Table of Content

15 May 2021, Volume 56 Issue 5

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Research Paper

Best evidence-based practice for promoting early mobilization in maternal women after cesarean：an interrupt time series study

CHEN Yun,WAN Jing,ZHU Zheng,SU Chunhong,MEI Zhengrong,WANG Shouping,TAN Xiangping,KONG Yingshi

2021, 56(5):  645-651.  DOI: 10.3761/j.issn.0254-1769.2021.05.001

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Objective This study aims to implement the best evidence of early mobilization in maternal women after cesarean in China’s clinical settings and to evaluate the effectiveness of the evidence-based nursing protocol.Methods The Evidence-based Continuous Quality Improvement Framework was used as the conceptual model. The process consisted of 4 steps including evidence acquisition,baseline evaluation,evidence introduction,and after-effect evaluation. From February 2019 to January 2020,an interruption time series design was applied in postpartum women to assess the changes of length of out-of-bed mobilization,24-hour out-of-bed rate,incidence of intestinal obstruction,and length of post-operative hospitalization.Results We finally included 8 pieces of evidence in protocol. The percentage of people with a pain score of <3 increased from 74.37% to 83.68%（ χ ²=1.77,P=0.041）;The length of out-of-bed mobilization decreased from 31.89±9.50 hours to 20.01±4.65 hours（t=11.48,P<0.001）. The 24-hour out of bed rate increased from 30.94% to 91.21%（ χ²=17.28,P<0.001）;the incidence of intestinal obstruction decreased from 5.31% to 1.70%（ χ²=2.17,P=0.015） and the average days of postoperative hospital stay decreased from 5.06±1.99 days to 3.51±0.99 days（t=10.74,P<0.001）.Conclusion The best evidence-based practice can promote early mobilization in maternal women after cesarean section,reduce the incidence of intestinal obstruction effectively,and shorten hospital stay significantly.

The effect of graded walking exercise on cancer-related fatigue in patients with gastric cancer during chemo therapy

ZHU Hongyu,ZHANG Yunfei,KE Xi,XU Zhenhua,LI Maolu,LUO Huiyu

2021, 56(5):  652-658.  DOI: 10.3761/j.issn.0254-1769.2021.05.002

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Objective To explore the effects of different walking exercises on cancer-related fatigue in patients with gastric cancer during chemotherapy.Methods The convenience sampling method was adopted to select 124 patients with gastric cancer chemotherapy admitted to a tertiary tumor hospital in Fujian Province from November 2018 to June 2019 as the research subjects. According to the bed management of the medical group,they were divided into a primary group,an intermediate group,an advanced group and a control group with 31 cases in each group. The primary,intermediate and advanced groups need to meet daily walking exercise requirements on the basis of routine care. Among them,the primary group is 5 000-7 499 steps/d;the intermediate group is 7 500-9 999 steps/d;the advanced group is ≥10 000 steps/d. The control group was given routine care and exercise education. The Chinese version of the Revised Piper Fatigue Scale（RPFS） was used for the assessment before the first chemo-therapy,the third,the fifth and the seventh admission to the hospital.Results Repeated measures analysis of variance showed that the RPFS scores of the primary,intermediate,and advanced groups were lower than those of the control group at different time points after the intervention,and the differences were statistically significant（P<0.05）;at the third chemotherapy,there was no statistically significant difference in RPFS scores among the primary,intermediate,and the advanced group（P>0.05）;during the 5th and 7th chemotherapy,the RPFS scores of the primary and intermediate groups were lower than those of the advanced group,and the differences were statistically significant（P<0.001）.Conclusion Walking exercise can reduce the severity of cancer-related fatigue in patients with gastric cancer during chemotherapy. During the first to third chemotherapy sessions,patients should be encouraged to walk ≥5 000 steps/d,and during the fourth to seventh chemotherapy sessions,it should be controlled at 5 000-9 999 steps/d.

Special Planning—Geriatric Nursing

Construction and validation of a prediction model for pulmonary infection in elderly patients with hip fracture after surgery

CHEN Xujuan,ZHU Xiaoping,TIAN Meimei,HUANG Jingbiao,QIU Rongmin,LI Xiaohong,AO Li

