中文版自我感受负担量表在癌症患者中应用的信效度评价

目的 研究中文版自我感受负担量表(self-perceived burden scale,SPBS)在癌症患者中应用的信、效度.方法 翻译并形成中文版SPBS,采用专家法测量其内容效度.进行预实验,对量表的表面效度进行评价,经过研究小组反复修改和调整后,形成最终量表.对220例癌症患者进行问卷调查以评定该工具的信、效度.结果 中文版SPBS共有8个条目,其Cronbach's α系数为0.874.因子分析得出2个公因子,累计方差贡献率为61.004％.结论 中文版SPBS具有良好的信、效度,适合中国文化背景下癌症患者自我感受负担的测量.     

中文版积极元认知元情绪问卷的修订及在乳腺癌病人中的信效度检验北大核心

目的:修订中文版积极元认知元情绪问卷(PMCEQ),并检验其在乳腺癌病人中的应用信效度。方法:依据Brisilin原则对PMCEQ进行翻译、回译和跨文化调试后,形成中文版PMCEQ。选取西安市2所三级甲等医院457例乳腺癌病人进行问卷调查,评价中文版PMCEQ的信效度。结果:中文版PMCEQ包括3个维度,共18个条目。量表水平的内容效度指数(S-CVI/Ave)为0.983,条目水平的内容效度指数(I-CVI)为0.900~1.000。总量表的Cronbach’sα系数为0.827,3个维度的Cronbach’sα系数为0.649~0.799,总量表折半信度为0.886。结论:中文版PMCEQ具有较好的信效度,可用于测量乳腺癌病人在面对癌症情况下的适应性元认知信念。     

肺栓塞患者生活质量量表的汉化和信效度检验

目的 引进、汉化肺栓塞患者生活质量量表,并检验其信效度。 方法 通过正向翻译、综合、回译、专家委员会评议、预调查,形成中文版肺栓塞患者生活质量量表。经专家测评评定量表的内容效度,对201例在呼吸科住院治疗并好转出院的肺栓塞患者进行调查,测定量表的信效度。 结果 量表的重测信度为0.83;量表的Cronbach’s α系数为0.85;全体一致性内容效度指数为0.94,平均内容效度指数为0.96;经探索性因子分析提取5个公因子,累计方差贡献率为76.65%。 结论 中文版肺栓塞患者生活质量量表具有较好的信效度,可以用于测评肺栓塞患者的生活质量。     

夜尿症相关生活质量量表的汉化及信效度检测

目的:对英文版夜尿症相关生活质量量表(N-QOL)进行汉化,并检测中文版N-QOL信效度。方法:征得源量表作者同意后对英文版N-QOL量表进行汉化,通过咨询相关专家及预试验对量表条目进行调适,并检测其信效度。结果:中文版N-QOL具有良好的信效度,各条目专家内容效度指数(I-CVI)范围为0. 8～1. 0,量表内容效度指数(S-CVI)为0. 923;睡眠/精力维度、困扰/关注维度及总量表的Cronbach'sα系数分别为0. 763、0. 734、0. 782;探索性因子分析中,共提取4个因子,4个因子的累积贡献率为70. 38%;量表对平均每晚排尿2次与≥3次两组患者的生活质量具有较好的区分效度。结论:中文版N-QOL量表具有良好的信效度,可用于我国夜尿症患者生活质量的测评及对夜尿症相关治疗效果的评价。     

中文版跌倒危险评定量表在住院老年患者中应用的信度和效度评价

目的对美国约翰霍普金斯医院跌倒危险评定量表（中文版）的信度和效度进行测评,探讨该量表在我国住院老年患者中的应用价值。方法 将美国约翰霍普金斯医院跌倒危险评定量表按照外文量表翻译的基本程序译成中文。由5名相关领域的医疗护理专家对该量表进行内容效度的评定;对201例60岁以上的住院老年患者进行量表的测试,用于评价量表的信度和效度。结果跌倒危险评定量表（中文版）的评定者间信度较好;量表第2部分的Cronbach’sα系数为0.703。量表各条目的内容效度指数为0.8-1.0,量表总体内容效度为0.833;该量表共提取2个公因子,累计贡献率为58.83%。以是否有跌倒史为分组变量,提示该量表的区分度成立（t=2.81,P〈0.01）。结论跌倒危险评定量表（中文版）具有较好的信度、效度和区分度,适合在我国住院老年患者中使用。     

