《护理科研》课程考核方式改革及效果评价

目的评价《护理科研》课程考核方案改革的效果。方法采用自行设计问卷对150名学生和12名指导教师进行调查，以了解《护理科研》课程的改革效果。结果表明多数学生老师认可新的考核方案，认为《护理科研》课程新的考核方式可体现学生对多学科知识的掌握程度，相对闭卷考试成绩更公平。结论通过对目前杂志上已发表论文的评价以及开题报告，能够锻炼学生多方面的能力，如学生的自学能力、创造力、语言表达能力、交际能力、知识查新能力、论文书写能力等。     

On-line computer estimation of carbon dioxide response curves

Anesthesiologists are concerned with the effect of various anesthetics on a patient's central nervous ventilatory control. The most widely accepted method of determining the effect of a drug is to compare carbon dioxide response curves ( e/PetCO₂, where e = minute ventilation [in L/min] andPetCO₂ = end-tidal carbon dioxide [in mm Hg]) measured before and after administration of the drug. Additional information concerning neuromechanical control can be obtained by also including a measure of the airway occlusion pressure (generally measured 100 ms after occlusion, i.e., P₁₀₀).To facilitate these measurements we have developed a portable, computer-controlled data acquisition system. It includes an Apple II+ computer and measures e,PetCO₂, and P₁₀₀. Each subject rebreathes exhaled carbon dioxide through a two-way breathing valve attached to a 9-liter reservoir, which is initially filled with 5% carbon dioxide and balance oxygen. Exhaled carbon dioxide concentrations are measured with an infrared medical gas analyzer on samples taken through a catheter connected at the mouthpiece. The exhaled flow is measured with a pneumotachograph in conjunction with a differential pressure transducer, and P₁₀₀ is determined with a Validyne MP45 pressure transducer.     

国产全自动生化检测系统的应用评价

目的参照我国全自动生化分析仪行业标准（讨论稿）和美国临床实验室标准化委员会（NCCLS）检测系统性能评价方案，对我国自主研发的全自动生化检测系统进行分析性能的评价，探讨国产检测系统的临床应用价值。方法对上海丰汇公司FH400型全自动生化分析仪、配套试剂和校准品组成的检测系统（简称丰汇检测系统），根据项目的反应原理特征选择丙氨酸氨基转移酶（ALT，零级动力学法）、尿素（Urea，一级动力学法）、总蛋白（TP，二点终点法）和胆固醇（Chol，终点法）进行精密度、线性范围、抗干扰能力实验评价，并与日立全自动生化分析仪与罗氏诊断产品有限公司试剂检测系统作患者样本比对实验。结果丰汇检测系统ALT、Urea、TP和Chol的批内精密度变异系数（CV）中值分别为1．18％、1．35％、0．62％和0．39％，高值分别为0．84％、0．97％、0．34％和0．41％。患者样本比对实验4个项目的相关方程和相关系数（r）分别为ALT：Y：1．068X-0．797，r=0．999；Urea：Y=1．006X＋0．181，r=0．999；TP：Y=0．989X＋0．629，r=0．997；Chol：Y=1．001X-0．128，r=0．998，其在医学决定水平处的偏倚均低于美国临床实验室改进修正法案（CLIA’88）允许误差范围。线性范围和抗干扰能力[维生素C（VitC）、总胆红素（TBil）、血红蛋白（Hb）和乳糜液]基本符合厂家的声明。结论被评价的丰汇检测系统各项分析性能满足临床使用要求，检测成本较低，有较高的临床应用价值。     

Accuracy of cone-beam computed tomography for syndesmosis injury diagnosis compared to conventional computed tomography

