广东省“互联网+护理服务”试点医疗机构护理服务调查

目的 了解广东省“互联网+护理服务”试点工作进展,为政策制定提供依据。 方法 选取177所“互联网+护理服务”试点医疗机构,使用广东省卫生健康委员会平台统一设计的统计表进行横断面调查,包括管理及服务制度、运行机制及流程、出诊护士培训体制等。 结果 实际开展“互联网+护理服务”工作的试点机构146个,其中三级医院占58.90%;共有13 154名护士参与服务,服务总人次为192 442,平均患者满意度96.63%,出诊护士对试点工作总体满意度为88.67%。实际开展“互联网+护理服务”项目数43项,其中服务量排序靠前的项目为母婴护理（44 074人次）、生命体征监测（23 313人次）、家庭巡视（21 636人次）;排序靠后为人工肛门便袋护理（16人次）和一般灌肠（16人次）。 结论 广东省的“互联网+护理服务”试点工作已经取得初步成效,初步形成符合本地特色的服务模式,但仍需扩大服务人群,补充服务项目,优化支付机制,加强监管系统。     

感染预防和控制护理缺失量表的汉化及信效度检验

目的 对英文版感染预防和控制护理缺失量表进行汉化,为评估护士在医院感染预防和控制活动上的缺失提供有效的测量工具。方法 按照Brislin原则对英文版量表进行翻译,通过专家咨询和预试验进行跨文化调适后,并采用便利抽样法选取450名护士进行问卷调查。通过经典测量理论和项目反应理论的Rasch模型对问卷进行信效度检验。结果 中文版感染预防和控制护理缺失量表由分量表B(31个条目,感控护理活动缺失的类型及频率)和分量表C(20个条目,感控护理缺失的原因)组成,分量表总的Cronbach′s α系数分别为0.973和0.902,重测信度分别为0.917和0.957,内容效度(S-CVI)分别为0.973和0.949。Rasch分析中残差主成分分析显示分量表B符合单维性,分量表C非单维性,其4个维度符合单维性;分量表B、C的项目信度分别为0.97和0.98,分离指数分别为5.27和7.20,样本信度分别为0.85和0.88,分离指数分别为2.42和2.73。结论 中文版感控护理缺失量表信效度较好,可作为评估护士的感控护理缺失现状及分析缺失原因的测量工具。     

基于潜在剖面分析的农村老年人自主性感知与自我养老能力的关系研究

目的 探究农村老年人自主性感知的差异性及其与自我养老能力的关系。方法 采用一般资料问卷、老年人自我养老能力量表、中文简版自主性感知量表对湖南省350名农村老年人进行问卷调查。运用潜在剖面分析识别自主性感知的潜在类别。结果 农村老年人的自主性感知被识别为3个潜在类别,分别定义为低自主-高依赖型(14.0%)、中等自主型(55.1%)、独立自主型(30.9%)。分层回归分析结果显示,控制人口学变量后,自主性感知可独立解释农村老年人21.9%的自我养老能力变异。结论 农村老年人的自主性感知呈现类别分布,即低自主-高依赖型、中等自主型、独立自主型;低自主-高依赖型者自我养老能力最低,需重点关注。     

跌倒恐惧对老年糖尿病患者生活空间移动的影响及阈值效应研究

目的 探讨跌倒恐惧对老年糖尿病患者生活空间移动性的影响及阈值效应。方法 对435例老年糖尿病患者采用一般资料问卷、修订版跌倒效能量表(测评跌倒恐惧)、生活空间评估表进行调查,行单因素分析、分层logistic回归分析、建立平滑拟合曲线分析阈值效应,探索影响因素与影响程度。结果 患者生活空间移动得分59.13±14.14,45.7%存在生活空间移动受限。跌倒效能得分7.55±1.44。分层logistic回归分析显示,跌倒恐惧、户外环境感知、糖尿病并发症是生活空间移动受限的主要影响因素(均P<0.05)。拟合曲线及阈值效应分析显示,跌倒效能得分≤6.50时生活空间移动水平不受影响(P>0.05),跌倒效能得分>6.50分时生活空间移动水平随跌倒效能得分的增加而增加(P<0.05)。结论 老年糖尿病患者生活空间移动受限比例较高,跌倒效能处于中等水平,跌倒效能得分>6.50可作为患者具有活动自信心的节点,制定安全活动干预措施还应综合考虑环境与糖尿病并发症的影响。     

慢性心力衰竭患者照护者健康素养的潜在剖面分析

目的 探讨慢性心力衰竭患者照护者健康素养的潜在分类,并分析不同类别的影响因素。方法 采用一般资料调查表和慢性心力衰竭患者照护者健康素养调查问卷,便利抽取245例慢性心力衰竭患者照护者进行调查。采用Mplus7.4对慢性心力衰竭患者照护者健康素养水平进行潜在剖面分析,并对不同类别间人口学变量的分布差异进行检验。结果 照护者健康素养水平可分为健康素养低等型(38.0%)、健康素养中等型(56.3%)和健康素养高等型(5.7%)3个潜在类别。不同年龄、与患者关系、文化程度、家庭人均月收入、照护患者的时间和是否有共同照护者的照护者健康素养类别比较,差异有统计学意义(均P<0.05)。结论 慢性心力衰竭患者照护者个体之间健康素养水平存在差异,医护人员应根据各类别的不同特征采取针对性的评估和干预,以提高照护者的健康素养。     

