Construction of a knowledge base for hierarchical prevention care of neonatal hypoglycemia based on risk prediction model / 中国实用护理杂志

Objective:To build the standardized knowledge base for hierarchical prevention care of neonatal hypoglycemia based on the risk prediction model of neonatal hypoglycemia, and to provide a decision-making basis for risk management to achieve predicitive neonatal hypoglycemia.Methods:Based on the best evidence summarized in strategies for the prevention and management of neonatal hypoglycemia published in 2020, evidence on the prevention and management of neonatal hypoglycemia was searched from BMJ Best Practice, UpToDate, Registered Nurses Association of Ontario, CNKI and other domestic and foreign databases and professional association websites. The retrieval period was from September 1, 2019 to August 31, 2022. The quality of newly included literature was evaluated, new evidence was extracted, and the best evidence in the prevention and management strategy of neonatal hypoglycemia published in 2020 was summarized and combined to form the first draft of the knowledge base. Experts in the field of neonatal nursing were invited to revise and discuss each item of the knowledge base, and the final draft of the knowledge base was formed. The final draft of the knowledge base was coded using the 2.5 version of the Clinical care classification system as the standardized language.Results:The risk prediction model of neonatal hypoglycemia was used as a grading tool, the final draft of the knowledge included 1 nursing diagnosis, 6 modules and 18 specific preventive nursing measures.Conclusions:The knowledge base for hierarchical prevention care of neonatal hypoglycemia based on risk prediction model can realize the prospective hierarchical nursing of neonatal hypoglycemia, which is scientific and practical, and is the basis to assist nurses to make clinical decisions.

Construction of exercise program for inpatients with diabetic foot based on evidence - based and Delphi method / 中国实用护理杂志

Objective:The evidence-based and Delphi methods were used to construct the exercise program for hospitalized patients with diabetes foot to provide guidance for clinical practice.Methods:Evidence on exercise management of diabetic foot patients was systematically searched from BMJ Best Practice, UpToDate, Registered Nurses′ Association of Ontario and other domestic and foreign databases and professional association websites. The retrieval period was from the establishment of the database to April 2021. The quality of the included literature was independently evaluated, and the evidence of the literature meeting the quality standards was extracted and summarized to form the first draft of exercise program for inpatients with diabetic foot. After two rounds of Delphi expert letter consultation, the program items were revised, and the final draft of the exercise program for inpatients with diabetic foot suitable for clinical practice was formed.Results:The effective recovery rate of the two rounds of expert correspondence questionnaire both were15/15. The expert authority coefficient was 0.865 and 0.895 respectively. And the Kendall coordination coefficient was 0.232 and 0.291 (both P<0.01). An exercise program for inpatients with diabetic foot had been formed, including 5 modules(exercise evaluation, exercise prescription, exercise monitoring, post-exercise evaluation and exercise management), 12 items and 40 operational items. Conclusions:The exercise program for inpatients with diabetic foot constructed in this study is scientific and clinically applicable, which provide scientific guidance for clinical medical staff to carry out exercise practice.

Application of 20% glucose solution in the treatment of diabetic patients with hypoglycemia / 中华危重病急救医学