BackgroundSyndesmosis injury can lead to ankle mortise instability and early osteoarthritis. Several multiple detector computed tomography (MDCT) methods for measurement have been developed. Weight-bearing cone beam CT (WB CBCT) is an emerging technique that offers the possibility of upright-position scanning and lower doses. This study sought to assess the diagnostic accuracy of WB CBCT in syndesmose injury compared to MDCT, with instability confirmed via manual testing upon arthroscopic examination.MethodsThree musculoskeletal radiologists with different levels of expertise prospectively analyzed 11 MDCT and eight WB CBCT scans of the same trauma-afflicted ankles with clinical suspicion of syndesmosis lesion over a period of 5 months. They evaluated 10 methods of measurement in both sides. Syndesmosis was considered pathological on arthroscopic examination in four patients. Correlation between readers was evaluated with intra-class correlation testing (p < 0.05 was considered significant). Capacity of discrimination was assessed by area under the curve (AUC) for all methods.ResultsInter-observer agreement was near excellent for both WB CBCT and MDCT for the anterior tibio-fibular (TF) distance (ICC = 0.781 and 0.831, respectively), posterior TF distance (ICC = 0.841 and 0.826), minimal TF distance (ICC = 0.899 and 0.875), and TF surface (ICC = 0.93 and 0.84). AUC were better for MDCT than WB CBCT in assessing syndesmosis instability for: anterior TF distance (ROC = 0.869 vs. 0.555, p = 0.01), minimal TF distance (ROC = 0.883 vs. 0.608, p = 0.02) and antero-posterior fibular translation (ROC = 0.894 vs. 0.467, p = 0.006).ConclusionsMDCT demonstrated better ability to distinguish pathological syndesmosis than WB CBCT, with the antero-posterior fibular translation the best discriminating measurement. The physiological widening of the contralateral syndesmosis occurring with the WB CBCT upright position may explain these results.     

Refractive indices for volatile anesthetic gases: Equipment and method for calibrating vaporizers and monitors

Objective. The objective of our study was to establish the refractive indices and the virial coefficients of the volatile anesthetic vapors. These indices and coefficients will allow refractometry to be used by manufacturers to produce accurate calibration, without requiring expensive high-precision calibration gases.Methods. We used a precision refractometer to measure the refractive indices for five volatile anesthetic vapors. We prepared our calibration gases by mixing a gravimetrically calibrated amount of liquid agent with a constant gas flow.Results. The refractive indices for the volatile anesthetic vapors are 1,603.2 for halothane, 1,540.4 for enflurane, 1,563.3 for isoflurance, 1,538.3 for sevoflurane, and 1,211.7 for desflurane. The maximum theoretical error in our measurements, due to all sensors and all uncertainty in our measurement of apparatus and physical constants, is ±0.56% of the reading (±0.70% for desflurane).Conclusions. If refractometry replaced calibration gases in cylinders, as a calibration standard, manufacturers might avoid errors that now occur because calibration gases manufactured by numerous companies seem to differ. We propose that our values serve as an interim database.     

Confirmatory factory analysis of the Neck Disability Index in a general problematic neck population indicates a one-factor model

Background contextThe Neck Disability Index frequently is used to measure outcomes of the neck. The statistical rigor of the Neck Disability Index has been assessed with conflicting outcomes. To date, Confirmatory Factor Analysis of the Neck Disability Index has not been reported for a suitably large population study. Because the Neck Disability Index is not a condition-specific measure of neck function, initial Confirmatory Factor Analysis should consider problematic neck patients as a homogenous group.PurposeWe sought to analyze the factor structure of the Neck Disability Index through Confirmatory Factor Analysis in a symptomatic, homogeneous, neck population, with respect to pooled populations and gender subgroups.Study designThis was a secondary analysis of pooled data.Patient sampleA total of 1,278 symptomatic neck patients (67.5% female, median age 41 years), 803 nonspecific and 475 with whiplash-associated disorder.Outcome measuresThe Neck Disability Index was used to measure outcomes.MethodsWe analyzed pooled baseline data from six independent studies of patients with neck problems who completed Neck Disability Index questionnaires at baseline. The Confirmatory Factor Analysis was considered in three scenarios: the full sample and separate sexes. Models were compared empirically for best fit.ResultsTwo-factor models have good psychometric properties across both the pooled and sex subgroups. However, according to these analyses, the one-factor solution is preferable from both a statistical perspective and parsimony. The two-factor model was close to significant for the male subgroup (p<.07) where questions separated into constructs of mental function (pain, reading headaches and concentration) and physical function (personal care, lifting, work, driving, sleep, and recreation).ConclusionsThe Neck Disability Index demonstrated a one-factor structure when analyzed by Confirmatory Factor Analysis in a pooled, homogenous sample of neck problem patients. However, a two-factor model did approach significance for male subjects where questions separated into constructs of mental and physical function. Further investigations in different conditions, subgroup and sex-specific populations are warranted.     

