家庭参与老年人机构养老行为及意愿量表的研制及信效度检验

目的 研制家庭参与老年人机构养老行为及意愿量表并评价其信效度。 方法 采用文献回顾法、半结构访谈法和2轮德尔菲专家咨询法形成量表初稿。对郑州市6家养老机构326名老年人家庭成员进行问卷调查检验量表的信度和效度。 结果 正式量表分为家庭参与机构养老行为和家庭参与机构养老意愿2个分量表,探索性因子分析2个分量表分别提取6个公因子,方差累积贡献率分别为66.054%和72.643%,2个分量表共有32个条目,Cronbach′s α系数分别为0.950和0.941,重测信度分别为0.905和0.960。 结论 家庭参与老年人机构养老行为及意愿量表具有较好的信效度,可用于评价我国家庭参与老年人机构养老的行为和意愿。     

护理院失能老年人长期照护需求评估问卷的编制及信效度检验

目的编制护理院失能老年人长期照护需求评估问卷,检验其信效度。方法根据马斯洛层次需求理论,结合文献分析、半结构式访谈以及专家座谈会的结果,初步拟订问卷条目池,再通过专家咨询确定问卷初稿;采用问卷初稿对上海市、苏州市、重庆市三家护理院的223名失能老年人进行问卷调查,测定问卷的信效度。结果护理院失能老年人长期照需求问卷共包含38个条目,探索性因子分析提取6个公因子,累积方差贡献率为80.495%。问卷内容效度指数为0.953,各条目内容效度指数为0.889~1.000。总问卷Cronbach′sα系数为0.948,重测信度为0.846。结论所编制的护理院失能老年人长期照护需求问卷具有良好的信效度,可用于护理院失能老年人长期照护需求的评估。     

社区老年人口腔健康知信行问卷的编制及信效度检验

目的编制社区老年人口腔健康知识、信念及行为问卷,并检测其信效度。方法以"知信行"理论和"健康信念模式"为指导,通过与老年人接触、文献查阅、2轮专家咨询、预试验形成正式施测问卷。对23名老年人间隔2周进行2次测试,检验问卷重测信度;对412名社区老年人进行正式施测,检验问卷信效度,形成最终版问卷。结果经因子分析提取10个因子,共47个条目。知信行3个层面累计解释变异量分别为53.24%、62.30%、48.72%。问卷内容效度分别为0.930、0.880、0.824,条目内容效度为0.800~1.000;Cronbach′sα分别为0.827、0.816、0.856;折半信度为0.676、0.727、0.762;3个层面的重测信度0.814~0.930。结论问卷具有良好的信效度,可以用于社区老年人口腔健康知识、信念及行为评估。     

腹膜透析患者延续护理需求评估问卷的编制及信效度检验

目的编制腹膜透析患者延续护理需求评估问卷并检验其信效度。方法通过微信随访、文献系统评价及专家会议形成问卷初始条目,通过咨询5名专家及调查255例腹膜透析患者行问卷信效度检验。结果探索性因子分析提取7个公因子,解释总变异量的75.183%;该问卷Cronbach′sα系数为0.909,各维度Cronbach′sα系数为0.673～0.885;问卷重测信度为0.905,各维度重测信度为0.689～0.892;问卷的内容效度为0.861,各条目的内容效度为0.840～1.000。最终版问卷共包含7个维度32个条目。结论腹膜透析患者延续护理需求评估问卷编制过程合理,问卷的信效度良好,可用于腹膜透析患者延续护理需求的评估。     

农村居家失能老年人健康管理需求评估问卷的编制及信效度检验

目的 编制农村居家失能老年人健康管理需求评估问卷,并检验其信效度.方法 以奥马哈问题分类系统为理论框架,综合文献回顾形成问卷条目池,对18名专家进行2轮Delphi专家函询形成预试问卷.对河南省213名农村居家失能老年人进行调查,检验问卷的信效度.结果 探索性因子分析共提取6个公因子29个条目,包括健康档案、身体评估、...     