2021, 56(5):  659-666.  DOI: 10.3761/j.issn.0254-1769.2021.05.003

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Objective This study was to investigate the risk factors of pulmonary infection in elderly patients with hip fracture postoperatively,and to establish a predictive model.Methods A total of 1 008 elderly hip fracture patients who underwent surgical treatment in a tertiary hospital in Shanghai from May 2017 to May 2019 were selected and divided into a pulmonary infection group（n=87） or a non-pulmonary infection group（n=921）,according to their pulmonary infections after surgery. The clinical data was compared. Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors of postoperative pulmonary infection in elderly patients with hip fracture. A risk prediction model was established and nomogram was drawn. The area under ROC curve and Hosmer-Lemeshow test were used to evaluate the predictive effect of the model.Results The multivariate regression analysis showed that age,time from fracture to surgery,smoking,ASA,COPD,hypoproteinemia,RDW,mechanical ventilation time,stay in ICU were independent risk factors of pulmonary infection postoperatively in elderly patients. The AUC of modeling patients was 0.891 and 0.881 in the verification sample. As to the Hosmer-Lemeshow Test,the P value of modeling patients is 0.726 and 0.497 in verification（P>0.05）.Conclusion Overall,this study uncovers different clinical features that can increase the risks of postoperative pulmonary infection in elderly patients with hip fracture,such as age >73,long time from fracture to surgery（day）>4 d and COPD. This model can effectively predict the occurrence of postoperative pulmonary infection.

Research on the influence of computer cognitive training on the cognitive function of the elderly with mild cognitive impairment

LI Chenxi,SHANG Yunfeng,WANG Liyun,YANG Yuqin,SHEN Yinghui

2021, 56(5):  667-672.  DOI: 10.3761/j.issn.0254-1769.2021.05.004

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Objective To explore the influence of self-made computer cognitive training program on the cognitive function of the elderly with mild cognitive impairment（MCI）.Methods From June to August 2019,59 MCI elderly people were selected as research subjects through health education activities and were randomly grouped. Among them,30 elderly people in the experimental group received computer cognitive training（CCT）. The training included attention,executive function,spatial rotation and working memory training;29 elderly people in the control group did not receive interventions and continued to live in normal life. Before the intervention and 5 weeks after the intervention,MoCA（Montreal Cognitive Assessment,MoCA）and MMSE（Minimum Mental State Examination,MMSE）were used to evaluate the cognitive function of the 2 groups of elderly people and the statistical analysis was performed. After the intervention,30 elderly people in the experimental group were interviewed.Results Before and after the intervention,MoCA and MMSE scores in the experimental group were significantly greater than those in the control group（P<0.05）. The improvement in most cognitive items of MoCA in the experimental group was significantly greater than those in the control group（P<0.05）. After the experiment,some elderly people said that their memory ability has improved and their reactions have increased,and they hope to continue the training.Conclusion Self-made computer cognitive training program can significantly improve the cognitive function of the elderly with MCI.

Application comparison of Frailty Phenotype and FRAIL Scale in frailty risk screening of elderly inpatients

WU Zhenzhen,ZHANG Rui,CHANG Yan,LU Hongyan

2021, 56(5):  673-679.  DOI: 10.3761/j.issn.0254-1769.2021.05.005

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Objective To compare the screening ability of Frailty Phenotype and FRAIL scale for frailty risk in elderly inpatients,and to provide references for clinical selection of appropriate screening tools for frailty.Methods A total of 462 elderly inpatients in a tertiary hospital in Ningxia were selected by convenience sampling method,and the Frailty Index,Frailty Phenotype and FRAIL scale were used to score them. Taking Frailty Index as the diagnostic standard,the predictive value of the 2 scales for frailty risk was compared by the Receiver Operating Characteristic（ROC） and Bayes discriminant analysis.Results The incidences of frailty in elderly hospitalized patients by Frailty Phenotype,FRAIL and Frailty Index were 34.2%,25.1% and 30.5%,respectively. The consistency of the screening results of Frailty Phenotype,FRAIL scale and Frailty Index showed that the Kappa values are 0.511,0.479（P<0.01）.The Frailty Phenotype and FRAIL area under ROC curve are 0.823（95%CI：0.784~0.858） and 0.853（95%CI：0.815~0.885）.The differences are not statistically significant（Z=1.366,P>0.05）.The accuracy of cross-validation in the determination of frailty are 78.6% and 79.0%. The best predictive values are 3 and 2;the sensitivity is 0.709 and 0.837;the specificity is 0.817 and 0.790;the Youden indexes are 0.529 and 0.625;the positive predictive values are 0.697 and 0.702;the negative predictive values are 0.825 and 0.891.Conclusion The ability of Frailty Phenotype and FRAIL scale to screen the frailty risk of elderly inpatients is moderate. FRAIL scale is more effective in predicting the risk of frailty and more convenient to use,and it is more suitable for screening the frailty risk of the elderly inpatients.

