Objective To develop an intravenous thrombolysis nursing guideline for acute ischemic stroke as a guiding tool for the implementation of intravenous thrombolysis for acute ischemic stroke，and to provide a reference for the practice and management of nursing in the standardization of thrombolytic therapy. Methods According to the method of evidence-based nursing practice guidelines，the draft of intravenous thrombolysis nursing guidelines for acute ischemic stroke was constructed. The draft guidelines were reviewed by experts using the catalogue of Clinical Guidelines Research and Evaluation System Ⅱ. According to the results and suggestions of expert review，the guidelines were modified to form the formal guidelines. Results The recommendations included 5 aspects，namely hospital organization management，disease observation，observation and treatment of complications，posture and bed-leaving activities，and quality management. Conclusion The guidelines for intravenous thrombolysis nursing in acute ischemic stroke are evidence-based guidelines based on the best evidence，clinical practice and the judgment of professionals，and can be used as a practical basis for clinical medical staff to make scientific decisions on intravenous thrombolysis therapy in patients with acute ischemic stroke.
In terms of stroke prevention and treatment,the most important work are early monitoring of stroke risk factors,efforts to reduce the incidence of stroke in the population,and integration and identification of stroke predictors. Wearable devices and machine learning based on stroke risk factors are expected to become an effective solution for risk monitoring and prediction for people at high risk of stroke. This article reviews the monitoring methods for high-risk factors of stroke based on wearable devices,the application of machine learning and mobile phone applications in stroke risk prediction,which provides references for improving stroke prevention and health management in China in the future.
Objective To investigate the status and influencing factors of dysphagia in elderly patients with chronic obstructive pulmonary disease（COPD）. Methods A total of 1 268 elderly patients with COPD hospitalized in the respiratory department of 13 general hospitals in Ningxia were selected by convenience sampling method from April 2019 to August 2020. Patients were investigated by the general information questionnaire，the Water Swallowing Test，Modified Medical Research Council Dyspnea Scale，Activities of Daily Living，the Geriatric Depression Scale，the Mini Nutritional Assessment-Short Form，COPD Assessment Test Scale，the FRAIL debilitation assessment scale. Logistic regression analysis was performed to analyze the influencing factors of dysphagia in COPD patients with statistically significant variables. Results The incidence of dysphagia in elderly COPD patients was 20.39%. Logistic regression analysis showed that smoking status，tooth loss，feeding attention，feeding position，PaCO2，dyspnea，nutritional status and COPD severity were the influential factors of dysphagia（P<0.05）. Conclusion The incidence of dysphagia in elderly COPD patients is higher. COPD patients with severe disease，high degree of dyspnea，high PaCO2，long-term smoking，number of missing teeth≥6，malnutrition，not paying attention to eating，and semi-recumbent position have a higher risk of dysphagia. Clinical medical staff can formulate relevant intervention measures according to the influencing factors to prevent the occurrence of dysphagia.
Objective To evaluate the effect of discharge preparation service in patients with chronic obstructive pulmonary disease (COPD) through meta-analysis. Methods A systematic search of PubMed,Cochrane Library,Web of Science,CINAHL,Embase,OVID,CNKI,CBM and Wanfang database was carried out to collect randomized controlled trials(RCTs) on discharge preparation service for COPD patients from inception to March 2021. Literature screening,information extraction and quality evaluation were conducted by 2 reviewers,and RevMan 5.2 software was adopted for meta-analysis. Results A total of 14 RCTs with 2 023 patients were finally included. The results showed that discharge preparation services reduced readmission rates [OR=0.62,95%CI(0.48,0.80),Z=3.69,P<0.001],the number of readmissions [MD=-0.57,95%CI(-0.96,-0.19),Z=2.94,P=0.003] and length of stay [MD=-1.77,95%CI (-2.78,-0.76),Z=3.42,P<0.001],and improved MMRC [MD=-0.39,95%CI(-0.70,-0.09),Z=2.56,P=0.010]. There was no significant difference in quality of life by the SGRQ [MD=-3.27,95%CI(-7.57,1.03),Z=1.49,P=0.140]. The quality of life was improved by the SOLDQ [MD=49.38,95%CI(43.11,55.65),Z=15.43,P<0.001]. There was no significant difference in reducing mortality [OR=0.90,95%CI(0.61,1.34),Z=0.50,P=0.620]. Conclusion Discharge pre-paration service can effectively reduce the readmission rate,the number of readmissions and length of stay,and improve MMRC in patients with COPD,but the impact on mortality and quality of life is still uncertain,and high-quality research is still needed for further demonstration.