农村老年人老化期望现状及影响因素研究

目的 了解农村老年人的老化期望现状,分析其影响因素,为针对干预提供参考。方法 采用一般资料调查表、UCLA孤独感量表简化版、老化期望量表、简版自我感知老化量表对199名农村老年人进行问卷调查。结果 老化期望总分为32.72±9.18,孤独感得分为15.11±3.82,自我感知老化得分为52.75±2.76;多元线性回归分析显示,性别、婚姻状况、患慢性病种数、独居、孤独感、自我感知老化及经济来源是农村老年人老化期望的影响因素（调整R2=0.612,均P＜0.05）。结论 农村老年人的老化期望水平较低,女性、孤独、无配偶、患慢性病较多、老化态度消极及低收入人群是关注的重点。     

致伤前后不同时间照射对大鼠伤口愈合的影响规律

目的 观察致伤前后不同时间照射对大鼠伤口愈合的影响规律。方法 采用大体及光镜观察、免疫组化（显示Ⅲ型胶原）和原位杂交等方法,动态观察致伤前后不同时间照射对大鼠伤口愈合影响的病理变化过程。结果 伤前２ｄ至伤后７ｄ照射增能延迟伤口愈合,其中以伤后即刻照射影响量显著,其余依次为伤后３ｄ、伤前２ｄ及伤后７ｄ照射。结论 不同时间辐射大鼠伤口愈合的影响程度不同。     

Reduction of gait data variability using curve registration

Timing in peak gait values shifts slightly between gait trials. When averaged, the standard deviation (S.D.) in gait data may increase due to this inter-trial variability unless normalization is carried out beforehand. The objective of this study was to determine how curve registration, an alignment technique, can reduce inter-subject variability in gait data without perturbing the curve characteristics. Twenty young, healthy men participated in this study each providing a single gait trial. Gait was assessed by means of a four-camera high-speed video system synchronized to a force plate. A rigid body three-segment model was used in an inverse dynamic approach to calculate three-dimensional muscle powers at the hip, knee and ankle. Curve registration was applied to each of the 20 gait trials to align the peak powers. The mean registered peak powers increased by an average of 0.10±0.13 W/kg with the highest increases in the sagittal plane at push-off. After performing curve registration, the RMS values decreased by 13.6% and the greatest reduction occurred at the hip and knee, both in the sagittal plane. No important discontinuities were reported in the first and second derivatives of the unregistered and registered curves. Curve registration did not have much effect on the harmonic content. This would be an appropriate technique for application prior to any statistical analysis using able-bodied gait patterns.     

Computerized classification of benign and malignant masses on digitized mammograms: a study of robustness

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the robustness of a computerized method developed for the classification of benign and malignant masses with respect to variations in both case mix and film digitization. MATERIALS AND METHODS: The classification method included automated segmentation of mass regions, automated feature-extraction, and automated lesion characterization. The method was evaluated independently with a 110-case database consisting of 50 malignant and 60 benign cases. Mammograms were digitized twice with two different digitizers (Konica and Lumisys). Performance of the method in differentiating benign from malignant masses was evaluated with receiver operating characteristic (ROC) analysis. Effects of variations in both case mix and film digitization on performance of the method also were assessed. RESULTS: Categorization of lesions as malignant or benign with an artificial neural network (or a hybrid) classifier achieved an area under the ROC curve, Az, value of 0.90 (0.94 for the hybrid) on the previous training database in a round-robin evaluation and Az values of 0.82 (0.81) and 0.81 (0.82) on the independent database for the Konica and Lumisys formats, respectively. These differences, however, were not statistically significant (P > .10). CONCLUSION: The computerized method for the classification of lesions on mammograms was robust with respect to variations in case mix and film digitization.     

Forensic identification of skeletal remains from members of Ernesto Che Guevara’s guerrillas in Bolivia based on DNA typing

We report the positive identification of several members of the guerrillas led by Ernesto “Che” Guevara on the 1960 s in Bolivia by means of DNA fingerprinting. Successful DNA typing of both short tandem repeat loci and the hypervariable region of the human mitochondrial DNA was achieved after extracting total DNA from bones obtained from two burial sites. Given the size of the Cuban database for the STR allele frequencies, a conservative approach was followed to estimate the statistical significance of the genetic evidence. The estimated probabilities of paternity for the two cases in which the paternity logic was applied were higher than 99%. One case was analyzed using mitochondrial DNA and could not be excluded from the identity proposed by the forensic anthropology team. A fourth case was identified by exclusion, on the basis of the positive identification of the other remains, the historical and other anthropological evidence. Received: 19 January 1999 / Received in revised form: 15 April 1999