Efficacy of intelligent medication management system in elderly people in care institutions

PENG Yihang,XIE Liling,LIANG Yan,XIAO Mingzhao,ZHAO Qinghua,YU Xiuli,CHEN Limei,SHU Lingzhi

2021, 56(5):  680-685.  DOI: 10.3761/j.issn.0254-1769.2021.05.006

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Objective To explore the intervention effects of intelligent medication management system on elderly drug use in care institutions.Methods The convenience sampling method was used to select 94 elderly people from 2 long-term care facilities in Chongqing. The subjects were randomly divided into an intervention group and a control group with 47 cases in each group. The intervention group used the intelligent medication management system composed of a drug sensing terminal,a web management background and a Wechat mini program,while the control group received the routine care for 3 months. Before the intervention and at the 3rd month after the intervention,the data on the demographic information questionnaire,the medication status questionnaire and medication knowledge-efficacy-adherence questionnaire was collected. The effect evaluation scale of intelligent medication management system in the intervention group was also collected at the 3rd month of the intervention.Results After the intervention of the intelligent medication management system,the differences of medication adherence scores and medication self-efficacy scores before and after the intervention in the intervention group were significantly higher than those in the control group（P<0.05）;the differences of medication knowledge scores of those who used Wechat mini program in the intervention group before and after the intervention were significantly higher than non-users（P<0.05）;95.7% of the elderly are satisfied with the system as a whole.Conclusion The intelligent medication management system can effectively improve medication adherence and rational medication self-efficacy of the elderly in the care institutions,and ensure their medication safety.

Prevalence of frailty in older patients with diabetes：a systematic review

GAO Qianqian,MEI Fan,ZHAO Li,CHEN Fei,HU Kaiyan,SHANG Yi,MA Yuxia,MA Bin

2021, 56(5):  686-693.  DOI: 10.3761/j.issn.0254-1769.2021.05.007

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Objective To systematically evaluate the prevalence of frailty in older patients with diabetes and provide evidence for nursing interventions.Methods Systematic review of the literature was conducted in electronic databases,namely PubMed,Embase,Web of Science,CBM,CNKI,VIP and Wan fang Data,and observational studies about the prevalence of frailty in older patients with diabetes published before August 2020 were included. 2 researchers independently screened the literature,extracted the data,and assessed the quality of included studies using Critical Appraisal Tools published by JBI and NOS. The meta-analysis was performed by Stata 15.0 software. Fixed-effect or random-effect models were used to pool data. Egger rank correlation and funnel plot were used to determine publication bias.Results 27 studies were finally included with a total of 8 127 patients. The pooled prevalence of frailty in older patients with diabetes was 30%[95%CI（0.24~0.37）],and it was 44%[95%CI（0.38~0.51）] for pre-frailty. Subgroup analysis showed that the prevalence of frailty in patients with diabetes in female was higher than that in male;the prevalence of frailty in patients with diabetes in hospital was higher than that in community;the prevalence of frailty in patients with diabetes using multidimensional frailty measures to evaluate frailty was higher than that using physical frailty measures;the prevalence of frailty in patients with diabetes in North America was higher than that in Asia and Europe.Conclusion There is a higher prevalence of frailty/pre-frailty in older patients with diabetes. In the future,nursing staff should not only pay attention to the early screening of the frailty of this population,but also strengthen the identification of the pre-frailty,and develop reasonable interventions to improve the prognosis and quality of life of the elderly diabetic patients.

Internet-based interventions for family care of older people with dementia：a scoping review

LENG Minmin,ZHAO Yajie,LI Liyu,LI Ce,XIAO Hongmei,WANG Zhiwen

2021, 56(5):  694-698.  DOI: 10.3761/j.issn.0254-1769.2021.05.008

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Objective To identify the core components and application status of internet-based interventions for family care of older people with dementia,so as to provide guidance for future research.Methods This scoping review was conducted under the Joanna Briggs Institute guidelines. A literature search was performed in the PubMed,Embase,CINAHL,Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,and CBM databases to identify relevant studies. The included studies were summarized and analyzed.Results A total of 31 articles were included. The core components of internet-based interventions included the provision of information and care skills guidance,peer support,contact with professionals,decision-making support,psychological support,and self-care guidance. The outcome types were mainly the effect evaluation and feasibility evaluation of interventions.Conclusion Internet-based interventions have positive effects on family caregivers of dementia patients,and the personalized internet-based interventions combined with multiple components are more favored by family caregivers. Future research should combine the hierarchical medical system and artificial intelligence decision-making technology,explore the strategy of realizing personalized support in the context of “Internet + nursing service”.

Progress in the application of information-based assessment and monitoring technology in the screening of old adults with cognitive impairment

SUN Xue,WANG Lina,SHEN Xinhua,LIU Xiaoshen,WANG Simeng

2021, 56(5):  699-704.  DOI: 10.3761/j.issn.0254-1769.2021.05.009

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The professionalization,complexity,subjective reporting bias,cross-sectional assessment characteristics might limit the application and accuracy of neuropsychological testing. In order to provide more comprehensive information for early detection and nursing intervention of individuals with cognitive impairment,cognitive function needs real-time and dynamic evaluation and monitoring in a higher level of ecological validity. Based on the background of nursing informatization,this study reviewed some information technologies of evaluation and monitoring for cognitive function,including types,advantages/disadvantages and studies in the future,and elaborated the guiding significance of this kind of technology to nursing practice,so as to provide references for the practice and research of nursing informatization.