Objective:To explore the safety and efficacy of 20% glucose solution in the treatment of adult diabetic patients with hypoglycemia.Methods:A non-randomized controlled paired design trial was conducted. The diabetes patients with hypoglycemia (blood glucose < 3.9 mmol/L) who were admitted to the department of endocrinology and metabolism of Affiliated Hospital of Jiangsu University from December 2020 to May 2021 were enrolled. When the patients developed hypoglycemia for the first time, 75 mL of 20% glucose solution was pumped intravenously at a constant speed within 15 minutes, which was named the 20% glucose solution group. When the patients had hypoglycemia again, 30 mL of 50% glucose solution was pumped intravenously at a constant speed within 3 minutes, which was named the 50% glucose solution group. If the blood glucose was still ≤ 3.9 mmol/L at 15 minutes of hypoglycemia treatment, or the patients were uncomfortable due to too fast drip speed, it should be terminated immediately. The hypoglycemia treatment should be handled according to the Chinese guidelines for the prevention and treatment of type 2 diabetes (2020 edition). The peripheral blood glucose level and the range of increase at 15 minutes of treatment, the success rate of one treatment, the peripheral blood glucose values at 60 minutes after successful hypoglycemia treatment, the incidence of phlebitis and exudation after hypoglycemia treatment, and the pain of local blood vessels in patients with hypoglycemia treatment were analyzed and compared between the two groups. Results:A total of 65 patients completed the treatment of hypoglycemia with 20% glucose solution and the success rate of one treatment was 100%. The peripheral blood glucose value at 15 minutes of hypoglycemia treatment was (8.30±1.37) mmol/L, and the increased range was (4.86±1.30) mmol/L. The peripheral blood glucose value at 60 minutes after successful hypoglycemia treatment was (6.96±1.48) mmol/L, which indicated that 20% glucose solution could effectively increase blood glucose. Among 65 patients, 32 patients had hypoglycemia again, who were treated with 50% glucose solution, and the success rate of one treatment was 100%. When patients who received 50% glucose solution for hypoglycemia formed a paired design with the first 20% glucose solution treatment, the results showed that there was no significant difference in the peripheral blood glucose value and the increased range in blood glucose at 15 minutes of hypoglycemia treatment between the 20% glucose solution and the 50% glucose solution groups [peripheral blood glucose (mmol/L): 8.20 (7.70, 9.70) vs. 8.30 (7.80, 8.80), increase in blood glucose (mmol/L): 4.96±1.39 vs. 4.70±1.32, both P > 0.05], indicating that the glucose changing at 15 minutes of hypoglycemia treatment with 20% glucose solution was similar to that with 50% glucose solution. The peripheral blood glucose value at 60 minutes after successful hypoglycemia treatment of 20% glucose solution group was significantly lower than that of 50% glucose solution group (mmol/L: 6.37±1.04 vs. 7.20±1.36, P < 0.01), which meant that the blood glucose tended to be more stable. There was no phlebitis and exudation after hypoglycemia treatment in both groups. The pain score of 20% glucose solution group was 0, however, 3 patients in 50% glucose solution group complained of local vascular pain, and the pain score was 1. Conclusions:20% glucose solution can effectively treat hypoglycemia in diabetic patients, which has the same curative effect as 50% glucose solution and much safer. It can be used in patients with severe hypoglycemia.

Research of the current situation of impaired awareness of hypoglycemia / 中国实用护理杂志

Impaired awareness of hypoglycemia is an acquired complication of insulin therapy, which affects people with type 1 and insulin-treated type 2 diabetes mellitus, whereby the ability to perceive the onset of hypoglycemia becomes diminished or absent, which not only affects life health, but also causes fear of hypoglycemia , and causing a serious burden on the quality of life. The paper reviews the concept,the assessment tools,the occurrence,the influencing factors and intervention strategies of impaired awareness of hypoglycemia.In order to provide suggestions for the researches of impaired awareness of hypoglycemia in China.

Application of home care platform in follow-up management of patients with gestational diabetes mellitus / 中华护理杂志

Objective To construct the diabetic home care platform and to explore its effects in follow-up man agement of patients with gestational diabetes mellitus.Methods The diabetic home care platform contained clientsides for both nurses and patients,who could use the platform via identification and binding technology.Totally 200 patients with gestational diabetes mellitus in outpatient department from November 2015 to December 2016 were recruited using convenience sampling.Patients were divided into the experimental group and the control group with 100 cases in each group based on the voluntary principle.Both groups received routine follow-up management,and the experimental group also used diabetic home care platform management.Results There were no differences in gestational weeks,mode of delivery,postpartum hemorrhage,other complications,fetal intrauterine distress,neonatal hypoglycemia,and deformity between two groups(P＞0.05).Rate of macrosomia in the experimental group was lower than that in the control group(P＜0.05),and rate of breastfeeding was higher than the control group(P＜0.05).The total score of Diabetes Self-Care Activeties-6 and scores of each dimension in the experiential group were higher than those in the control group 8 weeks after intervention(P＜0.001);the total score of Problem Areas in Diabetes Scale and scores of each dimension in the experimental group were lower than those in the control group(P＜0.05).Conclusion Application of diabetic home care platform is helpful for fetal weight control,and can improve rate of breastfeeding,promote women's self-management behavior and emotional disorders.

