基于奥马哈系统的社区老年糖尿病足患者居家访视护理问题评估体系的构建

目的 研制社区老年糖尿病足患者居家访视评估表单,以便护士进行全面系统的入户评估。方法 基于奥马哈问题分类系统,结合社区糖尿病足患者的特点,采用文献回顾及德尔菲法形成社区老年糖尿病足患者居家访视评估表,编制专家咨询问卷进行上下2轮的专家咨询。结果 经2 轮专家咨询,最终形成一级指标4 项、二级指标37项的社区老年糖尿病足患者护理问题评估体系。专家积极系数为100%,权威系数为0.796。2 轮各级指标的协调系数检验均有统计学意义（P＜0.01）。结论 经专家咨询及修改、增删条目,本研究所构建的社区老年糖尿病足患者居家访视评估单结构清晰、内容全面,具有较好的科学性与可靠性。     

基于奥马哈问题分类系统的社区老年糖尿病足患者居家访视评估表单构建

目的构建社区老年糖尿病足患者居家访视评估表单,以便社区护士能参照此表单进行全面、系统的入户评估。方法基于奥马哈问题分类系统,结合社区糖尿病足患者的特点及文献回顾,初步形成社区老年糖尿病足患者居家访视评估表并编制专家咨询问卷,于2020年7—10月进行专家咨询。结果2轮专家咨询后,专家积极系数为100%,权威系数为0.796,2轮专家咨询各级指标的协调系数均有统计学意义(P0.05),最终形成一级指标4项、二级指标37项的社区老年糖尿病足患者居家访视评估表单。结论本研究构建的社区老年糖尿病足患者居家访视评估表单结构清晰、内容全面,具有较好的科学性与可靠性。     

住院老年脑卒中患者护理评估体系的构建

目的构建符合我国国情、适合老年人特点的住院老年脑卒中患者护理评估体系,以评价老年脑卒中患者的健康问题。方法在文献研究的基础上,构建住院老年脑卒中患者护理评估体系草案。采用德尔菲专家咨询法,选取24名专家,进行专家咨询。按照2轮专家咨询意见,结合临床经验,对条目进行修改。结果 2轮咨询问卷有效回收率均为100%,第2轮咨询专家的权威系数为0.825,一、二、三级指标专家意见协调系数分别为0.534、0.295、0.320(P<0.001)。最终形成的住院老年脑卒中患者护理评估体系包括4项一级指标(一般医学评估、躯体功能状况、社会参与、心理健康状况),14项二级指标,40项三级指标。结论本研究构建的住院老年脑卒中患者护理评估体系科学、可靠,能为临床护士制订护理策略提供依据。     

老年择期手术患者术前护理评估内容的构建

目的 构建科学、规范的老年择期手术患者术前护理评估内容。方法 在文献研究、质性访谈及专家会议的基础上,通过德尔菲法进行2轮专家咨询确定评估内容。结果 来自老年护理、临床护理、护理管理及老年医学领域的12名专家参加咨询,专家工作年限（28.17±5.05）年,2轮专家咨询问卷的回收率均为100%,专家权威系数为0.89。形成的老年择期手术患者术前护理评估内容包括一级指标3项（一般状况评估、老年综合评估、手术相关评估）,二级指标12项,三级指标51项。结论 构建的老年择期手术患者术前护理评估内容具有科学性及临床实用性,可引导、规范外科护士的术前评估行为,为制订个性化的老年患者围手术期照护计划提供依据。     

老年患者护理评价指标体系的研究

目的 探讨并建立老年患者护理评价指标体系.方法 通过专家咨询法建立老年患者护理评价指标体系,在建立过程中着重考虑指标的完整性、客观性和可及性.结果 经2轮专家咨询和修改,最终形成三级指标体系.其中一级指标3项,二级指标10项,三级指标33项.专家的权威系数为0.879,可以认为专家的权威性较高,评分结果可信.专家对指标体系各指标的评估合格率均在90.0%以上,说明专家对指标条目认同的一致性比较高,指标体系已能较好地评估老年患者的护理效果.结论 老年患者护理指标体系可较好地反映社区护理现状,对老年患者护理服务考评标准的制订具有参考价值.     