Research progress of continuous glucose monitoring in elderly patients with diabetes

WANG Tian,LU Haiying,WANG Chenghao,LIU Xiaoyu,WEI Rong,SHAN Yawei

2021, 56(5):  705-709.  DOI: 10.3761/j.issn.0254-1769.2021.05.010

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Continuous Glucose monitoring（CGM）,also known as dynamic glucose monitoring,provides Ambulatory Glucose Profile（AGP）to alert glucose fluctuations,which has unique advantages for the identification of latent high/low blood glucose. This artical introduced the classification method,the suitable population and the core indexes of CGM,reviewed the research status and influencing factors of CGM in blood glucose management of older adults with diabetes,and gave the enlightenment and suggestions,in order to provide references for the application of CGM and the improvement of blood glucose in older adults with diabetes.

Specialist Practice and Research

Evaluation of the application effect of shoulder joint exercise in patients with limited shoulder joint movement after implantation of arm infusion port

ZHANG Sulan,LIU Qianqian,WANG Jiaqi,SHAN Chang,ZHAO Juan,LIANG Li,WANG Xiaoyu,LI Xingya

2021, 56(5):  710-715.  DOI: 10.3761/j.issn.0254-1769.2021.05.011

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Objective To observe and evaluate the effect of self-designed shoulder exercise in patients with limited shoulder joint movement after the implantation of an arm infusion port.Methods 116 inpatients with limited shoulder joint movement after the implantation of the arm port were selected by oncology nurses of a tertiary hospital using convenience sampling method from October to December 2019. By the random number table method,the patients were randomly divided into an experimental group（59 cases）and a control group（57 cases）. The experimental group received shoulder exercise for 3 months,while the control group received ball gripping exercise for the same time period. The total score of shoulder joint function,the score of each sub-group,the occurrence of thrombus and tube blockage in the arm infusion port were compared between the 2 groups before and after the exercise for 3 months.Results 3 months after the exercise,there was no statistically significant difference between the experimental group and the control group in the total scores before the exercise（P>0.05）,while there was statistically significant difference in the total scores after the exercise（P<0.05）. The shoulder joint movement,activity ability of daily life and muscle strength scores in the experimental group were higher than those in the control group with statistically significant differences（P<0.05）. A month after the exercise,the incidences of catheter-related thrombosis and tube blockage in the experimental group were lower than those in the control group,and the differences between the 2 groups were statistically significant（P<0.05）. During the whole exercise period,the total incidence of catheter-related thrombosis and blockage in the experimental group was lower than it in the control group with statistically significant differences（P<0.05）.Conclusion Shoulder joint exercise is helpful to improve the limitation of shoulder joint movement in patients with the arm infusion port,to reduce the incidences of thrombus and blockage of the arm infusion port,and it is worthy of clinical promotion.

The effect of improved hand and knee delivery position on primipara delivery outcome and comfort

LÜ Hairong,BAO Lei,LUO Li,SUN Yani,WANG Hongli,REN Yu,ZHAI Jinguo

2021, 56(5):  716-720.  DOI: 10.3761/j.issn.0254-1769.2021.05.012

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Objective To evaluate the effect of improved hand knee delivery on the outcome and comfort of primipara in the second stage of labor.Methods From October 1,2019 to March 31,2020,290 primiparas delivered in the delivery center of a tertiary hospital were selected as the study population. With informed consent,the study method of randomized controlled trial was adopted. According to the method of randomized numerical table,the study group was divided into an experimental group（n=145）and a control group（n=145）. The experimental group adopted the improved hand knee delivery position in the second stage of labor,and the control group adopted the traditional knee-bent supine position in the second stage of labor. The difference of delivery outcome and comfort between the 2 groups was compared.Results The natural delivery rate of parturients in the experimental group was higher than that in the control group（χ²=12.590）;the rate of episiotomy was lower than that in the control group（χ²=48.019）;the second labor period was shorter than that of the control group（t=-2.579）;the amount of bleeding during and after delivery was less than that of the control group（t=-2.134）;the maternal comfort was higher than that of the control group（t=-10.775）;the difference was statistically significant（P<0.05）. There was no significant difference in neonatal asphyxia rate between the 2 groups（χ²=0.344,P=0.995）. Conclusion The improved hand knee delivery position can improve the natural delivery rate,shorten the second labor period,reduce the rate of dystocia and lateral episiotomy,reduce postpartum hemorrhage,and improve the comfort of delivery.

