牙周炎患者口腔健康素养量表的修订及信效度评价

目的 修订适用于牙周炎患者的口腔健康素养评估工具,并评价其信效度。方法 对成人口腔健康素养量表进行跨文化调适,通过患者访谈和专家会议对量表条目进行筛选和补充,通过Delphi专家咨询和预调查对量表条目进行修订完善,形成中文版牙周炎患者口腔健康素养量表。选取北京市某三甲口腔医院牙周炎患者720例进行调查,对量表进行信效度评价。结果 探索性因子分析提取4个公因子,累积方差贡献率为46.116%。验证性因子分析结果χ²/df=1.514,RMSEA=0.032,CFI=0.950,TLI=0.943,模型适配良好。最终形成的量表包括阅读理解和知识能力、决策能力、计算能力、倾听能力4个维度,共21个条目。量表总体Cronbach′sα系数为0.833,折半信度为0.847。量表条目水平的内容效度指数为0.800～1.000,量表水平的内容效度指数为0.970。结论 中文版牙周炎患者口腔健康素养量表具有良好的信效度,可作为临床和科研评价牙周炎患者口腔健康素养水平的可靠工具。     

牙周炎患者口腔健康素养量表的修订及信效度评价

目的 修订适用于牙周炎患者的口腔健康素养评估工具,并评价其信效度。方法 对成人口腔健康素养量表进行跨文化调适,通过患者访谈和专家会议对量表条目进行筛选和补充,通过Delphi专家咨询和预调查对量表条目进行修订完善,形成中文版牙周炎患者口腔健康素养量表。选取北京市某三甲口腔医院牙周炎患者720例进行调查,对量表进行信效度评价。结果 探索性因子分析提取4个公因子,累积方差贡献率为46.116%。验证性因子分析结果χ²/df=1.514,RMSEA=0.032,CFI=0.950,TLI=0.943,模型适配良好。最终形成的量表包括阅读理解和知识能力、决策能力、计算能力、倾听能力4个维度,共21个条目。量表总体Cronbach′sα系数为0.833,折半信度为0.847。量表条目水平的内容效度指数为0.800～1.000,量表水平的内容效度指数为0.970。结论 中文版牙周炎患者口腔健康素养量表具有良好的信效度,可作为临床和科研评价牙周炎患者口腔健康素养水平的可靠工具。     

肠造口周围潮湿相关性皮肤损伤风险评估量表的构建与信效度检验

目的 构建肠造口周围潮湿相关性皮肤损伤风险评估量表，为临床评价肠造口周围潮湿相关性皮肤损伤风险提供评估工具。 方法 在文献分析基础上整理肠造口周围潮湿相关性皮肤损伤相关风险因素并形成初始条目池。通过专家会议法、2轮德尔菲专家函询，对指标体系进行修订，形成肠造口周围潮湿相关性皮肤损伤风险评估量表。调查普外科行肠造口手术患者118例，对评估量表进行信效度检验。 结果 构建的正式量表包括4个一级指标，11个二级指标，21个三级指标。量表水平的平均内容效度指数（S-CVI/ave）为0.956，条目水平的内容效度指数（I-CVI）为0.914~1.000。118例肠造口手术患者中发生肠造口周围潮湿相关性皮肤损伤42例（35.59%）。量表预测效度ROC曲线下面积（AUC）为0.865（P＜0.001），当量表临界值为14.5时，Youden指数为0.525，灵敏度为0.643，特异度为0.882。量表总的Krippendorff′s α系数为0.794，一级指标的Krippendorff′s α系数0.651~0.779。 结论 构建的肠造口周围潮湿相关性皮肤损伤风险评估量表具有良好的信度和效度，为临床护理人员早期识别高危患者提供了有效的评估工具，以减少肠造口患者皮肤损伤。     

