照顾者预防儿童哮喘发作健康信念问卷具有较好的信效度，可用于照顾者预防儿童哮喘发作健康信念的评估。     

老年住院患者照护者健康素养问卷的编制及信效度检验

目的 编制老年住院患者照护者健康素养问卷并检验其信效度。 方法 以健康素养概念模型为理论基础，通过文献回顾、小组讨论、专家咨询、预调查形成初始版老年住院患者照护者健康素养问卷，选取229名老年住院患者照护者进行调查，对问卷进行信效度检验。 结果 老年住院患者照护者健康素养问卷包括健康知识、照护技能、知识获取、心理支持、寻求帮助5个维度共30个条目。通过探索性因子分析共提取5个公因子，累计方差贡献率为71.462%；问卷水平的内容效度指数为0.867，条目水平的内容效度指数为0.800～1.000；问卷Cronbach′s α系数为0.947，折半信度为0.893，重测信度为0.954。 结论 老年住院患者照护者健康素养问卷具有良好的信效度，能够用于评估老年住院患者照顾者健康素养水平。     

腹膜透析患者延续护理需求评估问卷的编制及信效度检验

目的编制腹膜透析患者延续护理需求评估问卷并检验其信效度。方法通过微信随访、文献系统评价及专家会议形成问卷初始条目,通过咨询5名专家及调查255例腹膜透析患者行问卷信效度检验。结果探索性因子分析提取7个公因子,解释总变异量的75.183%;该问卷Cronbach′sα系数为0.909,各维度Cronbach′sα系数为0.673～0.885;问卷重测信度为0.905,各维度重测信度为0.689～0.892;问卷的内容效度为0.861,各条目的内容效度为0.840～1.000。最终版问卷共包含7个维度32个条目。结论腹膜透析患者延续护理需求评估问卷编制过程合理,问卷的信效度良好,可用于腹膜透析患者延续护理需求的评估。     

城市空巢老人社区居家医养结合服务需求问卷的构建及信效度检验

目的 编制城市空巢老人社区居家医养结合服务需求问卷,并检验信效度。方法 以马斯洛层次需求理论、积极老龄化理论为指导,通过文献分析、半结构式访谈、专家函询形成初始版问卷。采用方便抽样法选取495名城市空巢老人进行调查,检验问卷的信效度。结果 最终形成的问卷包括8个维度、37个条目,累计方差贡献率为65.559%;条目水平的内容效度指数为0.824～1.000,问卷水平的内容效度指数为0.930;问卷总Cronbach′s α系数为0.966。验证性因子分析χ²/df=1.236,RMSEA=0.033,SRMR=0.030,CFI=0.982,TLI=0.980,IFI=0.982。结论 编制的问卷具有良好的信效度,可作为评估城市空巢老人社区居家医养结合服务需求的工具。     

农村居家失能老年人健康管理需求评估问卷的编制及信效度检验

目的 编制农村居家失能老年人健康管理需求评估问卷,并检验其信效度.方法 以奥马哈问题分类系统为理论框架,综合文献回顾形成问卷条目池,对18名专家进行2轮Delphi专家函询形成预试问卷.对河南省213名农村居家失能老年人进行调查,检验问卷的信效度.结果 探索性因子分析共提取6个公因子29个条目,包括健康档案、身体评估、...     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.