老年住院患者基于护理结局分类预防跌倒质量评价指标体系构建

目的 基于护理结局分类构建老年住院患者预防跌倒质量评价指标体系.方法 采用德尔菲法,经过2轮23名专家咨询,确立老年住院患者预防跌倒质量评价指标体系.结果 经过2轮专家咨询,确立了老年住院患者预防跌倒质量评价指标体系包括一级指标7项,二级指标29项.2轮专家积极系数分别是100%、100%,2轮的专家咨询协调系数经检验均具有统计学意义(P<0.01);第2轮专家咨询判断系数为0.91,熟悉系数为0.94,权威系数为0.93.结论 经专家咨询,修改、删除条目,构建老年住院患者预防跌倒质量评价指标体系,结果可靠,信度较高,为评价老年住院患者跌倒的预防提供了方法和依据.     

门诊妊娠期高血压患者护理问题评估体系的构建

目的构建门诊妊娠期高血压患者护理问题评估体系。方法基于奥马哈问题分类系统,通过交叉映射和分类回顾性分析及专家访谈,结合门诊妊娠期高血压患者的特点,应用德尔菲法,通过2轮20位专家咨询构建门诊妊娠期高血压患者护理问题评估体系。结果第一轮专家积极性为95%,第二轮专家积极性为100%,专家权威系数为0.86。结论经过专家咨询及修改,增删条目,本研究所构建的门诊妊娠期高血压患者评估体系结构清晰,内容全面,有利于母婴专科门诊护士全面评估妊娠期高血压患者的护理问题。     

基于三维质量结构模型构建老年失能患者延续护理的质量评价指标体系

目的 探讨并构建老年失能患者延续护理质量评价指标体系。方法 于2022年7-9月,以三维质量结构模型为理论基础,结合文献回顾、德尔菲专家函询方法,根据老年失能患者延续护理服务内容和评估需求,构建了以“结构-过程-结果”模式为框架的老年失能患者延续护理服务质量评价体系。结果 经过2轮护理专家函询的权威系数、判断系数、熟悉系数分别为0.931、0.929、0.933;确定老年失能患者延续护理服务三维质量评价体系中包含一级指标3项,二级指标9项,三级指标36项;2轮专家函询的协调系数为0.455、0.410。结论 老年失能患者延续护理服务三维质量评价体系内容严谨、科学、全面及可靠,有利于延续护理服务质量的改进。     

应用德尔菲法构建老年慢性病患者居家护理评估表

目的研制一份适合社区护士使用的老年慢性病患者居家护理评估表。方法以Gordon健康型态为理论评估框架,结合日常生活能力(activities of daily living,ADL)和工具性日常生活活动(instrumental activities of daily living,IADL)量表评估,初步构建老年慢性病患者居家护理评估表的框架和指标。采用目的性抽样的方法选取浙江省3所医院内从事社区护理、护理管理、健康教育及科研等方面工作的15名专家为咨询对象,利用德尔菲法确立评估表的最终结构和各项评估指标。运用专家意见的协调程度、积极系数、权威系数等指标对咨询的可靠性和代表性进行检验。结果专家的积极系数分别为100%和93.3%(>70%),权威系数分别为0.83和0.84(>0.7);两轮专家咨询后各项指标的变异系数为0.05～0.18(<0.3)。结论根据专家咨询的积极系数、权威系数、变异系数等结果证明,专家咨询的代表性和可信度高,基于德尔菲法构建的老年慢性病患者居家护理评估表可以全面地反映老年慢性病患者的健康状况。     

