Objective To develop a father involvement scale and test the reliability and validity.Methods The scale was developed based on previous studies and depth interviews with more than 20 fathers.Totally 1565 families from 3 provinces were recruited.Item analysis was conducted to identify valid items.Then the construct validity of the scale was tested by exploratory and confirmatory factor analysis (EFA & CFA).Finally the reliability and criterion validity of the scale was examined.Results The scale was consisted of 8 factors wihch were involvement attitude,activities and playing,accompany and taking care of children,attentiveness,discipline and school encouragement,economic support,protection,support mother.They explained 59.94％ of the total variance.Besides,the CFA results demonstrated a satisfactory construct validity of the scale (RMSEA =0.05,NFI =0.95,NNFI =0.96,CFI =0.97).The Cronbach(')s α coefficients of the scale was 0.897,and those of its 8 were 0.828,0.788,0.764,0.781,0.671,0.754,0.528 and 0.693 respectively.Conclusion The Father Involvement Scale with 8 factors has a good reliability and validity,demonstrating it a valid tool to measure father involvement in China.

Objective To investigate reveal the main general situations of medical researches,levels,especially progresses and accomplishments,and progresses of medical research in Guangdong Province.Methods The We collected informations about prizes of of medical researches achievements awarded by National Science and Technology Award and Guangdong Science and Technology Award in Guangdong Province from 1999 to 2010 were collected,and analyzed these prizes in the respect of distribution byof years,regions,institutions and subjectsdiscipline.Results In the last 12 years,There were 30 medical researches achievements won theawarded National Science and Technology Awards,and 865 won awarded Guangdong Science and Technology Awards in the last 12 years.The amounts of distribution by year award-winning achievements awarded of National Science and Technology Awards were was not average evenevery year,which while were opposite to those awarded the distribution of Guangdong Science and Technology Awards was.Geographically,Mmost of these medical research achievements centered were in economically developed cities like Guangzhou,Shenzhen,Shantou,etc.The amounts of awards-winning achievements of won by medical institutionshospitals and colleges were far more than those of enterprises,research institutions and management agencies,.But the awards of hospitals and the fluctuation fluctuated of annual distribution of award-winning achievements ofmore than the those of medical institutions was bigger.Among the award-winning achievements awarded National Science and Technology Award,the amounts on oOncology,ophthalmology,traditional Chinese medical science and Chinese materia medica were won the most of the awards,but the amount onand basic medical medicine won the was fewerfewest awards.The distribution of subjects of award-winning achievements awarded Guangdong Science and Technology Award were largercovered more disciplines than the other.Conclusion Medical research in Guangdong Province has achieved a great accomplishment much but with some deficiencies existingcertain problems.Guangdong Province must take some appropriate measures in order to achieve a greater accomplishmentMeasures need to be taken to overcome those problems,for example,increasing its input in medical research including funds,equipments and talented persons,etc.

Objective To investigate effect of hypothermia on coagulation function in major trauma patients and assess value of thromboelastography (TEG) monitoring.Methods Twenty-two patients with major trauma admitted to the emergency intensive care unit between January 2010 and June 2011 were enrolled in the study.The venous blood of the patients was sampled for TEG determination at different temperatures (37,35 and 33 ℃) to analyze variation of the indices including coagulation reaction time (R),clot formation time (K),rate of clot formation (Angle),maximum amplitude (MA)and coagulation index (CI).The patients were divided into normal coagulation group and abnormal coagulation group based on the CI value at 37 ℃ to analyze effects of temperature on TEG indices in both groups and their differences between groups.Results (1) Among 22 patients,TEG indices including R and K trended upward (P ＜ 0.01),but Angle,MA and CI trended downward (P ＜ 0.01) with decline of the temperatures.(2) K and Angle values,indicators of fibrinogen function,were obviously inhibited (P ＜ 0.05) with the temperature decreasing from 37 ℃ to 35 ℃,but other TEG indices had no significant changes.Whereas,all TEG indices were significantly inhibited when the temperature was decreased from 35 ℃ to 33 ℃.(3) There were significant differences in variation of each TEG index inhibited by hypothermia (P ＜ 0.01).All TEG indices showed significant differerces in the pairwise comparison,except for the differences between R and K as well as between Angle and MA (P ＜0.01).(4) R and K were increased,but Angle,MA and CI were decreased in both groups,with decline of the temperatures.Moreover,all TEG indices in the abnormal group were worse than those in the normal group.Conclusions Hypothermia has significant effect on coagulation function of patients with major trauma.TEG,which may be measured at any temperature,is more accurate in reflection of patients' actual coagulation function and is helpful for choice of an appropriate temperature in the mild hypothermia therapy.

ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.

