护士伦理行为量表的汉化及信效度检验

目的 汉化护士伦理行为量表修订版(the Ethical Behavior Scale for Nurses-Revise),并检验其信效度。方法 获取原量表作者授权后，通过正译、回译、文化调适、认知性访谈和预调查对原量表进行汉化，形成中文版护士伦理行为量表。选取535名临床护士进行调查，以评价量表信效度。结果 中文版护士伦理行为量表包括3个维度、15个条目。条目水平的内容效度指数为0.890～1.000,量表水平的内容效度指数为0.985;探索性因子分析提取3个公因子，累计方差贡献率为60.952%。量表总的Cronbach′s α系数为0.892,3个维度的Cronbach′s α系数分别为0.897、0.870、0.838;Guttman分半信度为0.918。结论 中文版护士伦理行为量表具有良好的信效度，适合作为中国文化背景下护士伦理行为的评估工具。     

健康问题解决量表的汉化及信效度检验

目的 汉化健康问题解决量表并在2型糖尿病患者中验证其信效度。 方法 采用Brislin模式对健康问题解决量表进行翻译、回译及跨文化调适,形成中文版健康问题解决量表,并对262例2型糖尿病患者进行调查。通过专家咨询分析量表的内容效度,并通过Cronbach′s α系数、重测信度、折半信度验证健康问题解决量表的信度。通过与个人问题解决量表的相关性分析验证其效标关联效度,并同时采用探索性因子分析进行结构效度检验。 结果 形成的中文版健康问题解决量表共包括6个维度、30个条目。 量表水平的内容效度指数为0.970,条目水平的内容效度指数0.830~1.000。效标关联效度为-0.675（P＜0.05）;探索性因子分析共提取6个公因子,累计方差贡献率为59.017%。量表Cronbach′s α系数为0.911,各维度Cronbach′s α系数为0.715~0.839;Spearman-Brown折半信度为0.764,重测信度为0.798。 结论 中文版健康问题解决量表具有良好的信效度,可用于2型糖尿病患者健康问题解决能力的评估。     

医护人员医疗成本意识量表的汉化与信效度检验

目的 引入医护人员医疗成本意识量表并进行汉化与信效度检验,为评估医护人员医疗成本意识提供适合的工具。 方法 按照Brislin翻译原则对医护人员医疗成本意识量表进行翻译、回译与文化调适,以便利抽样法选择四川省6所三甲综合医院重症医学科医护人员264人进行调查并检验量表信效度。 结果 中文版医护人员医疗成本意识量表包括感知到具有成本意识的高价值照护、感知到控制医疗成本的参与以及感知到控制医疗成本的责任3个维度共15个条目,累计方差贡献率为62.629%。量表条目水平的内容效度指数为0.857～1.000,量表水平的内容效度指数为0.988;总量表Cronbach′s α为0.914,各维度Cronbach′s α为0.727~0.895,重测信度为0.797。 结论 中文版医护人员医疗成本意识量表信效度良好,可用于评估医护人员医疗成本意识水平。建议结合我国医疗人文环境特点进一步发展出本土化评估工具。     

灾害适应与复原力量表的汉化及信效度检验

目的 汉化灾害适应与复原力量表（Disaster Adaptation and Resilience Scale,DARS）,并在灾害暴露社区居民中检验其信效度。方法 通过翻译、回译、文化调适和预调查形成中文版DARS,对广州市中心4个社区的901名社区居民进行调查,以检验中文版DARS的信效度。结果 量表水平的平均内容效度指数为0.975,条目水平的内容效度指数为0.875~1.000;探索性因子分析提取6个公因子,累计方差贡献率为73.492%;验证性因子分析显示,χ2/df为3.143,RMSEA值为0.066,IFI、CFI、TLI值分别为0.920、0.919、0.914。中文版DARS包括物质资源、社会资源、解决问题的能力、压力调节、乐观主义5个维度共45个条目。总量表的Cronbach′s α系数为0.978,5个维度的Cronbach′s α系数为0.919~0.955;量表的折半信度为0.878。结论 中文版DARS的汉化充分结合中国国情及社会文化背景,具有良好的信效度,可作为我国灾害暴露者灾害适应与复原力的有效测评工具。     