Therapeutic Efficacy of Shengxuening Tablets in the Treatment of Iron-deficiency Anemia during Pregnancy:A Meta-analysis / 中国药房

OBJECTIVE:To evaluate therapeutic efficacy of Shengxuening tablets in the treatment of iron-deficiency anemia during pregnancy,so as to provide evidence for clinical decisions. METHODS:Retrieved from CNKI,Wanfang,VIP and PubMed,clinical randomized controlled trials(RCTs)about Shengxuening tablets in the treatment of iron-deficiency anemia during pregnancy were collected during 2008-2018. After screening literatures and extracted information, the literature quality was evaluated by using improved Jadad scale. Meta-analyses was performed by using Stata 12.0 software. RESULTS:A total of 11 RCTs were included,inulving 1 617 patients. Total response rate of Shengxuening tablets was significantly higher than those of ferrous sulfate [OR＝8.73,95%CI(2.964,25.69),P＜0.05],ferrous succinate [OR＝1.86,95%CI(1.04,3.33),P＜0.05] and dietory conditioning [OR＝3.43,95%CI(2.08,5.66),P＜0.05],with statistical significance. CONCLUSIONS:Therapeutic efficacy of Shengxuening tablets is significantly better than that of routine iron supplements in the treatment of iron-deficiency anemia during pregnancy.

Advance in Contents and Standard of Disability-related Data / 中国康复理论与实践

@#This paper reviewed international documents of disability statistics. The results showed that all disability measurements had been adopted International Classification of Functioning, Disability and Health (ICF) terminology and approach. Disability statistics in US tailored to ICF framework and classification. Disability statistics in China had partially adopted ICF approach.

Construction of Framework and Indicators of Disability-related Service Data in China Using ICF / 中国康复理论与实践

@#Objective To develop a framework and indicators system for disability-related service data in China. Methods Using International Classification of Functioning, Disability and Health (ICF) framework and approach, the framework and indicators system were developed using content analysis, logical reasoning and expert consultation. Results A system with nine aspects, 35 dimensions and 115 indicators was established. Eleven experts with disability-related background all accepted the system, and satisfied in the importance and operability.Conclusion A data framework and indicators system with nine aspects, 35 dimensions and 115 indicators has been established for disability-related service, which can be used in further data collection.

Development of Framework, Content and Standard of Disability Data Using ICF / 中国康复理论与实践

@#Objective To establish theoretical framework, content, and standard of disability data using International Classification of Functioning, Disability and Health (ICF). Methods The structure and content of the Disability Survey Project Form by Washington Group on Disability Statistics, World Health Organization Disability Assessment Schedule 2.0, Model Disability Survey developed by World Health Organization and ICF Core Set (General) were analyzed with ICF categories and coding. Results The sturcture and contents of disability measurements has been developed and analysed using ICF.Conclusion The framework, content and data standard had been developed.

Content Analysis of Definition and Measurement of Disability: Based on ICF and UN Convention on the Rights of Persons with Disabilities / 中国康复理论与实践

@#Objective To analyze theoretical frameworks, definitions, terminology and measurements of disability using International Classification of Functioning, Disability and Health (ICF), and United Nations Convention on the Rights of Persons with Disabilities (CRPD), to provide a scientific basis for developing definition, classification and measurements to meet international standards.Methods Content analysis had been conducted for the definitions and measurements of disability issued by international organizations using the ICF terminology and code and the definitions of disability and people with disability by CRPD.Results The core concepts and content had been reviewed using the ICF terminology and code, and the definitions of disability and people with disability by CRPD. The contents of definitions of disability proposed by international organizations cover all components of ICF. The contents of standardized disability measurements issued by United Nations or World Health Organization cover all components of ICF and map to CRPD definitions of disability and people with disability as the framework, classification, terminology and coding system had been adopted for the development.Conclusion The definition and measurements had been developed using ICF and CRPD framework, terminology, and coding system of disability. The framework and standard of disability had been constructed. The standard of disability data will implement in the fields of health, rehabilitation, education, employment, community and social services for people with disability to promote data exchange across sectors.

Development of Framework and Approach of Community-based Physical Activity in Perspective of WHO Community-based Rehabilitation Guideline / 中国康复理论与实践

@#Objective To analyze the policies and theories, and built the theoretical framework and methods to provide policy support and service development for the development of community-based physical activity and rehabilitation for people with disabilities based on WHO Community-based Rehabilitation (CBR) Guidelines.Methods The relevant policies at home and abroad were analyzed using policy research and literature research methods, and the functions of community-based physical activity were systematically analyzed based on the framework of WHO CBR Guidelines.Results The community-based physical activity can empower people with disabilities in the fields of health, rehabilitation, education, life, and social integration.Conclusion Based on WHO CBR Guidelines, the theory and policy framework of community-based physical activity for people with disabilities has been developed. It is benefit to promote the implementation of the National "Healthy China 2030 Outline" and the "National Fitness Program" to develop community-based physical activity for PWDs, to strengthen guidance and support services for community-based physical activity and to integrate physical activity and rehabilitation at community level for people with disability. It is also to achieve inclusive community development.

