Objective To retrieve，evaluate and summarize the best evidence on the management of ocular complications in intensive care patients ventilated in prone position，and to provide references for clinical practice. Methods Evidence on management of ocular complications in intensive care patients ventilated in prone position was systemically retrieved in the guideline websites，professional association websites and databases，such as the BMJ Best Practice，UpToDate，Cochrane Library，Joanna Briggs Institute，PubMed，Web of Science，Science Direct，Embase，CNKI，Wanfang and other databases，including guidelines，clinical decisions，evidence summaries，expert consensuses，group standards，systematic reviews and scoping reviews，published from January 2013 to June 2023. The guidelines were individually evaluated by 4 researchers，and the remaining literature was individually evaluated by 2 researchers. The literature that met the criteria was extracted and graded. Results A total of 15 articles were involved，including 6 guidelines，2 clinical decisions，2 evidence summaries，3 systematic reviews，1 scoping review and 1 group standard. Finally，6 evidence topics and 16 pieces of best evidence were formed，including organization and training，risk identification，eye assessment，eye protection，position management and regular observation. Conclusion This study summarized the best evidence on the management of ocular complications in intensive care patients ventilated in prone position. In the application，the best evidence should be selected according to the clinical situation，so as to reduce the incidence of ocular complications and improve the quality of life of patients.
Objective To construct a patient guideline for the non-pharmacological management of gestational diabetes mellitus（GDM） to provide decision support for the self-management of patients with GDM. Methods Utilizing evidence-based methods，health problems were identified through literature analysis，personal interviews，and on-site investigations. Systematic search was conducted on domestic and international guideline websites，professional association websites，and comprehensive databases. The quality of evidence was graded according to the GRADE system. The Evidence-to-Decision（EtD） framework was employed to summarize the evidence，leading to the initial formulation of recommendations. These recommendations were then refined，and the consensus was achieved through a round of expert consensus meetings and 2 rounds of Delphi method for expert correspondence，resulting in the final draft of the patient guideline. Results The core content of the patient guideline encompasses 5 aspects：screening and diagnosis of GDM，prenatal management，labor and delivery management，neonatal hypoglycemia management，and postpartum management. Conclusion This patient guideline，developed through a rigorous process，takes into account patients’ preferences，and it is scientifically sound，acceptable，operable，and readable. It can provide a foundation for decision-making in the self-management of patients with GDM.
Objective This study aims to develop a decision support system for the non-drug management of gestational diabetes mellitus（GDM），conduct a preliminary application study，evaluate its usability and accuracy in clinical practice，and lay the foundation for a randomized controlled trial to explore its application effects. Methods A research group on GDM was established to construct a decision support system for non-drug management of GDM. The man-machine interaction technology was employed to develop 5 modules，including patients’ personal information，monitoring and feedback of blood glucose，diet，weight，and exercise records.The convenience sampling method was used to select GDM patients in the obstetrics nutrition clinic of a obstetrics and gynecology hospital in Shanghai in March 2022 as the research objects, and the systematic preliminary application was carried out. The data on using the system were analyzed，and surveys were conducted to evaluate the usability and structured evaluation of the system among medical staff，research groups，and patients. Results After initial application，the system was 100% effective in identifying abnormal blood glucose levels and sending immediate treatment tips，and 51% effective in generating blood glucose warning and prevention reports. The usability evaluation scores of GDM patients for the system and the structured evaluation scores of the system construction team members and health care workers were 88.15 and 90.63，respectively，which were both at a high level. Conclusion The system can provide accurate and objective decisions for medical staff and patients，and the preliminary application results reveal high accuracy and good usability. Additional studies can be conducted to investigate its effect on improving patients’ blood glucose levels and pregnancy outcomes to enhance the existing non-drug management model for GDM.