助产士创伤压力量表的汉化及信效度检验

目的 汉化助产士创伤压力量表,并检验中文版量表的信效度,为我国助产士创伤压力评估提供测评工具。方法 采用Brislin翻译模型对日文版原量表进行汉化,采用中文版量表对385名助产士进行调查,以检验中文版量表的信效度。结果 中文版量表为单维度,共15个条目,分为频率和影响程度分量表,Cronbach′s α系数分别为0.888、0.953,分半信度为0.916、0.819,重测信度为0.824、0.884,与焦虑-压力-抑郁量表的效标关联效度为0.525、0.272(均P<0.05);量表水平的平均内容效度指数为0.949,条目水平的内容效度指数为0.833～1.000。探索性因子分析共提取1个公因子,方差贡献率为70.784%。验证性因子分析结果显示各项指标均达到标准,模型拟合较好。结论 中文版助产士创伤压力量表在中国助产士群体中具有良好的信效度,可用于测评助产士的创伤压力水平。     

拉什顿道德复原力量表的汉化及在医务人员中的信效度检验

目的 汉化英文版拉什顿道德复原力量表，并检验其信效度，为医务人员道德复原力测量提供有效工具。 方法 采用Brislin模式进行翻译、回译，采用跨文化调适和预测试对拉什顿道德复原力量表进行修订，形成中文版量表。采用中文版拉什顿道德复原力量表、马氏职业倦怠量表服务版、心理弹性量表对372名医护人员进行调查，分析量表的信效度。 结果 中文版拉什顿道德复原力量表包括道德逆境应对、道德效能、关系完整性、个人完整性4个维度16个条目，量表条目水平的内容效度指数为0.820~1.000，量表内容效度指数为0.901；中文版拉什顿道德复原力量表得分与职业倦怠量表、心理弹性量表评分相关系数分别为-0.307、0.560（均P＜0.05）；经探索性因子分析累积方差贡献率为64.293%；验证性因子分析模型拟合良好（χ2/df=2.067，RMSEA=0.076）。量表Cronbach′s α系数为0.763，各维度Cronbach′s α系数为0.523~0.842。 结论 中文版拉什顿道德复原力量表具有良好的信效度，可作为医务人员道德复原力现况的测评工具。     

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。     

血液透析患者家庭照顾者生活质量量表汉化及信效度检验

目的 汉化血液透析患者家庭照顾者生活质量量表,检验其信效度。 方法 采用Brislin模式将英文版血液透析患者家庭照顾者生活质量量表翻译成中文,采用中文版量表对738名血液透析患者家庭照顾者进行调查,检验量表信效度。 结果 中文版量表各条目水平的内容效度指数为0.848～1.000,量表水平的内容效度指数为0.935,探索性因子分析提取5个公因子,共35个条目,累积方差贡献率为64.172%。验证性因子分析的模型适配度良好。总量表Cronbach′s α系数为0.831,5个公因子的Cronbach′s α系数为0.694～0.821,重测信度为0.886。中文版量表总分与ZBI照顾者负担量表总分相关系数为-0.821（P＜0.05）。 结论 中文版血液透析患者家庭照顾者生活质量量表具有较好的信效度,适用于我国血液透析患者家庭照顾者生活质量测量。     

癌症患者临终沟通准备度量表的汉化及信效度检验

目的 汉化癌症患者临终沟通准备度量表,并检验其信度和效度。方法 获取量表原作者授权后,采用Brislin翻译模式对英文版癌症患者临终沟通准备度量表进行翻译、回译、文化调适,形成中文版量表;对242例晚期癌症患者进行调查,以评价量表的信效度。结果 中文版癌症患者临终沟通准备度量表包含沟通思想准备、沟通经验、价值观3个维度,共12个条目,累积方差贡献率为76.985%,量表Cronbach′s α系数为0.910,各维度的Cronbach′s α系数为0.869～0.919;Spearman-Brown折半信度为0.699,重测信度为0.872。量表水平的内容效度指数为0.917。结论 中文版癌症患者临终沟通准备度量表具有较好的信度和效度,可用于评价我国癌症患者临终沟通准备状况。     

安宁疗护沟通舒适度量表汉化及信效度检验

目的 对安宁疗护沟通舒适度量表进行汉化，并检验其在医护人员中应用的信效度。方法 依据跨文化调适指南对英文版量表进行直译、回译、跨文化调适、预调查后对量表进行修订，形成中文版安宁疗护沟通舒适度量表。采用便利抽样法对527名医护人员进行调查，检验中文版量表的信效度。结果 中文版量表包括团队考虑、处理医疗决策、精神考虑、处理症状、慎重意识、文化考虑共6个维度，累积方差贡献率为80.349%;条目水平的内容效度指数为0.860～1.000,量表平均内容效度指数为0.980;Cronbach′s α系数为0.910,重测信度为0.869。结论 中文版安宁疗护沟通舒适度量表信效度良好，可作为测量我国医护人员安宁疗护沟通舒适度的工具。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

---

Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.