以ICF理论为指导的社区老年糖尿病患者综合评估指标体系的构建

目的构建适用于社区老年糖尿病患者综合评估的指标体系,为患者制定全面科学的评估工具提供理论依据。方法基于《国际功能、残疾和健康分类》理论,经过文献分析法、专家会议法和两轮德尔菲法建立社区老年糖尿病患者综合评估指标体系,并应用层次分析法确认指标权重。结果两轮咨询表回收率各为100.0%和80.0%;专家熟悉程度各为0.887、0.933,判断依据各为0.960、0.950,权威程度各为0.924、0.942。第1轮各指标重要性均数为3.53~4.93,变异系数为0.05~0.38,协调系数为0.218(χ^(2)=313.348,P<0.01);第2轮各指标重要性均数为3.75~4.92,变异系数为0.06~0.26,协调系数为0.312(χ^(2)=334.843,P<0.01)。两轮专家函询后,依据指标删除标准及专家建议,最终构成6个一级指标、18个二级指标及64个三级指标构成的社区老年糖尿病患者综合评估指标体系。结论基于ICF理论构建的社区老年糖尿病患者综合评估指标体系科学且可行,可为社区老年糖尿病患者的评估工作提供理论依据。     

应用FITC系统建立非均衡竞争雌二醇(E2)化学发光法

目的 建立能广泛应用于雌二醇(E2)检测的方法.方法 制备辣根过氧化物酶(HRP)标记兔抗人E2多克隆抗体及异硫氰酸荧光素(FITC)标记E2类似物.以抗FITC抗体包被发光板,FITC-E2类似物与抗FITC抗体结合形成固相抗原,固相抗原与血清中E2竞争结合抗E2抗体-HRP,建立化学发光法(CLIA)血清E2检测系统(FITC系统),进行方法 学评价,并与E2-牛血清清蛋白直接包被系统(非FITC系统)和罗氏公司Elecsys2010系统进行比较.结果 FITC系统检测线性范围为10~3 000 pg/mL,灵敏度为10 pg/mL;批内、批间变异系数均小于5%,优于非FITC系统;与Elecsys2010系统检测结果 的相关系数为0.978 0,测定结果 差异无统计学意义(P＞0.05).结论 成功建立基于FITC系统的非均衡竞争E2检测CLIA系统,精密度、灵敏度等指标均符合临床要求,可用于临床标本检测.     

Inhibitory effects of aminoglycoside antibiotics on reduction of cytochrome c from Candida krusei

Five aminoglycoside antibiotics (AGAs)--kanamycin (KM), bekamycin (AKM), dibekacin (DKB), ribostamycin (RSM) and paromomycin (PRM)--were studied for their effects on the nonenzymic reduction of cytochrome c by FeSO4 (Yamabe's system). Their inhibitory activity was in the order: DKB greater than AKM greater than KM greater than RSM greater than PRM. As this order correlated closely with that of the antibacterial activity of AGAs, Yamabe's system has proved useful in predicting the latter activity. Divalent metal ions other than Fe2+ enhanced the AGA-dependent inhibition of Yamabe's system in the order: Cu2+ greater than Mn2+ greater than Zn2+ greater than Co2+ greater than Ni2+ greater than. This order was similar to that of stability constants with general chelators except for the low positions of Ni2+ and Co2+. These findings suggested a metal chelation with free or bound Fe2+ for the action mechanism of AGAs on Yamabe's system and the bacterial growing system. The antagonistic effects of exogenous Fe2+ on the antibacterial activity against Staphylococcus aureus and Escherichia coli as measured by the agar dilution method supported this concept. A dual relationship of molecular structure with chelating and antibacterial activities demonstrated the importance of high molecular basicity in a potent AGA. However, the combination effect of pipemidic acid (stimulator on Yamabe's system) with KM was different from that with 1,10-phenanthroline (inhibitor on Yamabe's system) as measured by Dye's method using Pseudomonas aeruginosa.     