Objective To investigate the effectiveness and safety of dexmedetomidine combining with sufentanyl in controlling PCIA after laryngeal carcinoma surgery. Methods One hundred laryngeal carcinoma patients (ASAⅠorⅡ) were randomly assigned into 2 groups (n = 50, in each group). Group SF: sufentanil 0.04 mg/(kg·h)+dolasetron 12.5 mg; Group DE: dexmedetomidine 0.1 mg/(kg·h) +sufentani 0.02 mg/(kg· h) +dolasetron 12.5 mg, in which all drugs were dissolved in 100 mL 0.9% normal saline. Parameters: Infusion speed 2 mL/h; PCIA dosage 0.5 mL each time; monitor time: 15 min. PCIA were administrated after anesthesia recovery; BP, HR, SpO2, RR, RPP, pain and sedation score, side effect formation rate at 4、12、24、48 h after surgery were also recorded. Results MAP, RPP and HR in group DE were significant decreased compared with group SF at each time point,(P < 0.05); VAS scores had no significant difference between the two groups(P >0.05); Ramsay calm scores in group DE were significant better than that in group SF at each time point after surgery (P < 0.05); Frequency of nausea,vomiting and chills in group DE were significant lower than those in group SF (P < 0.05). Conclusion Small dose dexmedetomidine combination with sufentanil administration in PCIA after laryngeal carcinoma surgery could acquire satisfied analgesic effect , also could eliminate the patient anxious mood , enhance the security in the perioperative period and improve the patients' satisfaction degree , whichis very suitable for multi mode analgesia acquirement.

Objective To evaluate the relationship between emergency department length of stay (EDLOS) and outcome of multiple trauma patients in ICU.Methods A retrospective cohort study was performed in multiple trauma patients admitted from the emergency department to ICU during 2010.Patients' data were recorded,including demographic information (gender,age,etc.),characteristics of injury (injury causes,diagnosis,ISS,GCS,emergency operation rate,type of operation),and outcome (inhospital mortality,length of ICU stay,total length of hospital stay,expenditure).Patients were assorted into delayed group (EDLOS ＞ 6 h) and non-delayed group (EDLOS ≤ 6 h),then demographic information,characteristics of injury,and outcome were compared between the two groups.Multivariate Logistic and linear regression analyses were performed to identify the correlation between EDLOS and outcome for all patients and for those with and without emergency operation.Results A total of 476 patients aged (47.5 ± 16.0) years were enrolled in the study and male patients accounted for 73.5％.Median ISS was 29 points (interquartile range,22-34 points),median EDLOS was 4.0 hours (interquartile range,2.8-6.4 hours),and inhospital mortality was 9.2％.Delayed (n =135) and non-delayed (n =341) groups were similar in age,gender,ISS,inhospital mortality (13.3％ vs 7.6％),length of ICU stay,and total length of hospital stay (P ＞ 0.05).Multivariate analysis demonstrated prolonged EDLOS increased inhospital mortality (OR=3.19,95％ CI 1.28-7.95,P ＜ 0.05),especially in patients without emergent operation (OR =4.01,95％ CI 1.31-12.27,P ＜ 0.05).However,prolonged EDLOS produced no effect on mortality in patients with emergent operation (OR =1.72,95％ CI 0.79-3.43,P ＞0.05),length of ICU stay,total length of hospital stay,and expenditure.Conclusion Prolonged EDLOS increases mortality of multiple trauma patients admitted to ICU,especially in patients without emergency operation,thus rapid transportation of these patients from emergency room to ICU will improve the outcome.

Objective To prospectively investigate the characteristics and correlative influential factors of pulmonary hypertension (PHT) in patients on long-term maintenance hemodialysis (MHD). Methods Pulmonary artery systolic pressure (PASP) was assessed by echocardiography according to the guideline from the American Society of Echocardiography in 2010 and PASP more than 35 mm Hg was diagnosed as PHT.Echocardiography and pulse wall velocity (baPWV) was performed in the next day after hemodialysis.Arteriovenous fistula (AVF) flow was evaluated by the ultrasound dilution method.Hemodialysis-related informations and laboratorial parameters were detected in the same period. Results One hundred and eleven MHD patients [male 45,female 66,mean age (57.32±12.49) years old] in our hemodialysis center were included in the study.All of the patients received MHD treatment for more than 6 months with AVF as the vascular access.The patients with any possible diseases causing PHT were excluded.The mean MHD period was (70.51±44.98) months.Twenty-eight patients (25.32％) were diagnosed as PHT with mean PASP (45.68±10.83) mm Hg.Left ventricular diastolic dysfunction was severer in patients with PHT than that in patients without PHT.The prevalence of moderate to severe diastolic dysfunction was statistically higher in PHT group compared to non-PHT group (53.60％ vs 6.02％,P＜0.01).Ejection fraction (EF),fractional shortening of left ventricular diameter in PHT group were also significantly lower than those in non-PHT patients (62.06％±14.90％ vs 69.72％±8.60％,36.46％±10.04％ vs 40.20％±7.86％,P＜0.01).The patients with EF less than 50％ were 21.43％and 3.61％ in PHT and non-PHT group respectively.However,there were no significant differences in age,sex,MHD periods,body mass index (BMI),interval dialysis weight growth,blood pressure before dialysis,hemoglobin,albumin,pre-albumin,serum calcium and phosphorus,iPTH,nPCR,Kt/V,baPWV and AVF flow between the two groups. Conclusions PHT is a common complication of patients on long-term MHD.There is close relationship between PHT and left ventricular insufficiency.PHT is not significantly relevant to mineral metabolic disturbance,AVF flow,hemoglobin,dialysis adequacy and nutrition status.