Disease communication experience between couples in patients with colorectal cancer stoma：a qualitative study

CHENG Xiang,DU Ruofei,ZHOU Huiyue,CHEN Changying,LI Yanli,WANG Tao

2021, 56(5):  721-726.  DOI: 10.3761/j.issn.0254-1769.2021.05.013

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Objective To explore the problems and causes of disease communication between colorectal cancer patients and their spouses,and to provide a basis for further interventions.Methods Purposive sampling method was used to select patients with colorectal cancer from September to December 2019 in a tertiary hospital in Zhengzhou for semi-structured interviews. Data was analyzed by Colaizzi method.Results 4 themes were extracted. Theme 1 is negative communication problems during the treatment（including heavy communication burden of male patients,the lack of emotional support in communication content,couples avoidance of cancer-related topics）. Theme 2 is positive communication experience in the rehabilitation period（including positive communication about the new life after illness,the increasing of the sense of tacit understanding）. Theme 3 is the influence of negative communication on patients（including the increased negative emotions,the increased inner loneliness of patients,the decline of self-confidence,the conflicts caused by over protection of spouses）. Theme 4 is patients’ expectation of effective communication between the husband and wife（including the obtaining of professional knowledge guidance to improve communication efficiency,the hope to get training in communication skills）.Conclusion There are differences in disease communication of couples in different stages of ostomy patients with colorectal cancer. Negative communication will have a negative effect on the patient’s psychological status. Therefore,nurses should pay attention to such patients and give effective interventions.

Centrality and serverity of symptoms in people living with HIV: a cross-sectional study

YANG Hongli,ZHU Zheng,HU Yan,BI Xiongfeng,XU Jinjie,LUO Lan,ZHANG Lin

2021, 56(5):  727-731.  DOI: 10.3761/j.issn.0254-1769.2021.05.014

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Objective To explore the prevalence and severity of HIV-related symptoms and to identify symptom networks in people living with HIV（PLWH）.Methods From June to October 2020,we recruited 572 PLWH through a convenient sampling in one HIV/AIDS designated hospital in Kunming,Yunnan Province. HIV Symptom Checklist was used to measure the prevalence and severity of 27 HIV-related symptoms. Spearman association network and Fruchterman-Reingold layout were used to identify symptom networks.Results The most common symptom was fatigue（44.41%）,sleeping disturbance（37.76%）,and memory loss（37.41%）. The most severe symptom was fatigue,sleeping disturbance,and memory loss. The network showed fatigue（r_S=8.62,r_C=1.16,r_B=36） and slow reaction（r_S=8.54,r_C=1.07,r_B=14） were the most central symptoms across three centrality indices including strength,closeness,and betweenness.Conclusion This study suggested that it is particularly important to include assessment and treatment of fatigue and cognitive symptoms as essential components of HIV care. There is a need to evaluate HIV-related symptoms by a structural patient reported outcome measures.

A study on the status of adult patients with Cushing’s disease

ZHUANG Yuan,WANG Qi,TIAN Bingjie,ZHANG Qin,QIN Ji,HUANG Ying

2021, 56(5):  732-736.  DOI: 10.3761/j.issn.0254-1769.2021.05.015

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Objective To investigate the status of adult patients with Cushing’s disease and its influencing factors,and to provide evidence for optimizing the quality of the patients.Methods The cross-sectional survey was carried out from November 2018 to June 2020 among adult patients with Cushing’s disease recruited by convenience sampling in a single center. Research instruments included the General Information Questionnaire,Chinese version of Cushing’s syndrome patients’ quality of life questionnaire,PHQ-9 depression screening scale,GAD-7 self-assessment scale,Karnofsky functional status rating scale. Data cleaning,statistical description,single factor analysis and multivariate regression analysis were completed with SPSS 23.0 software.Results The score of the quality of life in patients with Cushing’s disease was（46.49±20.58）. The results of multivariate regression analysis showed that cortisol level,depression and anxiety were risk factors of low quality of life in patients with Cushing’s disease（P<0.05）.Conclusion The quality of life of adult patients with Cushing’s disease is not high. Medical staff should pay more attention to patients with Cushing’s disease with high cortisol level,depression and anxiety,and try to prevent the occurrence of risk factors and implement targeted interventions and care as soon as possible once any risk factors are identified.

Symptoms and its influencing factors among breast cancer survivors undergoing adjuvant endocrine therapy