Gender-based measurement invariance of the Substance Use Risk Profile Scale

Gender may influence the psychometric properties of psychological and affect-related measures. The American Psychological Association has made recommendations to conduct tests of group-level measurement invariance (MI) before comparing scores between groups. Gender-based measurement invariance has been examined in many well-known psycho-social scales such as the CES-D and the Big Five Inventory. The Substance Use Risk Profile is a 23-item scale measuring affective- and personality-related traits known to increase risk for substance use, with 4 dimensions: anxiety sensitivity, hopelessness, sensation seeking and impulsivity. Despite similarities in the constructs assessed by the SURPS, the CES-D and the Big Five Inventory, gender-based measurement invariance of the SURPS has not yet been published. Multi-group confirmatory factor analysis was used to assess the measurement invariance of the four dimensions of the SURPS across gender. MI was conducted with M-Plus 6.2 using a 2-step analysis for ordinal variables suggested by Muthén and Muthén, and model fit was assessed using the comparative fit index (CFI) criteria recommended by Cheung and Rensvold. A single group confirmatory factor analysis (CFA) was also conducted. The sample was composed of 1352 adolescents (56% female, mean age of 14 years) participating in the BC Adolescent Substance Use Survey, an online survey capturing substance use and psychosocial trends in secondary students across British Columbia, Canada. Measurement invariance across gender was demonstrated for the SURPS (ΔCFI = 0.003), and the single group CFA supported a four-dimensional structure for the SURPS items (CFI = 0.92, RMSEA = 061, 95% CI = 0.058–0.065).     

全民健康覆盖:从理念到行动

世界卫生组织对全民健康覆盖界定为:所有人都应当享有所需要的、有质量的卫生服务,并且不因利用这些服务出现经济困难。全民健康覆盖的核心价值取向是社会公平,实现全民健康覆盖的主要任务是缩小国家间、地区间和人群间卫生服务可及性和费用负担的差距。国际组织和世界上许多国家正在为推进全民健康覆盖付诸努力。我国卫生改革与发展对国际社会推动全民健康覆盖做出了重要贡献,但全面实现目标还任重道远。     

生殖激素水平测定对早期先兆流产妊娠预后的判断价值

目的探讨生殖激素水平测定对早期先兆流产妊娠预后的判断价值。方法选择30例早期先兆流产患者和30例健康早孕妇（对照组）为研究对象,30例早期先兆流产妊娠患者根据其妊娠结局分为观察I、Ⅱ组,每组各15例。使用放射免疫法测定所有受试者的血孕酮（P）,绒毛膜促性腺激素（β-HCG）,雌激素（E2）,卵泡刺激素（FSH）,催乳素（PRL）及黄体生成素（LH）,并对测定值进行统计分析。结果观察Ⅱ组的血P、β-HCG、E2明显低于对照组,且也明显低于观察I组（P〈0．01）,但其FSH、PRL、LI-I值与对照组比较,差异无统计学意义（P〉0．05）。灵敏度分析显示,P、β-HCG、E2对诊断先兆流产不良预后的灵敏度分别为80．0％,80．0％、100．0％,特异度分别为74．0％,78．0％、83．0％,诊断的总符合率分别为77．0％,79．0％、91．0％。结论测定P、B—HCG、E2对预测早期流产妊娠患者的预后有重要价值,其中以E2最为可靠,值得临床推广。