护士悲伤状态量表的汉化及信效度检验

目的 汉化护士悲伤状态量表(Grief State Scale for Nurses, GSSN)并在临床护士中检验信效度。方法 获得原量表作者的授权，严格按照Brislin模型对护士悲伤状态量表进行翻译、回译，通过文化调适后形成中文版护士悲伤状态量表。2022年12月采用便利抽样法选取湖州市2所三级甲等医院221名临床护士行正式调查，在调查2周后从中随机抽取30名护士再次填写量表，评价中文版护士悲伤状态量表的信效度。结果 中文版护士悲伤状态量表的Cronbach′s α系数为0.813,4个维度的Cronbach′s α系数分别为0.729、0.855、0.846、0.929;重测信度为0.915。总量表的平均内容效度指数为0.980,条目水平内容效度指数为0.833～1.000。探索性因子分析共提取出4个公因子，累积方差贡献率74.232%。结论 中文版护士悲伤状态量表具有良好的信效度，适用于测量护士职业悲伤水平。     

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。     

基于precede-proceed模式的护士职业性腰背痛预防行为量表的汉化及信效度评价

目的 汉化英文版护士职业性腰背痛预防行为量表(occupational low back pain prevention behaviours of nurse, OLBPPBN)并进行信效度检验。方法 通过翻译、专家咨询和预调查，形成初始汉化版护士职业性腰背痛预防行为量表，采用整群抽样法抽取陕西省某三甲医院346名护士进行调查，后进行项目分析，信效度检验，形成最终量表。结果 最终形成的护士职业性腰背痛预防行为量表，共包含30个条目、6个维度，与源量表一致。总量表项目分析显示良好，Cronbach’s α系数为0.904,重测信度为0.910;内容效度指数为0.971,条目水平内容效度指数为0.714～1.000;探索性因子累积方差贡献率为68.422%;验证性因子显示各指标达标。结论 中文版OLBPPBN信效度良好，可以用来测量护士职业性腰背痛预防行为水平。     

证据应用障碍因素和促进因素评定量表的编制及信效度检验

目的 编制证据应用障碍因素和促进因素评定量表,并检验其信效度。方法 通过对45项证据应用项目参与人员进行访谈形成测评框架和量表初稿,然后通过2轮专家函询形成初试量表,经过215名证据应用项目护理人员的初测形成正式测评量表,最终通过1 604名护士的调查对评定量表信效度进行检验。结果 证据应用障碍因素和促进因素评定量表包含6个维度共40个条目。总问卷的Cronbach′sα系数为0.931,各维度的Cronbach′sα系数为0.922～0.966,内容效度为0.904。探索性因子分析共提取6个公因子,累积方差贡献率为77.012%。验证性因子分析显示,模型拟合度良好。结论 证据应用障碍因素和促进因素评定量表具有良好的信效度,可用于证据应用过程中的障碍因素和促进因素的分析和预测。     

护生护理信息能力量表的编制及信效度检验

目的编制适合我国护生的护理信息能力量表,并对其信度和效度进行分析。方法以护理信息能力概念为指导,参考国外护理信息能力标准及文献、经过专家评议、小样本预调查形成初始量表。选取298名护生进行正式调查,采用内容效度、探索性因子分析、验证性因子分析、各维度间及与总量表间的相关系数、Cronbach′sα系数、折半信度等评价量表的信效度。结果量表包括基本计算机知识与技能、临床信息知识与技能和临床信息态度3个维度共25个条目,探索性因子分析提取3个公因子,累积贡献率为67.868%,验证性因子分析各指标在理论允许范围之内,量表内容效度为0.827,总量表的Cronbach′sα系数为0.955,折半系数为0.821。结论所编制的护生护理信息能力量表具有良好的信度和效度,能较好地测评护生的护理信息能力。     

护患关系信任度量表的修订及信效度检验

目的对护患关系信任度量表进行修订并检验其信效度。方法对护患关系信任度量表进行修订,采用便利抽样法对399例住院患者进行问卷调查。结果护患关系信任度量表保留12个条目,探索性因子分析提取2个公因子,分别命名为态度和关怀、能力和安心感。2个公因子的Cronbach′sα系数分别为0.893和0.854,累积解释方差量为62.154%。验证性因子分析结果显示模型拟合度指标基本适配。结论修订后的护患关系信任度量表具有信效度好、条目少的特点,可以作为临床了解患者对护士信任程度的测评工具。     

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。     

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。     

带教老师对预防与应对实习护生遭受工作场所暴力知信行量表的编制与验证

目的 编制带教老师对预防与应对实习护生遭受工作场所暴力的知信行量表,并检验信效度。 方法 以知信行理论为指导,在文献回顾基础上,结合半结构访谈法及德尔菲法初步形成带教老师对预防与应对实习护生遭受工作场所暴力的知信行量表。对302名临床护理带教老师进行调查,检验量表信效度。 结果 量表包含知、信、行3个Ⅰ级维度,8个Ⅱ级维度,共44个条目。条目水平的内容效度指数为0.889~1.000,量表水平内容效度指数为0.941。探索性因子分析中,知、信、行维度分别提取4、2、2个公因子,累积方差贡献率分别为73.897%、75.388%、82.052%;验证性因子分析显示模型的适配度较好。量表的Cronbach′s α系数为0.961,各维度Cronbach′s α系数为0.920、0.904、0.977;量表折半信度为0.987,各维度折半信度为0.965、0.950、0.989;量表重测信度为0.927。 结论 量表具有良好的信效度,可作为测评带教老师预防与应对实习护生遭受工作场所暴力的有效工具。     

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。     

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.     

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.