The effect of phytosterol intensive diet intervention in patients with type2 diabetes mellitus combined with nonalcoholic fatty liver / 中国实用护理杂志

Objectives To investigate the effects of phytosterol intensive diet intervention on blood glucose, blood lipid and liver function in patients with type 2 diabetes mellitus combined with nonalcoholic fatty liver disease(NAFLD). Methods Patients with NAFLD admitted to the department of endocrinology, the Affiliated Hospital of Jiangsu University from January 2016 to June 2016 were recruited.We divided the groups according to the order of patient admission,with patients admitted from January to March who received conventional diabetes mellitus low-fat diet enrolled as control group,and patients admitted from April to June received extra phytosterol intensive diet on the basis of conventional diabetes mellitus diet as treatment group. The changes of blood glucose, blood lipid and liver function between two groups with a follow-up of six months before and after intervention were compared and analyzed. Results After intervention,the levels of fasting blood sugar(FPG)and blood glucose(2hPG), glycosylated hemoglobin (HbA1c), cholesterol (TG), triglyceride (TC), alanine aminotransferase (ALT) of patients in control group(11.13 ± 3.17)mmol/L,(18.65 ± 6.21)mmol/L,(9.82 ± 1.69)%,(2.81 ± 1.43) mmol/L、(5.40 ± 1.14)mmol/L,77.27%(51/66),which were lower than those before intervention((8.51 ± 2.83)mmol/L,(10.39 ± 3.62)mmol/L,(7.78 ± 1.46)%,(2.18 ± 1.13)mmol/L,(4.99 ± 1.04)mmol/L, 90.91%(60/66),P<0.05,and FPG,2 hPG,HbA1c,TG,TC,LDL-C,ALT and aspartate aminotransferase (AST) in the experimental group were(11.32 ± 3.64)mmol/L,(20.09 ± 4.83)mmol/L,(9.70 ± 2.12)%, (2.68 ± 1.74)mmol/L,(5.16 ± 1.10)mmol/L,(3.18 ± 0.92)mmol/L,(70.27)%(52/74),(86.49)%(64/74), which were significantly lower than those before intervention((7.37 ± 2.08)mmol/L,(9.20 ± 3.35)mmol/L, (6.75 ± 0.99)%,(1.86 ± 1.13)mmol/L,(4.69 ± 1.06)mmol/L,(2.67 ± 0.72)mmol/L, 91.89%(68/74), 98.65%(73/74), P<0.05, and the differences was statistically significant(t=4.584,9.329,7.349,2.823, 2.140,χ2=4.587, P<0.01 or 0.05 in control group;t=8.106,15.715, 10.826,3.393,2.651,3.755,P<0.01 in experimental group). The levels of FPG, 2 hPG and HbA1c were significantly lower in the experimental group compared with those in control group after intervention(P<0.05),and the positive-to-negative rate of fatty liver were found to be significantly higher (33.8%,25/74) than that (9.1%,6/66) in controls(P<0.05).There were not significantly differences in the level of TG,TC,high density lipoprotein(HDL-C), LDL-C, ALT and AST between the control group and experimental group(P>0.05). Conclusions Phytosterol intensive diet intervention can effectively reduce LDL-C,AST and the blood glucose level of type 2 diabetes patients with NAFLD, improving the positive-to-negative rate of fatty liver. Phytosterol intensive diet intervention can effectively reduce LDL-C, AST and the blood glucose level of type 2 diabetes patients with NAFLD,improve the positive-to-negative rate of fatty liver.