Objective To construct the decision-making behavior model of blood glucose management among pregnant women with gestational diabetes mellitus（GDM） based on protection motivation theory. Methods A total of 1 261 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were selected by convenient sampling and investigated through the cross-sectional survey. The Self-Developed Blood Glucose Management Decision-Making Behavior Questionnaire，Protection Motivation Questionnaire，Knowledge Questionnaire and General Information Questionnaire were used to collect data. Multi-linear regression analysis was used to identify the influencing factors of decision-making behavior. Structural equation model was used to establish and revise the decision-making behavior model of blood glucose management. Results 1 181 pregnant women with GDM were included in this study. Vulnerability，severity，response efficacy，self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior（P<0.001）. Perceived severity（β=0.204），vulnerability （β=0.196） and self-efficacy（β=0.336） had a direct positive influence on decision-making behavior. Perceived vulnerability had an indirect positive influence on decision-making behavior mediated by self-efficacy（β=0.136）. Response costs（β=-0.186） had a direct negative influence on decision-making behavior. Knowledge had an indirect influence on decision-making behavior mediated by response costs（β=0.016）. All the indicators for fit test were acceptable or optimal，and the path coefficients of model reached significant level（P<0.05）. Conclusion The decision-making behavior of blood glucose management among pregnant women with GDM could be improved through increasing perceived severity，vulnerability and confidence，providing more knowledge and decreasing barriers related to blood glucose management.
Objective To systematically evaluate relevant guidelines on calories and 3 nutrients allocations during pregnancy in patients with gestational diabetes mellitus，and to compare the similarities and differences in recommendations between these guidelines. Methods Domestic and foreign guideline networks，websites of specialist associations related to diabetes，obstetrics and gynecology，as well as databases，were systematically searched from January 2010 to June 2022. There were 2 appraisers who used the Appraisal of Guidelines for Research & Evaluation II to evaluate the quality of guidelines and then used the content analysis method to synthesize the recommendations of each guideline and compare similarities and differences. Results This study included 18 guidelines with fair overall quality（10 with grade A，2 with grade B and 6 with grade C）. The guidelines provided recommendations in 5 aspects of meal allocation，calories，carbohydrates，proteins，and fats，totaling 57 recommendations. While the recommendations for meal allocation were consistent across guidelines，there were significant differences in the recommendations for calories and the 3 major nutrients. Conclusion The recommendations regarding the distribution of calories and the 3 major nutrients mostly rely on expert consensuses，with low-quality evidence but mostly strong recommendations. These guidelines exhibit significant variations from one to another. Consequently，future studies with higher quality on the distribution of calories and 3 nutrients should be conducted，and high-quality evidence-based nutrition guidelines for gestational diabetes should be developed in China.
Objective To overview the systematic reviews on efficacy of non-pharmacological management of preoperative anxiety in adult patients undergoing elective surgery. Methods In August 2021,CNKI,VIP Full-text database,Wanfang Full-text Database,China Biomedical Literature Database and Joanna Briggs Institute,the Cochrane Library,PubMed,Embase,CINAHL,and psycINFO databases were searched to collect systematic reviews or meta-analysis on the efficacy of non-pharmacological management of preoperative anxiety in adult patients undergoing elective surgery. 2 researchers screened systematic reviews and extracted the data independently. AMSTAR 2 scale and GRADE system were used to assess the quality of included systematic reviews. Results A total of 19 systematic reviews were included. The evaluation results showed that the methodological quality of 2 pieces of the literature was low and the methodological quality of 17 was critically low. Evidence for 9 non-pharmaceutical management interventions was evaluated. The results showed that optimization of preoperative management and application of non-pharmaceutical techniques had positive effects on preventing or alleviating preoperative anxiety. However,the grade of evidence quality is not high,and only a piece of evidence is intermediate. Conclusion Non-pharmacological management may relieve preoperative anxiety relatively. However,the methodological quality and evidence quality of the study are low,so it is necessary to use evidence carefully and carry out more standardized and rigorous studies.
Objective To understand the motivation of blood glucose management behavior changes in pregnant women with gestational diabetes mellitus（GDM）,in order to provide suggestions and evidence for promoting good blood glucose management in GDM patients. Methods Purposive sampling method was used to select 28 pregnant women with gestational diabetes mellitus from September to December 2020 in 4 hospitals in Shanghai for semi-structured in-depth interviews. Content analysis was used to analyze and refine the theme. Results The motivation of blood glucose management behavior change of GDM pregnant women includes perceiving the severity of the disease,perceiving the risk of bad blood glucose management behaviors,and perceiving the benefits of healthy blood glucose management behavior. Conclusion Clinical nursing staffs can improve the awareness of GDM pregnant women on the severity of disease and the risk of bad blood glucose management behaviors,and improve the awareness of GDM pregnant women on healthy blood glucose management behaviors,so as to improve their motivation to change their poor blood glucose management behavior and unhealthy lifestyles.