Objective To investigate the characteristics of patient throughput in emergency room (ER),and the factors causing increase in ER length of stay in order to improve the quality of emergency service.Methods Data of critically ill patients presented to an emergency room in a tertiary teaching hospital in 2010 were retrospectively studied,and the characteristics of patient throughput including patients referred to different departments with different outcomes,and variation in number of patients round the clock in workdays and weekends were analyzed.Results ( 1 ) The median length of stay (LOS) of 7966 critical patients in emergency room (ER) was 11 h,and of them,56.6％ stayed in ER for more than 6 h,and 21.6％ over 24 h.(2) There were significant differences in LOS in ER among patients treated by different departments leading to no shorter length of time consumed for treatment by many departments other than the following specialties of emergency department,neurosurgery,neurology and general medicine department in sequence from less time required to the longest length of time consumed.( 3 ) There were significant differences in LOS in ER among patients with different courses after disposition leading to the longest length of time consumed by those discharged by patients 'own decision and admitted into the hospital,and the shortest time required in patients after emergency operation.(4) There were also significant differences in specialty,outcomes and time needed for throughput between workdays and weekends,and during different time intervals round the clock.Conclusions The situation of patient throughput of critical illness in emergency room in this hospital was not ideal.The factors associated with prolonged stay in ER included different specialties in charge of patients,different courses and outcomes after disposition,severity of illness,different time intervals round the clock,and this investigation deserves a further study.

Objective To explore factors associated with prolonged emergency room (ER) stay of critically ill patients admitted so as to accelerate throughput of emergency patients.Methods Data of critically ill patients admitted into the emergency room of a tertiary teaching hospital in 2010 were retrospectively studied.Stepwise Cox regression analysis was used to determine factors likely associated with prolonged stay in ER.Results ( 1 ) A total of 6246 critical illnesses were admitted into emergency room,the ER length of stay [M (Qr)] was 11 h (3 ～23 h).Of them,56.6％ patients stayed in ER more than 6 h and 21.6％ over 24 h.(2) Univariate analysis showed the major factors contributing to prolonged stay in ER were insufficient inpatient bed capacity,followed by poor family finances,complicated diseases needed care from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of critical care,age,gender and arrival time to ER.(3) Multivariate analysis showed that the main factors contributing to prolonged stay were insufficient inpatient beds,poor family finances,complicated diseases needed treatment from multiple departments,emergency operation,lack of specialty wards,lack of department bearing main responsibility of treatment,gender and arrival time to ER.Age was not an independent factor.Conclusions Plenty of critically ill patients admitted to this hospital had prolonged stay in emergency room with variety of factors.The possible factors contributing to this were insufficient inpatient bed capacity,poor family finances and complicated diseases needed care from multiple departments,and this investigation deserves a further study.

Objective To explore the determinant factors influencing the constituent parts of radiological examination in severe trauma patients so as to provide scientific basis for optimized strategy of radiological examination. Methods A prospective study was carried out from April to July 2010 in a tertiary hospital. Clinical data of 60 severe trauma patients admitted to emergency department and ICU were recorded. The type, number and site of trauma under radiological examination were described and compared among different stages of treatment. The correlation between number of radiological examinations and age, number of injured site, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU stay and overall length of hospital stay were analyzed. Results (1) The majority of radiological examinations in 60 patients were radiography and CT, with a corresponding median number of 6.0(3.0～ 11.0, IQR)and 10.0(8.0 ～ 13.8, Qr) times per patient. (2) The numbers of radiography examinations requested in emergency room, emergency ICU and general ward were quite approximately equal (x2 =4.043 ,P =0. 132), while CT examinations were mainly requested in emergency room and emergency ICU (x2 = 20. 274 , P < 0. 001). (3) The numbers of radiological examinations requested for different sites of injury were quite significantly different between radiography and CT during different stages of treatment (x2 = 114.609, 75.932, P < 0.01). (4 ) The number of CT scan requested was positively correlated with number of injured site, ISS, ICU and overall length of hospital stay (r =0.273,0.369,0.523,0.417,all P <0.05). Conclusions The sum of radiological examinations in severe trauma patients was great mainly in radiography and CT, and CT was more predominantly requested. The number of CT scans examinations was positively correlated with severity of injury and length of ICU stay. Further study is warranted to optimize radiological examination in severe trauma patients.