护理人员告知坏消息能力量表的汉化及信效度检验

目的 对英文版护理人员告知坏消息能力量表进行汉化及信效度检验,为评估我国护理人员告知坏消息能力提供可靠工具。方法 采用Brislin翻译模型对量表进行汉化,对274名在职护士进行调查并检验中文版护理人员告知坏消息能力量表的信效度。结果 中文版护理人员告知坏消息能力量表包括准备、策略、共情、考虑、沟通、感知6个维度共25个条目,总的Cronbach′s α系数为0.923,各维度的Cronbach′s α系数为0.732~0.885,重测信度为0.886;各条目水平的内容效度指数0.890~1.000,量表水平的内容效度指数为0.980。经探索性因子分析提取6个公因子,累积方差贡献率为70.228%。结论 中文版护理人员告知坏消息能力量表具有良好的信效度,可作为评估我国护理人员告知坏消息能力的有效工具。     

公众健康积极指数量表汉化及在慢性病患者中的信效度研究

目的 汉化英文版公众健康积极指数量表，对其信度和效度进行检验。 方法 遵循Brislin翻译模式，经过翻译、回译、跨文化调适和预调查，采用便利抽样法对江苏省6所社区医疗卫生机构的182例慢性病患者进行测试。 结果 中文版量表的总体Cronbach′s α系数为0.812，重测信度系数为0.979；量表水平的平均内容效度指数（S-CVI/Ave）为0.960，条目水平的内容效度指数（I-CVI）为0.800~1.000；探索性因子分析共提取知识、自我效能及行动3个公因子，累积方差贡献率为68.784%。 结论 中文版量表在慢性病患者中具有良好的信效度，可作为慢性病患者健康积极度的测量工具。     

Kihon老年衰弱筛查量表的汉化及信效度检验

目的翻译并修订Kihon老年衰弱筛查量表,对其进行信效度评价。方法遵循Brislin模式,经过翻译、回译、文化调适和预试验,确定中文版老年衰弱筛查量表条目。采用方便抽样法,对太原市6个社区458名老年人进行调查,评价信效度。结果总量表Cronbach′sα系数为0.882,各维度系数为0.733~0.856;总量表重测信度系数为0.944,各维度重测信度系数为0.902~0.979;量表总内容效度指数为0.989,各条目内容效度指数为0.857~1.000。探索性因子分析提取7个公因子累积贡献率为69.146%。验证性因子分析所构建的结构方程模型经修正后,模型拟合良好。结论中文版本Kihon老年衰弱筛查量表有良好的信效度,可作为社区老年人衰弱筛查工具。     

基于Servqual模型的个案管理服务质量量表的汉化及信效度检验

目的 将基于Servqual模型的个案管理服务质量量表汉化,并评价其信效度.方法 遵循Brislin模式翻译和跨文化调适,形成基于Servqual模型的个案管理服务质量量表中文版.采用便利抽样法对542例接受个案管理的患者进行调查,评价量表的信效度.结果 中文版基于Servqual模型的个案管理服务质量量表探索性因子分析提取有形性、可靠性、响应性、保证性和移情性5个维度,共22个条目,5个维度累积方差贡献率为80.394％;验证性因子分析显示,量表结构完整,模型拟合度较好.量表水平内容效度指数为0.977,条目水平的内容效度指数为0.833～1.000,总量表的Cronbach's α系数为0.815,重测信度为0.837.结论 中文版基于Servqual模型的个案管理服务质量量表具有良好的信效度,可用作评价个案管理服务质量的工具.     

创新行为量表的汉化及在护理人群中的信效度检验

目的汉化创新行为量表,并检验中文版量表在中国护士群体中的适用性及信效度。方法通过翻译、回译和文化调适,形成中文版创新行为量表。使用中文版量表对4所医院447名护士进行测试。将数据分成两部分分别进行探索性因子分析提取因子和验证性因子分析检测结构拟合度,通过计算Cronbach′sα系数和重测系数,检验问卷的内在一致性信度。结果中文版量表共删减3个条目,确认为20个条目,探索性因子分析提取出5个维度,累积方差贡献率为63.576%。验证性因子分析显示,修正后的模型各项指标均达到标准,模型拟合度良好。总量表的Cronbach′sα系数为0.923,重测信度为0.952。该量表各条目的内容效度指数为0.800~1.000,总量表的内容效度指数为0.932。结论中文版创新行为量表(IBI)具有良好的信效度,可作为测量护士人群创新行为的有效工具。     

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。     

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。     

中文版Braden QD压力性损伤风险评估量表在患儿中的信效度研究

目的对Braden QD压力性损伤风险评估量表进行汉化并检验其信效度。方法在获得原量表作者授权后,对原量表进行翻译、回译、检译、跨文化调适以及预调查,形成中文版Braden QD量表;采用方便抽样法选取323例住院患儿进行问卷调查,以测量量表的信度和效度。结果量表的Cronbach′sα系数为0.760,折半信度为0.820,各条目删除后新的Cronbach′sα系数均较删除前的Cronbach′sα系数低,组内相关系数为0.991(P<0.01);量表水平内容效度指数和条目水平内容效度指数均为1.000,探索性因子分析共抽取2个公因子,累积方差贡献率为63.959%,验证性因子分析结果显示模型拟合良好。结论中文版Braden QD量表经验证后具有良好的信效度,可用于我国住院患儿压力性损伤风险评估。     

线上教学效果量表的汉化及信效度检验

目的 汉化修订线上教学效果量表并进行信效度检验,为高校开展线上教学效果评价提供适宜工具。方法 通过翻译、专家函询、预调查及文化调适等方法形成中文版线上教学效果量表,对435名大学生进行调查,分析量表的信效度。结果 中文版线上教学效果量表经过探索性因子分析提取展示、专业、促进及参与4个因子共10个条目,累积方差贡献率为89.023%;验证性因子分析最终模型中10个条目的因子载荷为0.446～0.936 (P<0.001);指标模型适配良好;量表总内容效度指数为0.967,条目内容效度指数为0.812～0.989;总量表Cronbach′s α系数为0.925,重测信度0.899。结论 中文版线上教学效果量表具有良好的信效度,可用于学生视角来评价教师线上教学效果的测评工具。     

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。     

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.     

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.     

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.     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.