JING Feng,XING Weijie,QIU Jiajia,TANG Lichen,XU Lei,HU Yan

2021, 56(5):  737-742.  DOI: 10.3761/j.issn.0254-1769.2021.05.016

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Objective To describe the occurrence and risk factors of symptoms among breast cancer survivors undergoing adjuvant endocrine therapy.Methods Breast cancer patients undergoing adjuvant endocrine therapy were investigated online with convenience sampling by the general information questionnaire,knowledge and attitude questionnaire and Functional Assessment of Cancer Therapy-Endocrine Subscale during November 2019 to April 2020 in A level A tertiary hospitals in Shanghai,and the Shanghai Anticancer Rehabilitation Club.Results The total symptoms score of 613 breast cancer survivors undergoing adjuvant endocrine therapy was 18.99±11.43,among which irritable,mood swings,lost interest in sex,hot flashes,joint pain,pain or discomfort with intercourse are symptoms with a higher incidence and severity. The multivariate linear regression analysis showed that age,self-payment,types of endocrine therapy drugs,previous surgery,previous chemotherapy,attitude to endocrine therapy were the independent influencing factors of symptoms（P<0.05）,which accounted 19.1% of the total variation.Conclusion The incidence of adjuvant endocrine therapy-related symptoms in breast cancer patients is high,and the symptom burden is heavy. The patients with younger age,self-payment,the use of selective estrogen receptor modulator,previous surgery,previous chemotherapy,a poor attitude toward endocrine therapy tended to have a higher symptom burden.

Clinical Practice

Multidisciplinary collaborative treatment and nursing care of children with severe chlorine gas poisoning

DUAN Yingjie,FANG Boliang,ZHANG Linqi,LIU Lili,QU Bin,LI Guangyu,QIAN Suyun

2021, 56(5):  743-747.  DOI: 10.3761/j.issn.0254-1769.2021.05.017

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To summarize the multidisciplinary treatment and nursing experience of 6 children with severe collective chlorine poisoning. The hospital set up a multidisciplinary rescue team,implemented lung ventilation protection strategies,conducted airway management,eye care and targeted psychological care. The specialized care ensured the treatment effects of children with severe chlorine poisoning. All of the 6 children in this group were cured and discharged.

Nursing care of non-slow down post-pyloric feeding for 15 severe burn patients with prone ventilation

FENG Xiuqin,CAI Lingyun,ZHOU Jiajia,ZENG Fei,ZHANG Yuping,JIN Dingping

2021, 56(5):  748-750.  DOI: 10.3761/j.issn.0254-1769.2021.05.018

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To summarize the experience and effectiveness of non-slow down post-pyloric feeding in 15 severe burn patients with prone position ventilation. We established a multi-disciplinary prone position ventilation and enteral nutrition team,dynamically adjusted the personalized and precise nutrition plans,managed the target feeding rate,and implemented the intra-abdominal pressure oriented and non-slow down feeding strategy,and effectively prevented gastrointestinal intolerance. After careful care of 15 patients,the standard rate of enteral nutrition within 24 to 48 hours was 20%~60%,and the standard rate within a week was 50% to 95%. The gastrointestinal tolerance was good. The intra-abdominal pressure oriented and early post-pyloric non-slow down feeding is safe and effective in severe burn patients with prone ventilation.

Nursing care of a child with incision full-thickness fissure combined with enterostomy skin and mucosal separation

SHI Qianqian,WANG Xin,SHI Ling,LIANG Peirong,LI Ping

2021, 56(5):  751-754.  DOI: 10.3761/j.issn.0254-1769.2021.05.019

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To summarize the nursing experience of a child with incision full-thickness fissure combined with enterostomy skin and mucosal separation. The main points of nursing include active anti-infection;well management of the skin around incision,orifice and the use of the concept of wet healing,the scientific cutting and sticking of the pocket,the timely removing of the wound and orifice exudate and fecal water,the promotion of the wound and surrounding skin healing;implementing individualized nutrition programs to actively prevent the occurrence of pressure sores. After 62 d of treatment and careful nursing,the recovery effect of the wound was satisfactory.

Evidence Synthesis Research

Evidence summary of resistance training for breast cancer-related lymphedema

LIU Fei,SI Longmei,WANG Yingxin,WANG Yue,ZHANG Shuqi,DING Yanming,LI Jing,GU Hongtao

2021, 56(5):  755-761.  DOI: 10.3761/j.issn.0254-1769.2021.05.020

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Objective To retrieve,evaluate and summarize the best evidence of resistance training for breast cancer-related lymphedema.Methods We searched BMJ Best Practice,UpToDate,Registered Nurses’ Association of Ontario（RNAO）,National Comprehensive Cancer Network（NCCN）,National Institute for Health and Clinical Excel-lence（NICE）,Scottish Intercollegiate Guidelines Network（SIGN）,Medive,PubMed,CINAHL,Cochrane library,Joanna Briggs Institute（JBI） COnNECT+,CNKI,Wanfang,National Lymphedema Network（NLN）,International Society of Lymphology（ISL） to collect relevant guidelines,evidence summaries,recommended practice,systematic reviews and expert consensuses published from database construction to September 1st of 2020. 2 researchers evaluated the quality of various literature,and extracted recommendations and research conclusions from the included literature.Results Totally 21 articles were involved,including 1 guideline,14 systematic reviews,2 expert consensuses,1 recommended practice and 3 evidence summaries. Finally,23 pieces of best evidence about contraindications,timing of training,training forms,training intensity and training effectiveness were summarized.Conclusion Resistance training combined with individualized exercises,professional guidance and regular monitoring management is safe and beneficial. Clinical staff should develop resistance training program based on clinical environment as well as patient’s individual situation and training conditions.