Predicting the Development Trend of Health Expenditure Based on Methods of System Dynamics Simulation / 中国卫生经济

Objective:To explore the usage of system dynamics analyzing the influencing factors of total health expenditure(THE),forecast the trends of total health expenditure based on the method of System Dynamics and put forward relative countermeasures.Methods:According to the literature and expert consultation,the population,elderly,GDP,government health expenditures,drug costs and the number of health workers per thousand population were the important factors for THE.These factors were incorporated into system dynamics model for total health expenditure and conducted the simulation.Results:Based on the examination,the simulation results highly corresponded to historical data (2002-2014) and the official forecast (2015-2020),which showed that the model had good stability and reliability.The simulation results showed that steadily increasing total health expenditure would reach 7 457.12 billion yuan in 2025.Conclusion:The system dynamics approach had superior characteristics to other projection methods in terms of stability and reliability.In order to control the irrational growth of total health expenditure,it needed to increase the prevention investment,decrease the incidence of chronic diseases;sustainably improve the reform of public hospitals,implement the basic drug system;change the income-oriented performance appraisal to realize the labor value of medical staffs.

Initial revision of Symptom Distress Scale for postoperative patients with pituitary tumor / 中国实用护理杂志

Objective To revise the Symptom Distress Scale for postoperative patients with pituitary tumor and to test its reliability and validity. Methods On the base of previous qualitative interview and literature review, Delphi consultation was performed to identify items of the Symptom Distress Scale for postoperative patients with pituitary tumor. By convenience sampling method, totally 191 patients from four first-class ternary hospitals in Jiangsu province were investigated effectively by this scale. Results A scale of 4 factors and 16 items was identified by expert interviews, item analysis, exploratory factor analysis and the four factors could explain 69.812%of the variance. The Cronbachαcoefficient of the scale was 0.920, the content validity index was 0.915, and the interrater reliability was 0.860. Conclusions Symptom Distress Scale for postoperative patients with pituitary tumor has good reliability and validity to assess the symptom distress of pituitary tumor patients after operation.

Investigation and analysis of the status of incontinence and incontinence-associated dermatitis / 中国实用护理杂志

Objective To understand the prevalence and the nursing status of incontinence and incontinence-associated dermatitis (IAD),analyze the risk factors of the occurrence of IAD,and to provide effective measures for the prevention and management of IAD.Methods Using the questionnaire survey, 1 318 hospitalized patients in 2 grade three hospitals of Suzhou were investigated,and then the results were analyzed.Results The prevalence of incontinence was 10.70％(141/1 318),among the prevalence of urinary incontinence was 4.63％(61/1 318),fecal incontinence was 4.32％(57/1 318);with 24.11％(34/141) of incontinent patients having IAD;disposable pad and briefs were the most common containment devices,only 36.17％ (51/141) of the incontinent inpatients using skin protectant after perineal skin clean.Single factor analysis revealed that IAD was related with wards, types of incontinence, character of stools, frequency of feces, antibiotics, modes of nutrition support, Braden scores, level of albumin and prealbumin.Unconditional Logistic regression indicated that risk factors of IAD included the level of serum albumin (OR=0.769, P＜ 0.05), Braden scores(OR=0.335, P＜ 0.05) and frequency of feces(OR=11.076, P ＜ 0.05).Conclusions Incontinence and IAD are common in hospitalized patients,low serum albumin, low Braden scores and high frequency of feces are the risk factors of IAD.The clinical nurses have not paied enough attention on the prevention of IAD, lacked relevant knowledge and skin care regimen.

Applying graphics processing unit in real-time signal processing and visualization of ophthalmic Fourier-domain OCT system / 中国医疗器械杂志

This investigation introduces GPU (Graphics Processing Unit)- based CUDA (Compute Unified Device Architecture) technology into signal processing of ophthalmic FD-OCT (Fourier-Domain Optical Coherence Tomography) imaging system, can realize parallel data processing, using CUDA to optimize relevant operations and algorithms, in order to solve the technical bottlenecks that currently affect ophthalmic real-time imaging in OCT system. Laboratory results showed that with GPU as a general parallel computing processor, the speed of imaging data processing using GPU+CPU mode is more than dozens times faster than traditional CPU platform based serial computing and imaging mode when executing the same data processing, which reaches the clinical requirements for two dimensional real-time imaging.

Teaching strategies of dissertation writing for nursing undergraduates / 中华医学教育探索杂志

In order to improve the quality of nursing dissertations,we combined the teaching of nursing research with clinical internship to teach nursing dissertation writing,following the process of program input-situation experience-clinical internship-problem study-dissertation writing.Taking problem study as the leading role,students as subject,self experience as the main access and tutors as whole-process instructors,we taught and evaluated nursing dissertations at different stages.Students'interests in scientific research,enthusiasm for participation and quality of dissertations were improved effectively.95.78％ of the students showed positive attitude to this teaching method.