肠造口周围潮湿相关性皮肤损伤风险评估量表的构建与信效度检验

目的 构建肠造口周围潮湿相关性皮肤损伤风险评估量表，为临床评价肠造口周围潮湿相关性皮肤损伤风险提供评估工具。 方法 在文献分析基础上整理肠造口周围潮湿相关性皮肤损伤相关风险因素并形成初始条目池。通过专家会议法、2轮德尔菲专家函询，对指标体系进行修订，形成肠造口周围潮湿相关性皮肤损伤风险评估量表。调查普外科行肠造口手术患者118例，对评估量表进行信效度检验。 结果 构建的正式量表包括4个一级指标，11个二级指标，21个三级指标。量表水平的平均内容效度指数（S-CVI/ave）为0.956，条目水平的内容效度指数（I-CVI）为0.914~1.000。118例肠造口手术患者中发生肠造口周围潮湿相关性皮肤损伤42例（35.59%）。量表预测效度ROC曲线下面积（AUC）为0.865（P＜0.001），当量表临界值为14.5时，Youden指数为0.525，灵敏度为0.643，特异度为0.882。量表总的Krippendorff′s α系数为0.794，一级指标的Krippendorff′s α系数0.651~0.779。 结论 构建的肠造口周围潮湿相关性皮肤损伤风险评估量表具有良好的信度和效度，为临床护理人员早期识别高危患者提供了有效的评估工具，以减少肠造口患者皮肤损伤。     

护理人员共享决策能力自评量表的构建及信效度检验

目的 构建护理人员共享决策能力自评量表，并检验其信效度，为测评护理人员共享决策能力提供工具。方法 通过半结构式访谈和德尔菲法，构建护理人员共享决策能力自评量表，通过调查1 247名护理人员对量表进行信效度检验。结果 最终形成的护理人员共享决策能力自评量表包括知识与经验，技能与能力和综合素质3个分量表共51个条目；总量表Cronbach′s α系数为0.984,内容效度指数为0.974。探索性因子分析知识与经验分量表提取2个公因子，技能与能力分量表提取4个公因子，综合素质分量表提取2个公因子，累积方差贡献率分别为78.272%、75.975%及87.208%。结论 护理人员共享决策能力自评量表信效度良好，可作为护理人员共享决策能力的测评工具。     

临床护理人员信息素养自评量表的编制及信效度检验

目的编制临床护理人员信息素养自评量表,为评估临床护理人员信息素养提供工具。方法通过概念界定及文献分析,形成临床护理人员信息素养自评量表的条目池。经2轮专家函询、小样本预试验形成量表初稿,用于调查447名临床护理人员,其中227名的数据用于量表的项目分析及信效度检验,220名的数据用于验证量表结构。结果量表包括信息意识、信息能力、信息安全与道德3个维度共35个条目。总量表的Cronbach′sα系数为0.974,折半信度系数为0.855;量表水平的内容效度指数为0.900,条目水平的内容效度指数为0.857～1.000。探索性因子分析提取3个公因子,累积方差贡献率为72.100%。验证性因子分析模型的χ~2/df为2.041,CFI为0.953,TLI为0.961,SRMR为0.048,RMSEA为0.040。结论临床护理人员信息素养自评量表具有良好的信效度,可以作为临床护理人员信息素养水平自我评估工具。     

护士卫生应急素养测评量表的编制及信效度检验

目的 构建护士卫生应急素养测评量表,为评价护士卫生应急素养水平提供工具。方法 以知-信-行理论为框架,通过文献回顾拟订护士卫生应急素养测评条目;通过专家函询、小样本测试（n=208）、大样本测试（n=411）完成条目筛选及信效度检验。结果 探索性因子分析提取知识、态度、行为3个因子,累积方差贡献率68.870%,包含65个条目;验证性因子分析,三因子模型拟合结果可接受（χ²/df=4.008,RMSEA=0.086,CFI=0.860,TLI=0.853）。总量表Cronbach′sα系数为0.988,折半信度0.996,重测信度0.860,量表内容效度指数1.000。结论 护士卫生应急素养测评量表信效度基本达到问卷测量学要求,可用于测评护士的卫生应急素养水平。     

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。     

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。     

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。     

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.     

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.     

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.