Summary of best evidence on non-pharmacological management in children with postoperative delirium

WANG Mengmeng,WEN Yuanming,DENG Yongfang,HUANG Peiyu,LIU Peizhen

2021, 56(5):  762-766.  DOI: 10.3761/j.issn.0254-1769.2020.05.021

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Objective To search and retrieve the best evidence on non-pharmacological management in children who may develop postoperative delirium,and to provide evidence-based guidance for clinical practice.Methods We searched databases and websites from inception to February 2020,including Up to Date,BMJ Best Practice,Cochrane Library,the Association of perioperative Registered Nurses（AORN）,JBI（JBI Systematic Review/JBI Evidence Summary）,National Guideline Clearinghouse（NGC）,Guidelines International Network（GIN）,European Society of Anaesthesiology（ESA）,American Association of Nurse Anesthetists（AANA）,National Institute for Health and Care Excellence（NICE）,American Association of Critical-Care Nurses（AACN）,CNKI and CBM to collect the literature concerning guidelines,clinical decisions,best practices,system reviews,evidence summaries,Meta-analysis and expert consensuses on non-pharmacological management of children with postoperative delirium.Results A total of 9 articles were incorporated,including 3 clinical decisions,3 guidelines and 3 system reviews. A total of 20 pieces of best evidence including 5 aspects were summarized,namely assessment of high risk factors,preoperative interventions,intraoperative interventions,postoperative interventions and quality management.Conclusion Pediatric professionals should receive relevant training on non-pharmaceutical management skills on postoperative delirium in pediatric patients,master the high risk factors and implement non-pharmacological interventions based on the specific clinical situations,so as to prevent the incidence of postoperative delirium in children and improve their safety.

Quality appraisal of guidelines on nutritional management for esophageal cancer during the peri-radiotherapy period

WANG Peiru,LUO Zebing,ZHANG Jia,GUO Zhijun,LI Dandan,WANG Yiru

2021, 56(5):  767-774.  DOI: 10.3761/j.issn.0254-1769.2021.05.022

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Objective To evaluate the quality of nutritional management guidelines and expert consensuses for esophageal cancer during the peri-radiotherapy period and to summarize the relevant recommendations,so as to provide references for the establishment of the practice standards of nutritional care for esophageal cancer during the peri-radiotherapy period.Methods Guidelines and expert consensuses involving recommendations on nutritional management for esophageal cancer during the peri-radiotherapy period were searched in guideline networks,websites of nutritional associations and databases from their inception to April 28,2020. Related quality assessment tools were used to evaluate the quality of guidelines and expert consensuses. The recommendations on nutritional management for esophageal cancer during the peri-radiotherapy period were synthesized.Results A total of 5 guidelines and 4 expert consensuses were included. 1 of the 5 guidelines was rated as grade A recommendation,and 4 were rated as B. Items 1~5 in the quality evaluation results of the 4 expert consensuses were "yes" and item 6 was "no". The recommendations on nutritional management for esophageal cancer during the peri-radiotherapy period involved malnutrition diagnosis,nutrition treatment,nutrients,improvement of appetite,maintenance of swallowing function,exercise,home nutrition treatment,efficacy evaluation of nutrition treatment and follow-up.Conclusion The quality of included guidelines and expert consensus needs to be improved. The summary of nutritional management recommendations for esophageal cancer patients during the peri-radiotherapy period can provide reference for further formulating practice standards of nutritional care.

Effects of exercise therapy on cardiotoxicity in patients with tumor chemotherapy：a meta-analysis

GU Yiqin,LI Chaofeng,SHA Li,ZHANG Jing,GU Yan

2021, 56(5):  775-781.  DOI: 10.3761/j.issn.0254-1769.2021.05.023

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Objective To evaluate the effect of exercise therapy on the prevention and treatment of cardiac toxicity in cancer patients undergoing chemotherapy.Methods CNKI,WanFang Data,VIP,SinoMed,PubMed,Web of Science,Embase,Cochrane Library were searched for randomized controlled trials about exercise therapy of cardiac toxicity in cancer patients undergoing chemotherapy published from inception to August 2020. Excel was used for basic information extraction;bias risk assessment tool in Cochrane Reviewers Handbook 5.1.0 was used for literature quality evaluation. Meta-analysis was implemented with Review Manager 5.3 software;Grade pro 3.6 was used for quantitative evaluation of evidence.Results 11 articles were included in the analysis. Meta-analysis showed results as following.（1）Compared with the control group,exercise therapy could reduce HRmax[MD=-3.39,95%CI（-3.87,-2.92）,P<0.001],CK-MB[SMD=-3.59,95%CI（-5.83,-1.36）,P=0.002] and NT pro BNP[SMD=-5.92,95%CI（-11.29, -0.55）,P=0.03] of tumor patients receiving chemotherapy.（2）Exercise therapy could increase LVEF[MD=9.12,95%CI（1.32,16.93）,P=0.02] and VO₂max[SMD=1.47,95%CI（0.68,2.26）,P<0.001] of tumor chemotherapy patients.Conclusion Exercise therapy can reduce the HRmax,CK-MB and NT-proBNP in tumor patients receiving chemotherapy,and increase their LVEF and VO₂max. In one word,it has a positive effect on the remission of cardiac toxicity in tumor patients.