密闭式吸痰在重度颅脑外伤患者中的临床应用

目的观察密闭式吸痰对重度颅脑外伤患者血氧饱和度的影响。方法选择53例重度颅脑外伤患者并应用机械通气辅助呼吸的危重病人,随机分为密闭式吸痰组和开放式吸痰组,比较两组吸痰前后1min,经皮血氧饱和度（SpO2）的变化。结果开放式吸痰组吸痰后较吸痰前SpO2有明显下降,差异具有显著性（P〈0.05）,密闭式吸痰组SpO2吸痰前后比较差异无统计学意义（P〉0.05）;两组SpO2吸痰前比较差异无显著性（P〉0.05）,吸痰后开放式吸痰组SpO2低于密闭式吸痰组,差异具有显著性（P〈0.01）。结论密闭式吸痰不影响重性颅脑外伤患者氧合作用,可避免吸痰造成患者颅内压的波动,适用于重性颅脑外伤患者。     

Therapeutic evaluation of GM2 gangliosidoses by ELISA using anti-GM2 ganglioside antibodies

BACKGROUND: GM2 gangliosidoses, including Tay-Sachs disease, Sandhoff disease and the AB variant, comprise deficiencies of beta-hexosaminidase isozymes and GM2 ganglioside activator protein associated with accumulation of GM2 ganglioside (GM2) in lysosomes and neurosomatic clinical manifestations. A simple assay system for intracellular quantification of GM2 is required to evaluate the therapeutic effects on GM2-gangliosidoses. METHODS: We newly established a cell-ELISA system involving anti-GM2 monoclonal antibodies for measuring GM2 storage in fibroblasts from Tay-Sachs and Sandhoff disease patients. RESULTS: We succeeded in detecting the corrective effect of enzyme replacement on elimination of GM2 in the cells with this ELISA system. CONCLUSIONS: This simple and sensitive system should be useful as additional diagnosis tool as well as therapeutic evaluation of GM2 gangliosidoses.     

微粒子酶联免疫分析法检测血清β2-MG对消化系统肿瘤的诊断价值

目的研究血清β2微球蛋白(β2-MG)对消化系统肿瘤的诊断价值。方法应用微粒子酶联免疫分析法(MEIA)检测354例消化系统肿瘤患者,299例消化系统良性疾病病人和100例健康体检者的β2-MG浓度,并进行比较分析。结果β2-MG在各消化肿瘤组的阳性率在19.1%～44.4%之间,与良性疾病组相比均有差异(P<0.05),与健康体检组相比差异亦有统计学意义(P<0.05);β2-MG在各消化系统肿瘤组的平均浓度在2.07～2.67 mg/L之间,与良性疾病组相比均有差异(P<0.05),与体检组相比亦差异显著(P<0.05)。结论血清β2-MG在多种消化系统肿瘤中有较高的阳性率和表达量,检测β2-MG有助于这些疾病的诊断。     

人骨形成蛋白纳米微粒的制备与生物活性鉴定

目的制备重组人骨形成蛋白-2（rhBMP-2）聚氰基丙烯酸正丁酯纳米微球缓释系统，检测其对兔骨髓间充质干细胞（BMSCs）的生物学效应。方法采用改良的乳化溶液聚合法制备rhBMP-2纳米微球；采用MTT法检测微球对BMSCs增殖的影响；碱性磷酸酶（ALP）检测试剂盒检测细胞ALP活性。结果该微球缓释系统具有一定的生物活性，可促进BMSCs的增殖，并呈剂量依赖性。其效应高于单纯施加rhBMP-2的效应。结论纳米材料是一种较好的缓释系统，作用效果优于单纯使用rhBMP-2。     

Comparison of the response of saline tonometry and an automated gas tonometry device to a change in CO2

