血液透析患者控磷行为健康信念问卷的编制及信度效度检验

目的 ：编制适用于血液透析患者的控磷行为健康信念问卷并进行信度、效度检验,以期为临床护士评估血透患者的控磷行为健康信念提供可靠工具。方法：依据健康信念模型理论,通过文献回顾及专家焦点访谈,初步形成问卷条目池;应用德尔菲法进行2轮专家函询,根据专家意见调整问卷内容,形成初稿。采用问卷初稿对某医院308例血透患者进行调查,进行项目分析、信度检验、效度检验和探索性因子分析;选取20例患者在一周后进行重测,检验重测信度。结果 ：2轮函询问卷回收率均为100%,专家权威程度为0.905。2轮肯德尔协调系数分别为0.228和0.352(P<0.05)。正式版血液透析患者控磷行为健康信念问卷共包括26个条目,探索性因子分析共产生3个公因子,累计方差贡献率为71.294%。问卷内容效度指数为0.852,条目内容效度指数在0.8～1.0之间。总问卷Cronbach’s α系数为0.911,重测信度为0.866。结论 ：编制的血透患者控磷行为健康信念问卷具有良好的信度、效度,适用于血透患者控磷行为健康信念的评估。     

脑卒中患者保护动机问卷的编制及信效度检验

目的编制脑卒中患者保护动机问卷,并检验其信效度。方法以保护动机理论为基础,初步构建问卷框架和条目池,通过德尔菲专家咨询和预调查形成测试版问卷,对235例脑卒中患者进行问卷调查,进一步检验问卷的信效度。结果脑卒中患者保护动机问卷包括31个条目,探索性因子分析共提取7个公因子,累计方差贡献率为77.811%,问卷总体的内容效度为0.914,Cronbach’sα系数为0.847,重测信度为0.908。结论脑卒中患者保护动机问卷具有良好的信效度,适用于评估脑卒中患者保护动机水平。     

直肠癌保肛术后患者肠道症状自我管理行为问卷的编制及信效度检验

目的 编制适用于中国文化背景的直肠癌保肛术后患者肠道症状自我管理行为问卷并检验其信效度。方法 依据自我管理的定义,在综述现有文献的基础上,拟定问卷条目池。 通过专家内容效度评价形成测试问卷,采用该问卷对 172 例直肠癌保肛术后患者进行调查,测定问卷的信效度。 结果 直肠癌保肛术后患者肠道症状自我管理行为问卷包括 20 个条目,各条目内容效度指数为 0.80~1.00 ,问卷总体的内容效度为 0.98 ;探索性因子分析提取出 6 个因子,累计方差贡献率为 56.77% ;自我管理行为采用频率与肠道症状严重程度呈正相关。 整体问卷 Cronbach蒺s α 系数为 0.781 ,重测信度为 0.843 。 结论 该问卷具有良好的信度和效度,可作为评估直肠癌保肛术后患者肠道症状自我管理行为的研究工具。     

慢性阻塞性肺疾病病人过渡期护理需求问卷编制

目的:编制慢性阻塞性肺疾病(COPD)病人过渡期护理需求问卷并检验问卷信效度。方法:通过文献回顾提取问卷条目,构建问卷的条目池;通过德尔菲专家咨询法及界值法筛选条目,形成问卷施测稿。采用问卷施测稿对深圳市某三级甲等医院慢性阻塞性肺疾病病人进行调查,调查数据用于问卷项目分析、信度检验及效度检验,最终形成正式问卷。结果:慢性阻塞性肺疾病病人过渡期护理需求问卷共32个条目,探索性因子分析共提取5个因子,累计方差贡献率58.919%。Cronbach′sα系数为0.920,折半信度分别为0.830,0.862。问卷条目水平的内容效度指数(I-CVI)为0.87～1.00,平均内容效度S-CVI/Ave为0.97。结论:COPD病人过渡期护理需求问卷具有良好信效度,可以作为评估病人过渡期护理需求的适用工具。     

心房颤动知识问卷的编制及信效度检验

[目的]编制心房颤动知识问卷,并对问卷的信效度进行检验。[方法]参考心房颤动管理指南并查阅相关文献形成初始版问卷,邀请15名专家对问卷的内容效度和表面效度进行评估,并选取心房颤动病人评估问卷的内部一致性和重测信度。[结果]问卷整体内容效度为0.90,Cronbach’sα系数为0.70,重测信度系数为0.74,问卷条目的难度为0.20~0.81,区分度为0.15~0.66,最终形成包括20个条目的心房颤动知识问卷。[结论]本研究编制的心房颤动知识问卷具有较好的信度和效度,可用于测评心房颤动病人对疾病相关知识的掌握情况。     

