Construction of microsurgical nursing quality standard based on three-dimensional quality structure model / 中国实用护理杂志

Objective:To develop the microsurgical nursing quality standard, so as to provide reference for improving the nursing quality level of microsurgery.Methods:From March to August 2023, based on the theoretical framework of the three-dimensional "structure-process-outcome" quality model, the content and weight of microsurgical nursing quality standard were determined through literature review, semi-structured interviews, Delphi method and analytic hierarchy process.Results:The effective recovery rates of 2 rounds of expert consultations were 100.00%(24/24) and 95.83%(23/24). The authority coefficients were 0.931 and 0.928. The variation coefficients of each item ranged from 0.000 to 0.159 and from 0.000 to 0.135. The Kendall harmony coefficients were 0.076 and 0.091. Finally, the quality standard of microsurgery nursing included 3 first-level standards (structural quality criteria weight 0.200, process quality criteria weight 0.400, outcome quality criteria weight 0.400), 27 second-level standards and 87 third-level standards.Conclusions:Nursing quality standard of microsurgery is scientific, reasonable, specialized and operable, which can guide the clinical practice of specialized nurses and promote the improvement of microsurgical nursing quality.

Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture (version 2023) / 中华创伤杂志

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Status quo and hotspots in nursing studies on osteoporotic fracture care in China: a bibliometric analysis / 中国实用护理杂志

Objective:To learn about the research status of osteoporosis fracture care in China, explore the research hotspots and development trends and provide reference for further development.Methods:The online analysis function of CiteSpace software was used to conduct metrological and visual analysis on the literature related to the osteoporosis fracture care from January 1, 2001 to December 31, 2021 in CNKI and Wanfang database.Results:A total of 2 915 articles were included and published. The number of articles published showed an overall upward trend. The institutions′ cooperation was not good, the key words were clustered as psychology, vertebral compression fracture, femur fracture, hip fracture, etc. The high intensity words were joint function, surgery, etc.Conclusion:Osteoporosis fracture care research continues to increase and expand in scope, but there is less cooperation between the institutions; the research hotspots of osteoporosis fracture care focus on clinical care paths, complication management, patient and caregiver psychology, etc.; future research trends mainly include osteoporosis fracture prevention, fracture liaison services, accelerated rehabilitation, multidisciplinary collaboration, etc

Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study

INTRODUCTION@#The purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET).@*METHODS@#A cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital.@*RESULTS@#A high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05).@*CONCLUSION@#Most physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.

Application of"family member-like"care strategies among COVID-19 patients in an isolation ward / 中南大学学报(医学版)

Objective:To control the pandemic of coronavirus disease 2019 (COVID-19) effectively, strict isolation measures have been taken in China. Suspected patients must be isolated, and the confirmed patients specifically are isolated in negative-pressure isolation rooms. During the isolation, patients face difficulty in adapting to their surrounding environment, worry about the prognosis of the disease, lack confidence in treatment, separate from their families, and have a sense of distance from medical staff. Isolated patients may possess the feelings of negativity, including loneliness, anxiety, depression, insomnia, and despair. Hence, to reduce the risk of adverse psychological outcomes,"family member-like"care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic. This study aims to examine whether using"family member-like"care strategies can improve psychological resilience and reduce depression, anxiety, and stress symptoms among patients with COVID-19 in an isolation ward.Methods: A quasi-experimental design was used to evaluate the"family member-like"care strategies for adult patients with COVID-19 in an isolation ward. COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei province, were included in this study from February 9 to March 20, 2020. Healthcare providers who volunteered as family members were assigned to patients. They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge. Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Depression Anxiety Stress Scale-21 (DASS-21) were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission, 2 weeks after admission, and at their discharge from the hospital. Results: The questionnaire response rate of the"family member-like"strategies was 100％. Of the 60 patients, 39 (65.0％) were male, and 21 (35％) were female. The hospital stay was (27.5±3.5) days. All the 60 patients were cured and discharged without any death and serious complications. The total scores for CD-RISC were 8.83±6.86 at admission, 29.13±5.42 at 2 weeks after admission, and 33.87±6.14 at discharge, which were significantly improved at the 2 follow-ups (F=404.564, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity (F=360.839, P<0.001), strength (F=368.217, P<0.001), and optimism (F=328.456, P<0.001) at the 2 follow-ups. The total scores of DASS-21 were 49.27±11.30 at admission, 30.77±16.71 at 2 weeks after admission, and 4.17±11.03 at discharge, and the scores were significantly decreased at the 2 follow-ups (F=270.536, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression (F=211.938, P<0.001), anxiety (F=285.592, P<0.001), and stress (F=287.478, P<0.001) at the 2 follow-ups.Conclusion:"Family member-like"strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients. It might be an effective care method for COVID-19 patients. It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.