OBJECTIVE: To examine the speed of response of saline tonometry and an automated gas tonometry system by using standard tonometry catheters. DESIGN: In vitro validation study. SETTING: Experimental research laboratory. INTERVENTIONS: Tonometry catheters were placed in a test chamber designed to simulate the lumen of a hollow viscus and were exposed to a rapid change in CO2 from 0% to 5% or 10%. Measured CO2 over time was fit to a mathematical model to determine the response time constant (the time to reach 63% of the final value) for each system. MEASUREMENTS AND MAIN RESULTS: Response time to a change in CO2 was significantly faster with the automated gas system than with traditional saline tonometry. The mathematical time constant for a 5% change in CO2 in a gas environment was 2.8 mins (95% confidence interval, 2.6-3.0 mins) for the gas and 6.3 mins (95% confidence interval, 5.8-7.3 mins) for the saline technique. These times were longer for the CO2 change in a liquid environment: The time constant was 4.6 mins (95% confidence interval, 4.5-4.7 mins) for the gas system and 7.8 mins (95% confidence interval, 7.15-8.6 mins) for the saline tonometry. There was a significantly lower final equilibration value for the CO2 measurement with saline tonometry. There was essentially no difference in time constants for each system for a 5% change compared with a 10% CO2 change, except for a slightly faster time constant for the gas tonometry system with a 5% change in the gas environment (5%: 2.8 mins vs. 10%: 3.3 mins). CONCLUSIONS: The automated gas tonometry system has a significantly faster response to a change in CO2 than conventional saline tonometry.     

Measurement of extravascular lung water by thermal-dye dilution technique: mechanisms of cardiac output dependence

The extent to which extravascular lung water (EVLW) is dependent on cardiac output was analysed in anaesthetized and mechanically ventilated pigs. EVLW was measured by thermal-dye dilution technique, by a fibreoptic thermistor catheter system (system 1), and by a thermistor catheter-external optical cuvette system (system 2). During baseline conditions, at which cardiac output was 3.65 l/min, EVLW was 11.7 and 7.7 ml/kg b.w. with systems 1 and 2 respectively. A reduction of cardiac output to a mean of 1.90 l/min by the addition of halothane to the inspired gas did not significantly affect EVLW with system 1 (−5%) but increased EVLW by 39% (p<0.05) with system 2. An increase of cardiac output to a mean of 4.78 l/min by intravenous infusion of isoproterenol caused a small increase in EVLW with system 1 (14%;p<0.05) and a decrease with system 2 (10%;p<0.05). The dependence on cardiac output was the same whether the catheters were positioned centrally (aortic root) or peripherally (abdominal aorta). With system 1 the CO dependence was due to different time constants in thermistor and optical systems, and with appropriate phasing the dependence could be eliminated. With system 2 a large overestimation of the mean transit time difference between the two indicators was seen when cardiac output was low, resulting in overestimation of EVLW. It is concluded that the dependence of EVLW volume on cardiac ouptut is an artefact due to technical problems in the design of the recording equipment rather than a reflection of pulmonary or vascular effects. This study was supported by grants from the Swedish Medical Research Council (grant no. 5315), the Laerdal Foundation and the Swedish Medical Association     

Clinical comparison of two- and three-wavelength systems for continuous measurement of venous oxygen saturation.

OBJECTIVE: To evaluate clinically the accuracy of continuous SvO2 systems to reflect reference SvO2 values over a 24-hour period. DESIGN: Randomized clinical trial. SETTING: Six-bed cardiac surgical intensive care unit of a 540-bed federal facility. POPULATION: Sixty postoperative cardiac patients. INTERVENTIONS: Random assignment to a two- or three-wavelength continuous SvO2 catheter for postoperative SvO2 monitoring. At 4-hour intervals over a 24-hour period, mixed venous blood samples were analyzed with a reference cooximeter and compared with the monitor value of the SvO2 catheter. MAIN OUTCOME MEASURES: A reference cooximeter method to measure SvO2 in mixed venous blood; SvO2 as measured by the in-line, SvO2 catheter system. RESULTS: SvO2 measured by the three-wavelength system did not differ significantly from the reference SvO2 measurement. In contrast, SvO2 measured by the two-wavelength system was significantly lower than the reference SvO2 measurement within 4 hours of admission to the critical care unit and remained significantly lower throughout the 24-hour study period. CONCLUSIONS: The results of this clinical study confirmed a previous study in dogs, showing that SvO2 is measured more accurately by the three-wavelength continuous monitoring system.