军队医院灾难救援机动护士能力体系的构建

目的 构建军队医院灾难救援机动护士能力体系,以更好地适应军队医院灾难救援任务需求。方法 查阅国内外文献,初步形成军队医院机动护士灾难救援能力体系的草案,采用德尔菲法,对来自全国军队医院、院校、研究所的20名专家进行两轮专家咨询,最终确立军队医院机动护士灾难救援能力体系。结果 两轮专家函询问卷的有效回收率均为100%,权威系数分别为0.89、0.88,专家咨询协调系数经χ²检验后均有统计学意义(P<0.01),专家咨询后各指标的变异系数为0.025～0.181。构建的军队医院机动护士灾难救援能力体系包括4个一级指标、24个二级指标。结论 军队医院机动护士灾难救援能力体系构建方法科学,专家积极性和权威性高,各指标专家咨询意见趋于一致,可用于军队医院机动护士灾难救援能力的评估和培养。     

创伤专科护士岗位职责核心指标体系的初步构建

目的构建符合我国创伤救治体系架构特征的创伤专科护士岗位职责核心指标体系, 为创伤中心设置创伤专科护士岗位提供参考。方法通过文献研究法和小组讨论法构建创伤专科护士岗位职责核心指标体系初稿。应用Delphi专家咨询法对来自全国7个省(市)的15位专家进行两轮咨询, 确定指标体系终稿。计算两轮咨询专家的积极系数、权威系数(Cr)、肯德尔协调系数(Kendall′sW)、各级指标的重要性赋值均数及变异系数(CV)。结果两轮咨询专家的积极系数均为100%, Cr为0.953。第2轮咨询的Kendall′sW为0.188(χ2=155.29, P<0.001), 所有指标的重要性赋值均数范围为4.27～5.00分, CV均<0.25分。最终构建的创伤专科护士岗位职责核心指标体系包含7项Ⅰ级指标和49项Ⅱ级指标。结论创伤专科护士岗位职责核心指标体系科学合理、内容全面, 可以为我国创伤专科护士岗位设置提供参考依据。     

手术室护理操作难度系数评价指标体系的构建研究

目的 构建手术室护理操作难度系数评价指标体系,为评估手术室护理操作难度系数提供参考依据。方法 2020年1月-2022年12月期间,选取近10余家三甲医院手术室临床护理人员、护理管理人员共30名专家作为函询对象,运用文献检索、理论研究、半结构式访谈及层次分析法等方式初步构建手术室护理操作难度系数评价指标体系初稿,撰写专家咨询问卷,再运用德尔菲法(Delphi)对初稿中指标实施两轮专家函询咨询,形成具有科学性、客观性的手术室护理操作难度系数评价指标体系。结果 两轮专家函询问卷有效回收率分别为97.22%、91.42%,意见提出率分别为28.57%、15.62%,表明专家对本课题具有较高积极性;两轮专家函询Cr分别为0.86、0.89,说明专家参与制定指标体系权威性高,结果具有可信性;两轮专家函询总体指标W分别为0.347、0.404,Cv分别为0.203、0.155,差异有统计学意义(P<0.05),表明专家协调度良好;临床普遍认为Cronbach′s α系数在0.7以上表明可接受,本课题2两轮专家函询问卷Cronbach′s α系数分别为0.939、0.963,均符合上述标准,表...     

基于改进德尔菲法与层次分析法构建寒区冷习服评价指标体系

目的 针对寒区特殊环境的作业需求,采用德尔菲法和层次分析法构建一个可以对冷习服能力进行评价的指标体系。方法 按照德尔菲法原理,对在冷习服领域具有权威的21位专家进行3轮函询,根据指标筛选标准及专家反馈意见,确定评估指标体系并应用层次分析法计算权重。结果 3轮专家函询的积极系数分别为100.0%、95.2%、100.0%,专家权威系数在0.75～1.00之间,肯德尔和谐系数分别为0.198、0.201、0.113(P均<0.01)。第3轮各指标变异系数均<0.25,专家意见趋于一致,研究结果可靠性高。最终建立了由4个一级指标和18个二级指标构成的冷习服评价指标体系。结论 本研究充实了寒区冷习服评价指标体系的各种可行性权重指标,为评价寒区冷习服能力提供了科学的理论工具,但信度、效度及应用效果仍需进一步评估。     

介入专科多维度表格式护理评估单的构建

目的 探索构建适用于介入专科病房的表格式护理评估单.方法 应用德尔菲法研究介入专科护理评估单的维度和项目.研究组通过查阅文献、结合临床专科护理经验制定介入专科病房护理评估的初步维度和项目,通过电子邮件向15名介入护理专家征询意见,回收后归纳整理,再进行下一轮专家函询.分别对各维度和项目予以评价,按照“非常必要、必要、不必要”分别赋予5、3、1分.保留平均分≥2.25的项目,剔除平均分＜2.25的项目,根据各项目之间的逻辑关系整理排版,确立最终介入专科护理评估表.结果 介入专科病房护理评估可分为3个维度:专科通用护理评估、专病护理评估、特殊专项护理评估,共12个总项目,均构建了表格式的评估单.结论 多维表格式护理评估单的构建,符合介入专科病房的特点和要求,将使护理评估更专业、更全面,有利于护理程序的正确实施,值得推广和进一步研究.     