Objective To investigate the influencing factors of filter rupture in membrane-based therapeutic plasma exchange（mTPE） for neurological diseases. Methods A retrospective study was conducted to collect the clinical data of 196 cases of mTPE in 42 patients admitted to the department of Neurology in a tertiary hospital from January 2018 to May 2020. Univariate and multivariate Logistic regression analysis was conducted to analyze the risk factors for membrane rupture of the filter. Transmembrane pressure was used as a predictive indicator,and data of 35 plasma exchanges from June 2020 to October 2020 was collected for clinical verification and the best cut-off of transmembrane pressure was analyzed. Results Filter rupture occurred in 19（9.69%） cases of the 196 cases of mTPE. Logistic regression analysis showed that transmembrane pressure（OR=1.192） was an independent risk factor for filter rupture in（mTPE）（P<0.05）.The area under ROC curve（AUC） was 0.977 and 95%CI were 0.952~1.000（P<0.01）. According to the maximum Youden index value of 0.839,the optimal cut-off value of transmembrane pressure was 50 mmHg;the sensitivity was 89.5%;the specificity was 94.4%. With 50 mmHg as the cut-off value,the verification results showed that the sensitivity was 100%;the specificity was 91.42%;the accuracy was 91.42%. Conclusion The transmembrane pressure has a good predictive effect on filter rupture in mTPE. The clinical transmembrane pressure is maintained below 50 mmHg to prevent the filter rupture.
Objective To construct a quality index system for cognitive training nursing clinics in line with China’s national conditions,and to provide references for related practitioners. Methods Based on the literature research,theoretical analysis,and clinical investigation,a draft on indexes was constructed. Using Delphi’s expert consultation method,16 experts were selected and 2 rounds of consultations were conducted to establish a nursing quality index system for cognitive training nursing clinics. Results The recovery and effective rates of 2 rounds of consultation documents were 100%,and the authority coefficient of the second round of consulting experts was 0.836. Expert opinion coordination coefficients of the 3-level indexes were 0.755,0.813,0.929 respectively（P<0.05）. The final quality index system includes 3 first-level indicators（structure quality,process quality and outcome quality）,10 second-level indicators,and 34 third-level indicators. Conclusion The quality index system of cognitive training nursing clinics constructed in this study is scientific and practical,and it can provide references for comprehensive evaluation and standardized management of cognitive training nursing clinics.
The occurrence of sleep disorders can aggravate the cognitive function of patients with cognitive impairment,increase mental and behavioral abnormalities,reduce the quality of life,bring greater burden to caregivers,and increase social and economic costs. This article reviews,compares and analyzes the content,characteristics,application,and limitations of sleep impairment assessment tools in patients with cognitive impairment development status of assessment tools at home and abroad,and also proposes future research direction. It aims to provide a reference for the localization of the development of sleep assessment tools for patients with cognitive impairment,and to provide some useful information about the accurate assessment and personalized care of patients with cognitive impairment.
Objective To explore the mechanism of resourcefulness between perceived pressure and depression in newly diagnosed breast cancer patients,and to provide a reference for psychological intervention of breast cancer patients from a new perspective. Methods From May to November 2018,510 newly diagnosed breast cancer patients from a tevtiary hospital in Henan Province were investigated with the Resourcefulness Scale,the Chinese version of the Perceived Stress Scale,and the Hamilton Depression Scale. Results Perceived stress,depression and resourcefulness were negatively correlated,and perceived stress was positively correlated with depression（P<0.01）. The mediating effect of resourcefulness on perceived stress and depression was 0.203,accounting for 36.8% of the total effect. Conclusion Resourcefulness is a mediator between perceived stress and depression in newly diagnosed breast cancer patients,suggesting that medical staff should pay attention to the level of resourcefulness of breast cancer patients and actively evaluate the resourcefulness level of newly diagnosed patients in order to redule patient stress and depression levels.