运动自我效能感量表用于脑卒中患者中的信效度验证

目的验证并评价中文版运动自我效能感量表(SEE)应用于脑卒中患者的信效度。方法采用中文版SEE对100例脑卒中患者进行调查,运用统计软件对调查结果进行信效度分析。结果中文版SEE所有条目与量表总分的相关系数为0.558~0.831,内容效度为0.96;探索性因子分析得出两个公因子,累积方差贡献率为62.663%,信度为0.871。结论中文版SEE具有良好的信效度,可用于评价我国脑卒中患者的运动自我效能感。     

乳腺癌幸存者未被满足需求量表的汉化及信效度评价

目的 翻译并修订乳腺癌幸存者未被满足需求量表,并对修订后的量表进行信效度评价。方法 采用Brislin 翻译模式进行翻译和回译;通过专家组讨论和预调查,对翻译的量表进行跨文化调适;采用便利抽样方法,对长沙市某三级曱等肿瘤专科医院445例乳腺癌幸存者进行调查并评价其信效度。结果 中文版乳腺癌幸存者未被满足需求量表包含5个维度、18个条目,包括症状负担(6个条目,累积方差为75.51%)、功能（5个条目,累积方差为74.72%)、健康行为（2个条目,累积方差为62.92%)、经济负担（1个条目,累积方差为68.98%)、健康照护技能（4个条目,累积方差为70.21%)。量表各维度的Cronbach’s α系数为0.65~0.93;量表中各条目的内容效度指数均>0.85;总量表的内容效度指数为0.91。结论 汉化后的中文版乳腺癌幸存者未被满足需求量表适用于中国文化背景,具有良好的信度和效度。     

中文版慢性心力衰竭患者照顾者客观负担量表的信效度研究

目的 评价中文版慢性心力衰竭患者照顾者客观负担量表(Dutch Objective Burden Inventory,DOBI)的信效度.方法 对英文版DOBI量表进行引进及跨文化调适,并应用中文版DOBI量表和医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)对102例慢性心衰患者的主要照顾者进行调查,以评价中文版DOBI量表的信效度.结果 中文版DOBI量表各维度的内部一致性Cronbach'sα系数为0.843～0.932.内容效度指数为0.79;采用因子分析提取了4个公因子,共解释总变异的57.646％;量表各维度与HADS之间均呈显著相关,相关系数介于0.25～0.51之间.结论 中文版DOBI量表具有良好的信效度,可用于我国慢性心力衰竭患者照顾者客观负担的测评.     

中文版痴呆心境评估量表的信效度研究

目的 翻译痴呆心境评估量表(Dementia Mood Assessment scale,DMAS),并对其信、效度进行初步评价.方法 翻译并修订DMAS,用中文版DMAS对133例老年期痴呆患者进行调查,对测定结果进行信、效度分析.结果 中文版DMAS的内容效度CVI值为0.95;以老年性痴呆生活质量量表(Quality of Life-Alzheimer's Disease scale,QOL-AD)为效标,其效标关联效度为-0.77;因子分析萃取了4个公因子,方差累计贡献率为54.95%.量表的Cronbach's α系数为0.81,重测信度为0.94,评定者信度为0.93.结论 中文版DMAS信、效度较好,可用于评价中国老年期痴呆患者的心境状况.     

中文版糖尿病压力评价量表的信效度研究

目的 翻译并评价糖尿病压力评价量表（Appraisal of Diabetes Scale,ADS）的信效度,提供一种有效评估糖尿病患者压力的中文版问卷.方法 翻译、修订形成中文版ADS,请10名专家对量表的文化相关性和内容效度进行评定;对243例2型糖尿病患者进行调查,评定该工具的内部一致性、结构效度、效标关联效度、区分效度.间隔2周后对25名患者进行重测,计算重测信度.结果 中文版ADS所有条目均具有较好的文化相关性.中文版ADS内容效度指数为0.96;以糖尿病授权量表和糖化血红蛋白值为效标,其效标关联效度分别为-0.626、0.634;因子分析共提取出3个公因子：对糖尿病的控制、糖尿病对患者的心理影响、糖尿病症状管理的认知和态度,累计方差贡献率为76.44％.中文版ADS的Cronbach＇s α系数为0.731,重测信度为0.926.结论 中文版ADS具有较高的信度和效度,可作为2型糖尿病患者压力的评价工具.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.