失能老年人社区居家养老服务质量评价量表的编制及信效度检验

目的 构建失能老年人社区居家养老服务质量评价量表并进行信效度检验。 方法 以SERVQUAL理论为指导,通过文献回顾、质性访谈、德尔菲专家咨询,拟定预调查量表。选取183名失能老年人和家庭照顾者进行调查。 结果 最终形成的量表包含6个维度、23个条目,累积方差贡献率为67.368%。量表Cronbach′s α系数为0.922,各维度Cronbach′s α系数0.633~0.874;重测信度为0.716。 结论 编制的失能老年人社区居家养老服务质量评价量表具有较好的信、效度,可以作为失能老年人社区居家养老服务质量评价工具。     

老年人自我养老能力问卷的编制与信效度检验

目的编制老年人自我养老能力测评问卷,为老年人自我养老能力的评估、干预提供测评工具。方法采用文献回顾、半结构质性访谈、Delphi专家咨询法构建老年人自我养老能力测评体系,经185名老年人预调查形成初始问卷,再调查571名老年人分析问卷的信、效度。结果正式问卷包括3个一级维度、7个二级维度、45个三级条目。问卷的CVI为0.911;方差累积贡献率为65.364%;一级维度与总问卷的相关系数为0.690~0.919,二级维度与总问卷的相关系数为0.585~0.861;问卷能够区分在年龄、居住地、经济状况、生活自理功能、自觉健康状况等方面的得分差异(均P0.05)。总问卷的同质性信度(MIIc)为0.305、Cronbach′sα为0.952、分半信度为0.773。结论老年人自我养老能力测评问卷具有较好的信、效度,可作为老年人自我养老能力评估和干预的测评工具。     

痴呆恐惧量表的汉化及信效度检验

目的汉化痴呆恐惧量表,并在社区老年人中检验其信效度。方法根据Brislin翻译原则翻译痴呆恐惧量表,通过专家咨询和预试验进行文化调适,采用便利抽样法选取230名社区老年人进行问卷调查,检验中文版量表的信度和效度。结果中文版痴呆恐惧量表包含认知、社会和躯体3个维度,涉及痴呆症的体验与认识(7个条目)、担心家庭负担(4个条目)、羞耻感(3个条目)和躯体反应(4个条目)4个因子共18个条目。量表内容效度指数为0.934,各条目内容效度指数为0.857~1.000;探索性因子分析共提取4个公因子,累积方差贡献率为77.464%;总量表Cronbach′sα系数为0.893,重测信度为0.854。结论中文版痴呆恐惧量表在社区老年人中应用信效度较好,可用于老年人痴呆恐惧的识别和评估。     

中文版Hawkins全身麻醉患者满意度问卷的信效度研究

目的分析中文版Hawkins全身麻醉患者满意度问卷的信效度。方法采用专家评价法、条目区分度对问卷条目进行删减;对378例全身麻醉患者进行大样本测试,并进行信度、重测信度及结构效度检验。结果将Hawkins全身麻醉患者满意度问卷中文版修订为9个维度22个条目,条目平均内容效度(I-CVI)为0.87(0.80～1.00),总问卷内容效度(S-CVI/UA)为0.87;条目间差异有统计学意义(P0.05);探索性因子分析提取8个公因子解释累计方差贡献率为80.194%;验证性因子分析显示数据与模型拟合良好;问卷总Cronbachα系数为0.865(0.730～0.946),维度间重测信度Pearson相关系数为0.723～1.000。结论中文版Hawkins全身麻醉患者满意度问卷信效度良好。     

简化版双向社会支持量表的汉化及在社区老年人中的信效度检验

目的 翻译、修订简化版双向社会支持量表,并在社区老年人中对其进行信效度检验。 方法 采用Brislin翻译模式对简化版双向社会支持量表进行正译和回译,通过专家评议和预调查进行跨文化调适,调查619名社区老年人进行信度和效度检验。 结果 中文简化版双向社会支持量表包括4个维度、12个条目;总量表Cronbach′s α系数、重测信度、折半信度分别为0.929、0.785、0.800。验证性因子分析结果显示,χ2/df=2.421,CFI=0.989,RMR=0.029,IFI=0.989。 结论 中文简化版双向社会支持量表信度和效度良好,可以作为评估社区老年人双向社会支持现状及影响因素的工具。     

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.