Objective To monitor and analyze the association between 24-hour blood pressure and bleeding complications in patients with acute ischemic stroke after intravenous thrombolysis,for predicting bleeding complications with possible blood pressure range and monitoring time.Methods Totally 487 patients with acute ischemic stroke who were admitted to four stroke centers in Beijing from June 2015 to December 2017 were enrolled and received rt-PA intravenous thrombolysis. Demographic data,blood pressure before thrombolysis,blood pressure within 24 hours after thrombolysis,imaging examination during bleeding,and laboratory inspection data were collected and analyzed.Results A total of 168 patients（34.5%） had bleeding complications. The baseline blood pressure of patients with bleeding complications was higher than that of patients with non-bleeding complications,and the difference was statistically significant（P<0.05）. The optimal blood pressure monitoring time for systemic hemorrhage,intracranial hemorrhage and gingival hemorrhage was before thrombolysis or during thrombolysis. Respiratory hemorrhage occurred early after thrombolysis,while nasal and urinary hemorrhage occurred about 12 hours after thrombolysis. The threshold values of blood pressure were 146/81.5 mmHg（systemic hemorrhage）,159.5/108.5 mmHg（intracranial hemorrhage）,159.5/85 mmHg（gingival hemorrhage）,184/87.5 mmHg（nasal hemorrhage）,143.5/100.5 mmHg（respiratory hemorrhage）,136.5./91.5 mmHg（urinary hemorrhage）,respectively.Conclusion High blood pressure within 24 hours after thrombolysis is risk factor for hemorrhage. Bleeding complications with possible blood pressure range and monitoring time provide basis for nursing observation.
Objective To establish an hospitalized elderly stroke patients nursing assessment system to assess the health problems in this population.Methods Delphi method was used to organize the recommendations from 24 experts that specialized in geriatric care,neurological care,health management,nursing management and critical care. In accordance with two rounds of expert advices and clinical experience,some items were revised.Results The response rates of two rounds,both were 100%. The authority coefficient of experts in the second round was 0.825,and the coordination coefficients of three level indicators were 0.534,0.295,0.320,respectively（P<0.001）. The final design concluded with 4 first-level indicators,including general medical assessment,physical function status,social participation,mental health status,14 second-level indicators and 40 third-level indicators.Conclusion Delphi expert consultation method demonstrated that the scale is scientific and reliable and can provide a basis for clinical nurses to make nursing strategies. However,this hospitalized elderly stroke patients nursing assessment system needs further verification and improvement.
Objective To evaluate the effect of individualized continuous follow-up management in patients with remote ischemic conditioning（RIC） on compliance and treatment. Methods Using convenience sampling and historical control,patients received RIC from March to May 2017 were recruited as the control group,and those received RIC from June to September 2017 were recruited as the experimental group. The control group was provided with routine follow-up,whereas the experimental group was provided with individualized continuous follow-up management. Treatment compliance at 1,3,6 months,as well as recurrence rate of ischemic stroke events within 6 months for two groups were compared. Results The compliance in the experimental group was higher than that in the control group at 1,3,and 6 months,and the differences were statistically significant（P<0.001）. The recurrence rate of the ischemic stroke in the control group was 5.66% which was higher than 0% in the experimental group,but the difference was not statistically significant（P>0.05）. Conclusion Individualized continuous follow-up management can effectively improve the treatment compliance of patients undergoing RIC,thus ensuring the clinical research effect of RIC. This management method can provide reference for construction of RIC treatment and nursing model in the future.
Objective To establish a predictive model for post-thrombolysis hemorrhage in patients with acute ischemic stroke.Methods From January 2014 to December 2018,acute ischemic stroke patients who received rt-PA intravenously were recruited from an advanced stroke center at a tertiary hospital. General information,indicators related to hemorrhage,and blood test results were collected and analyzed using binary Logistic regression model.Results Among 924 recruited patients with acute ischemic stroke,566 had no bleeding complications within 36 hours after intravenous thrombolytic therapy（no bleeding group）,and 358 had bleeding symptoms（bleeding group）. The difference in hospitalization days between two groups was statistically significant（Z=-2.596,P=0.009）. Age,pre-thrombosis systolic pressure,history of falls,history of taking antithrombotic drugs,NIHSS score and DNT time were risk factors for hemorrhage. Based on the results,the predictive model was established and tested.Conclusion The incidence of peripheral bleeding after intravenous thrombolysis is higher,prognosis for patients with severe hemorrhage is poor. Attention should be paid to alert,prevention and treatment of hemorrhage. The predictive model is useful for providing reference for nursing observation,prevention and treatment of hemorrhage.