基于技术接受模型和信息系统成功模型的临床护理信息系统满意度量表编制

目的:基于技术接受模型(TAM)和信息系统成功模型(ISSM)编制临床护理信息系统满意度量表并对其信效度进行检验。方法:以TAM和ISSM理论为框架,在文献检索的基础上构建量表条目,通过德尔菲法形成测试版量表,选择120名护士进行预调查,采用项目区分度分析、内容效度分析、探索性因子分析优化量表条目,采用内部一致性检验和重测信度法检验量表信度。结果:探索性因子分析共提取出6个解释因子,其累计贡献率达74.13%,最终形成包括17个条目6个维度的系统满意度量表,其内容效度为0.882,各条目内容效度为0.727～1.000,Cronbach′s α系数为0.850,重测信度为0.820。结论:编制的临床护理信息系统满意度量表具有较好的信效度,从6个维度全面反映系统质量和信息质量,可用于临床护理信息系统使用效果评价。     

肠造口患者自我照护行为执行意向问卷的研制

目的 编制肠造口患者自我照护行为执行意向问卷并检验其信效度。方法以执行意向理论及其行动计划和应对计划2种具体形式为结构框架,经文献分析、邀请专家进行2轮专家函询形成问卷初稿。便利选取在青岛市某三级甲等医院门诊复诊的265例肠造口患者进行问卷调查,邀请7名专家进行内容效度测评。采用临界比值法、条目与总分相关系数、同质性检验对问卷进行项目分析;采用探索性因子分析、内容效度、内部一致性信度、重测信度对问卷进行信效度检验。结果专家函询过程中,第1轮函询发放问卷27份,回收27份;第2轮函询发放问卷27份,回收25份。2轮专家函询问卷条目的变异系数范围分别为0.066～0.357、0.040～0.199;2轮专家协调程度分别为0.306和0.505,显著性检验P0.05。形成的肠造口患者自我照护行为执行意向问卷包括2个维度、24个条目,探索性因子分析提取出4个公因子,累计方差贡献率为74.309%;问卷总的Cronbach'sα系数为0.961,重测信度为0.877;总问卷的专家内容效度指数为0.976。结论肠造口患者自我照护行为执行意向问卷具有良好的信效和效度,具有一定的推广价值,可用于测量肠造口患者自我照护行为执行意向现状。     

临床护士糖尿病知识评估量表的研制及信效度检验

[目的]研制临床护士糖尿病知识评估量表,并检验其信度和效度。[方法]结合访谈法结果和已有文献编制临床护士糖尿病知识评估初始量表,经2轮专家咨询后形成临床护士糖尿病知识评估量表,并对量表的信效度进行评价。[结果]临床护士糖尿病评估量表由糖尿病基本知识、糖尿病并发症、血糖监测、药物治疗、运动治疗、饮食治疗、注射技能7个维度100个条目组成,量表的条目内容效度为1,量表平均内容效度指数为1;总量表的重测信度系数为0.898,各维度的重测信度系数为0.578~0.802;总量表的Cronbach’sα系数为0.945,各维度的Cronbach’sα系数为0.727~0.890。[结论]编制的临床护士糖尿病知识评估量表信效度良好,能够用于评估临床护士对糖尿病知识的掌握水平。     

痛风患者疾病感知评估量表的编制及信效度检验

目的 编制痛风患者疾病感知评估量表并检验其信效度。方法 以自我调节常识模型为理论框架,通过文献分析、质性访谈和专家函询法编制量表初稿,便利选取2021年1月—5月在山东省某痛风临床医学中心就诊的799例痛风患者进行问卷调查,筛选量表条目并检验量表信效度。结果 痛风患者疾病感知评估量表包括6个维度、46个条目。探索性因子分析提取6个公因子,累计方差贡献率为56.297%。验证性因子分析显示,各主要评价指标均在可接受范围内。条目水平的内容效度指数为0.865～1.000,量表水平的内容效度指数为0.957。效标关联效度分析显示,量表总评分与校标量表简短疾病感知问卷得分呈正相关（r=0.446,P<0.01）。量表总的Cronbach’s α系数、折半信度、重测信度分别为0.941、0.784、0.965。结论 痛风患者疾病感知评估量表具有良好的信效度,可用于评估痛风患者的疾病感知水平。     

透析病人主要照顾者照顾性行为评估表的信效度研究

[目的]翻译"透析病人主要照顾者照顾性行为评估量表"(caregiving to adults on dialysis,LC-GADs),评价其信度、效度及文化相关性,提供一种有效方便的透析病人照顾性行为评估的中文版问卷.[方法] 应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价.对136例透析病人的主要照顾者应用问卷调查对其结构效度进行评价.对其中30例主要照顾者进行重测,进行重测信度评价.[结果]问卷中所有条目均具有较好的文化相关性,其中1个条目被重新修订.中文版LC-GADs有较好的信度和效度,内容效度指数(CVI)为0.975.问卷的信度和效度Cronbach's α分别为0.93和0.86,重测信度为0.80和0.76.因子分析显示中文版LC GADs具有与原英文版量表一致的结构效度.[结论]中文版LC-GADs是一种具有较高信度和效度的评估透析病人照顾者专用行为评估量表,可以为以后广大护理同仁在研究透析病人照顾者行为相关方面提供可靠的数据支持.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.