Objective To search，evaluate and summarize the best evidence of oral intake management during labor and to provide references for clinical practice. Methods According to the “6S” model of evidence resources，clinical decision support，best practice recommendations，guidelines，evidence summaries，expert consensuses and systematic reviews related to oral intake management published in computer decision support systems，guideline websites，association official websites and databases were searched from the establishment of databases to December 2021. A supplementary search was performed for randomized controlled trials published between January 2018 and December 2021. 2 researchers evaluated the methodological quality of the literature，extracted and summarized evidence according to the subject. Results A total of 12 articles were included，including 1 clinical decision support，5 guidelines，1 evidence summary，3 expert consensuses and 2 randomized controlled trials，and 19 pieces of best evidence were summarized from 4 aspects of health education，dynamic evaluation during labor，recommended schemes of oral intake during labor and systematic support. Conclusion This study summarized the best evidence of oral intake management during labor，which can provide a basis for clinical evidence-based practice. Healthcare professionals should combine the best evidence with clinical situation，expert judgment and maternal wishes to develop personalized oral intake management programs during labor for different groups，so as to ensure energy supply，improve maternal and child delivery outcomes，while improving maternal food satisfaction and relieving emotional stress.
Objective To describe the status of blood glucose management decision-making behavior of pregnant women with gestational diabetes mellitus（GDM）and to explore its influencing factors. Methods A total of 1 127 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were investigated with the blood glucose management protection motivation questionnaire,knowledge questionnaire,decision-making behavior questionnaire and general information questionnaire. Results The score of decision-making behavior in blood glucose management of pregnant women with GDM was 69.30±6.85,which is at a high level. Gestational age,vulnerability,severity,response efficacy,self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior in pregnant women with GDM（P<0.05）. Conclusion Nursing professionals should strengthen GDM pregnant women’s protection motivation of blood glucose management,especially for women who during the third trimester. This study suggested that GDM women’s decision-making behavior of blood glucose management could be improved through increasing patient’s cognition of disease severity and vulnerability,enhancing response efficacy and self-efficacy,and reducing response costs.
Objective To collect and summarize the best evidence of perioperative blood glucose management in patients with diabetes at home and abroad. Methods We systematically searched the National Guideline Clearing-house in the United States,Scottish Intercollegiate Guidelines Network,Registered Nurses’ Association of Ontario,Canada,National Institute of Health and Care Excellence in the United Kingdom,Joanna Briggs Institute,Cochrane Library,PubMed,Web of Science,the International Diabetes Federation and American Diabetes Association,Canadian Diabetes Association,Australian Diabetes Association,CNKI,CBM and Wanfang database to collect the literature including guidelines,systematic reviews,best practice information sheets,evidence summaries,expert consensuses,etc. The retrieval period was from the inception of databases to November 29,2019. 6 researchers independently evaluated the quality of the literature,combining with the judgment of professionals,to extract the data from the literature meeting the standards. Results A total of 9 articles were incorporated,including 6 guidelines,2 expert consensuses and 1 systematic review. The best evidence included 33 pieces of evidence in 4 categories,namely glycemic management principles,glycemic monitoring frequency,glycemic control objectives and drug management of glucose control. Conclusion The best evidence should be selected based on the characteristics of the hospital and the clinical environment,to reduce abnormal blood glucose events,reduce postoperative wound infections,and accelerate postoperative wound healing time in patients with diabetes.