我国飞行护士培养目标的探讨

目的：探讨我国飞行护士培养目标的具体内容,为未来选拔及培训飞行护士提供理论依据。方法采用文献分析法、专家访谈法形成专家咨询问卷,对不同领域的15名专家进行两轮Delphi专家咨询。结果构建了我国飞行护士培养的总体目标和具体目标,其中具体目标包括3个一级指标和22个二级指标。两轮专家咨询的问卷回收率均为100%,专家对一、二级指标的权威系数均在0.87以上,两轮咨询的所有肯德尔协调系数差异均有统计学意义（均P＜0.01）。结论专家的积极性和权威程度高,意见协调性好,所形成的培养目标合理,具有可操作性。     

我国空运后送专业护士培训课程体系的构建研究

目的结合我国飞行护士能力标准指标体系、飞行护士培训知识需求调查和飞行护士核心知识体系,探讨我国空运后送专业护士的培训对象、培养目标、课程模块及学时设置、具体课程内容和考核要点,以尝试构建我国空运后送专业护士的培训课程体系。方法通过国内外文献回顾和专家访谈法制定出专家咨询问卷,运用德尔菲法对15名专家进行两轮函询,并对数据进行分析处理。结果在两轮问卷中,93.3%的专家认同空运后送专业护士培训对象的要求,专家对具体培养目标、课程模块和考核要点的权威系数分别在87.0%以上、79.0%以上和85.0%以上,所有肯德尔协调系数均有统计学意义(P0.01)。结论构建的空运后送专业护士培训课程体系具有较高的科学性,对未来空运后送专业护士的培训与考核提供了重要理论依据。     

某大型舰船护理核心技术体系研究

目的 构建某大型舰船护理核心技术体系。方法 采用文献研究法、专家会议法、德尔菲法和层次分析法对20名专家进行两轮函询,选用SPSS 17.0、yaahp 10.3软件进行统计分析。结果 两轮问卷有效回收率均为100%,专家权威系数为0.88、0.90,协同系数0.216~0.416。最终确定包括舰船一般护理技术、急救技术、特殊护理技术、战创伤护理技术4个方面的某大型舰船护理核心技术体系,权重依次为0.093、0.305、0.143、0.459。结论 专家积极性和权威程度高,意见协调性较好,构建的护理核心技术体系可为开展护理技术培训提供理论参考依据。     

我国空运后送护理安全管理评价指标体系的构建研究

目的 初步构建我国空运后送护理安全管理评价指标体系,旨在降低空运后送伤病员护理安全隐患,有效减少不良事件的发生.方法 通过文献回顾法、专家议题小组法初步拟定专家咨询问卷;采用德尔菲法对不同专业的15位专家进行两轮专家咨询;使用Excel 2010、SPSS 23.0软件和yaahp层次分析软件对数据进行汇总分析,筛选指标并确定指标权重.结果 两轮咨询专家积极系数均为100％,专家权威系数均在0.912以上,肯德尔和谐系数差异均有统计学意义(P<0.05).最终确定包含5项一级指标、16项二级指标、85项三级指标的我国空运后送护理安全管理评价指标体系.结论 初步构建的我国空运后送护理安全管理评价指标体系具有较高的科学性和实用性,专家意见较为集中,经进一步验证后可作为空运后送护理安全评价工具.     

门诊医疗质控重点指标的构建与实践

目的 构建门诊医疗质控重点指标体系，以提高门诊医疗质量和患者满意度。方法 通过文献研究和专家访谈，形成咨询问卷，运用德尔菲法对17名专家进行两轮专家咨询，确立构建门诊医师医疗质控重点指标。提取医院HIS系统相关数据和移动终端满意度调查结果。结果 两轮专家函询的回收率均为100%,专家权威系数大于0.7,筛选后门诊医师质控重点指标体系包括3个一级指标、12个二级指标，指标问卷调查的克朗巴赫系数为0.728。从指标体系实践结果来看，预约挂号率增高了29.09%,基本药物占比增加了2.75%,门诊病历打印率增加了28.28%,出诊考勤合格率和患者满意度均有明显提升。结论 构建的医疗质控重点指标定位准确、导向性强，数据可量化，可用于门诊医疗质控，提升患者满意度。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。