Progress of invasive microcirculation monitoring methods after flap transplantation / 中华显微外科杂志

The technique of flap transplantation has been widely used in the field of wound repair, functional and surface feature reconstructions. After surgery vascular crisis directly affects the success rate of the flap transplantation, hence method of monitoring the after surgery microcirculation has been developed as a medical practice. However, clinical application of postoperative monitoring of microcirculation is still in debate. In particular, the invasive monitoring techniques are not systematically reported in China. The purpose of this review is to summarize the advantages and disadvantages of the postoperative monitoring of microcirculation and to provide reference for staffs in microsurgery.

Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas.@*METHODS@#A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE).@*RESULTS@#Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05).@*CONCLUSIONS@#In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.

Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases / 南方医科大学学报

OBJECTIVE@#To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas.@*METHODS@#A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE).@*RESULTS@#Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05).@*CONCLUSIONS@#In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.

Construction of a graded response system based on pediatric early warning score / 中国实用护理杂志

Objective A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses. Methods Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system. Results The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points. Conclusions The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′participation in clinical intervention decision-making and improve the quality of nursing.

Construction of a graded response system based on pediatric early warning score / 中国实用护理杂志

Objective@#A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses.@*Methods@#Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system.@*Results@#The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points.@*Conclusions@#The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′ participation in clinical intervention decision-making and improve the quality of nursing.

The labor analgesia effect in combination of water acupuncture and remifentanil patient-controlled intra-venous analgesia (PCIA) onmother and baby / 实用医学杂志

Objective To studythe labor analgesia effect incombination of water acupuncture andremifen-tanil patient-controlled intravenous analgesia (PCIA) and impact on mother and baby. Methods 90 Ninety sin-gle birth primiparous women were randomly divided into three groups (n = 30), groupⅠ, groupⅡ, groupⅢ. Content of β-endorphin, stress hormone levels,VAS scores were recorded at T0 and T1; adverse circumstance, Apgar score of newborn and neonatal behavioral neurological assessment were recorded. Results Comparing with groupⅢ or T0, at T1 β-EP in the groupⅠwas gone up, while ACTH、 COR and VAS scores were lower in the groupⅠand groupⅡ; adverse circumstance in the groupⅠreduced than that in the groupⅡ. The VAS scores inThe groupⅠand groupⅡand Apgar score and NBNA assessment in three groups were not significantly different. Conclusion Combination of water acupuncture and remifentanil patient-controlled intravenous analgesia iseffec-tive. Ithas no adverse effects on mother and baby. It is an ideal method of labor analgesia.

Clinical observation of methylprednisolone in the treatment of chidren with severe Mycoplasma pneumoniae pneumonia / 中国基层医药

Objective To observe the clinical efficacy of methylprednisolone in the treatment of chidren with severe Mycoplasma pneumoniae pneumonia(MPP).Methods 100 children with severe MPP were divided into con-trol group and treatment group.The control group was given to macrocyclic lactone antibiotics,symptomatic and sup-portive and other conventional treatment.The treatment group was given to Methylprednisolone dose for 2mg·kg -1 ·d -1 ×5d at the base of the control group.The clinical manifestations,such as the time of reducing cough,the tem-perature dropped to normal time,pulmonary rales disappeared time,affection absorption time,as well as length of the stay were observed.Results The time of reducing cough,temperature dropped to normal time,pulmonary rales disap-peared time and the affection absorption time of the treatment group were (5.46 ±2.03)days,(3.35 ±1.79)days, (7.08 ±2.56)days,(7.89 ±1.44)days,(10.15 ±2.03)days respectively,which of the control group were (4.23 ± 1.59)days,(5.00 ±2.30)days,(9.07 ±1.9)days,(9.23 ±1.64)days,(12.76 ±2.03)days respectively.The tem-perature dropped to normal time,pulmonary rales disappeared time and the affection absorption time of the treatment group were shorter than the control group(all P 0.05).There was significant difference in cure rate between the two groups(χ2 =5.488, P <0.05).Conclusion The efficacy of methylprednisolone therapy for children with grave Mycoplasma pneumoniae pneumonia(MPP)is affirmation,worthy of clinical application.