Objective To compare the cost-effectiveness of PICCs and PORTs from catheter insertion to removal,and to provide economic evidence to choose the more cost-effective central venous access devices（CVADs） for medium- to long-term use. Methods 444 patients who received medium- to long-term chemotherapy by PICCs in a tertiary hospital in Shanghai from January 2016 to October 2019 and 477 patients with PORTs in this hospital from January 2013 to October 2019 were included by convenience sampling method. Data was collected from a retrospective cohort study. A cost-effectiveness analysis was conducted from the hospital perspective to compare the total costs,effectiveness index,cost-effectiveness ratio and incremental cost-effectiveness ratio（ICER） of PICCs and PORTs in total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time of subgroups respectively. Results For the total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time,the average total cost per day or the average total cost were all significantly lower in PICCs than those in PORTs（P<0.001）. The effectiveness indexes were all slightly lower in PICCs than those in PORTs. The cost-effectiveness ratios were all lower in PICCs than those in PORTs. The ICERs were 543.50,234 411.00,120 092.25 and 109 164.00 respectively. Conclusion When catheter dwelling time was less than 12 months,PICCs were more cost-effective than PORTs. Therefore,PICCs should be recommended as the more cost-effective CVADs for medium- to long-term use from economic evaluation perspective. Furthermore,the ICER can be applied for decision-making. If the ICER was below the willingness-to-pay value,PICCs and PORTs were all acceptable cost-effective options;otherwise,PICCs were more cost-effective.
Objective To develop a blood glucose management protection motivation questionnaire for patients with gestational diabetes mellitus（GDM） and to test its reliability and validity. Methods Based on Protection Motivation Theory and according to the "Clinical Nursing Practice Guideline for Gestational Diabetes Mellitus",the primary questionnaire was formulated through literature review,patient semi-structured interviews and expert consultations. 7 experts and 408 patients with GDM were selected to test the reliability and validity. Results The protection motivation questionnaire contains 35 items in 7 dimensions. The content validity index of the questionnaire was 0.976. Cronbach’s α coefficients of the questionnaire was 0.901 and split-half reliability of the questionnaire was 0.965;Cronbach’s α coefficients of 7 dimensions ranged from 0.850 to 0.953 and split-half reliability of 7 dimensions ranged from 0.905 to 0.961. Exploratory factor analysis identified 7 principal factors,which accumulatively explained 75.32% of total variance. Confirmatory factor analysis indicated good model fit. Conclusion Blood glucose management protection motivation questionnaire has good reliability and validity,which can be used to evaluate GDM pregnant women’s blood glucose management protection motivation,and to analyze and predict their blood glucose management behavior.
Objective To select and obtain the best evidence for deep venous thrombosis（DVT） prophylaxis in spinal surgery patients after operation so as to provide reference for clinical practice to decrease the rate of DVT. Methods Using the method of evidence-based nursing,clinical question of DVT prevention in spinal surgery patients was raised. Relevant research was retrieved by computer search. JBI evidence appraisal and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with judgment of clinical professionals,totally 27 evidences selected,including DVT assessment,diagnosis and screening,intervention strategies,prevention time and methods,health guidance,etc. Conclusion This study summarized the best evidence for prevention and management of deep venous thrombosis after spinal surgery,and help clinical nurses and nursing admi-nistrators decision-making,ultimately through adapting the best evidence and using scientific nursing methods to solve the clinical problems and improve nursing quality.
Objective To establish an evaluation index system and an effectiveness index for PICC and PORT. Methods The Delphi method was adopted to identify the indicators and their weight coefficients in the evaluation index system for evaluating PICC and PORT through two rounds of expert consultation. Then the effectiveness index for evaluating the effect of PICC and PORT was established based on the synthetical index method. Results The responses rates of two rounds of Delphi consultation were all 100%. The experts’ authoritative coefficient was 0.87. The coordination coefficients of the two rounds of Delphi consultation were 0.283 and 0.306（both of them P<0.001）. The evaluation index system for evaluating the effect of PICC and PORT was established,including 3 primary indicators,9 secondary indicators,and 13 tertiary indicators. Then the effectiveness index for evaluating the effect of PICC and PORT was established based on exponential formula and synthetical index formula. Conclusion The established evaluation index system and the effectiveness index for evaluating the effect of PICC and PORT are scientific,reliable and feasible,providing a quantitative method for decision makers and administrators to make holistic comparison of the effect of PICC and PORT.