Review

Research progress on nursing care of thirst in critically ill patients

HAN Zunhai,HE Yin,LU Zhenhui,SHI Ying,JIN Jin,WANG Xinran

2021, 56(5):  782-785.  DOI: 10.3761/j.issn.0254-1769.2021.05.024

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Thirst is a prevalent and serious discomfort symptom of critically ill patients,which affects their physical and mental health. This article reviews the risk factors,nursing measures and management strategies of thirst for critically ill patients,in order to provide references for clinical staff.

Research progress on the intimate relationship between chronic disease patients and their spouses

SHI Genya,SHI Tieying,LIU Yu,CAI Yingjie,CAO Shengnan

2021, 56(5):  786-790.  DOI: 10.3761/j.issn.0254-1769.2021.05.025

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Based on a review of the concept of intimate relationship,this article summarizes the relationship resilience models,interpersonal process model of intimacy,behavioral marriage theory and other intimate relationship related theories,and the current situation and influence factors of intimate relationship between chronic disease patients and their spouses. It also introduces the interventions including cognitive behavioral couples therapy,FOCUS program,dyadic coping intervention,couples life story approach and so on. It provides references for further research on the intimate relationship between patients with chronic diseases and spouses in China.

Nursing Instruments Innovation

Production and application of an innovative twin bag system of peritoneal dialysis

WANG Shufen,WANG Haibo,ZHANG Hongmei,ZHANG Junmei,JIANG Qiuhuan

2021, 56(5):  791-794.  DOI: 10.3761/j.issn.0254-1769.2021.05.026

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Objective To design an innovative twin bag system of peritoneal dialysis for patients with end-stage renal disease and to evaluate the effectiveness of its application.Methods A total of 156 patients with peritoneal dialysis in the department of nephrology from January 2018 to December 2019 were selected as research subjects. Patients were divided into an experimental group which used the innovative twin bag system of peritoneal dialysis and a control group which used the traditional twin bag system of peritoneal dialysis. Some indicators were observed and compared,including the time of peritoneal dialysis fluid exchange,the rate of peritonitis,average cost of per peritoneal dialysis and the satisfaction of patients.Results Compared with these in the control group,the experimental group had shorter time of peritoneal dialysis fluid exchange,lower rate of peritonitis and lower average peritoneal daily cost. The total satisfaction rate in the experimental group was significantly higher than that in the control group. The differences were statistically significant（P<0.05）.Conclusion The innovative twin bag system of peritoneal dialysis is more convenient,which can reduce the time of peritoneal dialysis fluid exchange and peritonitis cost effectively and improve patient’s satisfaction.

Overseas Knowledge

Sinicization,reliability and validity of the quality of life scale in women with gestational diabetes mellitus

YANG Jiemei,YANG Qiaohong,LI Yaoxia,LI Jing,HUANG Dongxi,ZENG Shulan

2021, 56(5):  795-800.  DOI: 10.3761/j.issn.0254-1769.2021.05.027

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Objective The quality of life scale for women with gestational diabetes mellitus（GDMQ） was translated into Chinese,and its cultural adjustment,reliability and validity were tested.Methods The original scale was translated by the methods of translation,synthesis,back translation and expert committee;the cultural adjustment and content validity of the scale were evaluated by the cognitive interview and expert consultation;272 women with GDM were investigated by convenience sampling method. The reliability and validity of the scale were evaluated.Results The Chinese version of GDMQ contains 5 dimensions,which are consistent with the original scale,namely concerns about high-risk pregnancy（with 10 items）,perceived constraints（with 7 items）,complications of GDM （with 4 items）,medication and treatment（with 6 items）,support（with 5 items）. The S-CVI/UA was 0.81,the I-CVI was 0.86-1.00;the S-CVI/Ave was 0.97. The Cronbach’s α coefficient of the total scale was 0.914,and the Cronbach’s α coefficients of each dimension ranged from 0.656~0.920. The test-retest reliability of the total scale was 0.897.Conclusion The Chinese version of GDMQ has good reliability and validity,which can be used to evaluate the quality of life of pregnant women with GDM. It can provide corresponding bases for clinical medical staff to make health education strategies and targeted nursing measures.