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    10 December 2022, Volume 57 Issue 23
    Special Planning—Safety Management of Vascular Access
    Expert consensus on safety management of transfusion connection devices for vascular access
    Hospital Infection Management Committee of Chinese Nursing Association , Intravenous Therapy Committee of Chinese Nursing Association , Written by WANG Xia, SUN Zhong, ZHAO Lu, WANG Pei, MA Jingmiao, HOU Xiufeng, ZHANG Kaili, YUAN Xiaoning, WANG Lei, SUN Wenyan, GAO Fengli, WANG Huafen, SUN Hong, CAI Meng
    2022, 57(23):  2821-2824.  DOI: 10.3761/j.issn.0254-1769.2022.23.001
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    Objective The aim is to establish an expert consensus(hereinafter referred to as "Consensus")on safety management of transfusion connection and port protection devices for vascular access,to prevent catheter related bloodstream infection and provide patients with safe,effective and standardized intravenous therapy. Methods Using evidence-based methods,according to the level of evidence,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted,and then the first draft of consensus was formed. Through a round of Delphi expert consultation and 2 rounds of expert meetings,opinions from domestic experts in many fields and disciplines were sought and integrated;the content was adjusted and the consensus was reached. Results The positive coefficient is 100%;the authoritative coefficient is 0.92;the average value of each index is more than 4;the coefficient of variation is less than 0.22. The Kendall’s harmony coefficient of the expert’s opinion is 0.35( χ2=144.44,P<0.001). A consensus recommendation on the classification and maintenance of infusion connection devices was reached. Conclusion The Consensus is scientific,which can provide a reference for the safety management of transfusion connection and port protection devices in China,and provide a basis for clinical decision-making to prevent catheter related bloodstream infection.

    Risk factors for catheter-related thrombosis in cancer patients with totally implantable venous access ports:a Meta-analysis
    WEN Meng, DOU Xinman, MIAO Xiaoqi, FU Zhongxia, LIU Zhengli, LIU Jing, SUN Youhan, YAN Jun
    2022, 57(23):  2825-2833.  DOI: 10.3761/j.issn.0254-1769.2022.23.002
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    Objective Risk factors for catheter-related thrombosis in totally implantable venous access ports (TIVAP) in tumor patients were analyzed by systematic analysis. Methods Computerized retrieval of PubMed,EMbase,Web of Science,the Cochrane Library,CBM,WanFang Data,CNKI and VIP databases was carried out. Case-control studies and cohort studies about TIVAP catheter-related thrombosis risk factors in tumor patients were collected from the database establishment to August 2021. 2 researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan5.3 software. Results A total of 22 studies were included,including 4 case-control studies and 18 cohort studies,with a total of 10526 patients. The results of meta-analysis showed that tumor clinical stage[OR=3.06,95%CI(2.16,4.35),P<0.001],implantation location[OR=0.69,95%CI(0.53,0.89),P=0.005],body mass index(BMI)[OR=1.95,95%CI(1.21,3.13),P=0.006],tumor metastasis[OR=2.72,95%CI(1.38,5.38),P=0.004],infusion port material [OR=0.73,95%CI(0.56,0.95),P=0.020],hypercoagulable state[OR=2.69,95%CI(1.94,3.73),P<0.001] and diabetes history[OR=0.50,95%CI(0.33,0.76),P=0.001] are independent risk factors for catheter-related thrombosis in tumor patients with TIVAP. Conclusion Current evidence shows that the location,material,tumor stage,tumor metastasis,BMI,concomitant hypercoagulability,and diabetes are independent risk factors for TIVAP catheter-related thrombosis in cancer patients. Clinical nursing care should be strengthened for high-risk patients with the above risk factors,in order to reduce the incidence of catheter-related thrombosis and improve the clinical outcomes of patients.

    Systematic review of risk prediction models for catheter-related thrombosis in patients undergoing central venous catheterization
    WU Wenjin, XU Yihong, LIU Xiaolin, YAN Mengya, WANG Yina, WANG Meijuan, GAO Yang, YANG Dan, PAN Hongying, SHEN Xuhui
    2022, 57(23):  2834-2841.  DOI: 10.3761/j.issn.0254-1769.2022.23.003
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    Objective To systematically analyze and evaluate the prediction models for central venous catheter-associated thrombosis,in order to provide references for constructing higher quality risk prediction models for central venous catheter-associated thrombosis. Methods Original articles in Chinese and English were systematically searched from Chinese databases(CNKI,Wanfang,Sinomed) and English databases(PubMed,Embase,Web of Science,Cochrane Library,CINAHL),and the search period was from the database establishment to February 16,2022.There were 2 investigators who independently screened the literature and extracted data,and applied PROBAST,a risk of bias assessment tool for predictive modeling studies,to analyze the risk of bias and applicability of the included literature. Results A total of 15 studies were included to construct risk prediction models for central venous catheter-associated thrombosis, involving a total of 16 models. 156 models had an area under the subject operating characteristic curve ranging from 0.641 to 0.85. 12 studies had good applicability,while the remaining 3 studies had poor applicability. 15 studies had a high risk of bias,mainly due to failure to select appropriate data sources,inappropriate inclusion and exclusion criteria for study subjects,insufficient sample size,inadequate treatment of missing data,unreasonable variable screening process, consideration of competing risk factors,lack of model performance.The risk of bias was high in all 15 studies,mainly due to inappropriate selection of data sources,inappropriate inclusion and exclusion criteria, incomplete exclusion of predictors from outcome indicators,insufficient sample size,unreasonable treatment of continuous variables,insufficient attention to missing data,unreasonable variable screening process,consideration of competing risk factors,lack of model performance evaluation and over-simulation of the model,etc. Conclusion The construction of existing risk prediction models for central venous catheter-associated thrombosis is still in its initial stage.It is necessary to focus on the study of the validity of different risk assessment methods in the later construction in order to obtain better and highly accurate risk prediction models and provide certain references and bases for the development of relevant prevention strategies.

    Evidence summary for prevention and management of central venous catheter occlusion
    LI Huaiyan, LI Yuling, YU Jing, MENG Xiaohong, CUI Yingqin
    2022, 57(23):  2842-2850.  DOI: 10.3761/j.issn.0254-1769.2022.23.004
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    Objective To search,evaluate and summarize the best evidence for prevention and management of central venous catheterization. Methods According to the "6S" evidence model,related databases including BMJ Best Practice,UpToDate,NGC,JBI evidence-based database,Scopus platform,Yimaitong Guide.com,CINAHL,CNKI,Wanfang Database,CBM were searched from top to bottom. All evidence related to the prevention and management of central venous catheterization from August 2011 to August 2021 was included,involving clinical practice guidelines,systematic reviews,evidence summaries,best practice,expert consensuses,and original literature. 2 researchers independently evaluated the quality of relevant literature and standardized the integration and summary of the evidence finally included in the literature. Results Totally 14 pieces of the literature were included,involving 3 guidelines,3 systematic reviews,4 evidence summaries,3 expert consensuses and 1 meta-analysis. Finally,28 pieces of best evidence were formed,including 6 dimensions,namely intravenous treatment team,cathetering site and method,catheter flushing tool and operation,blockage prevention strategy,blockage treatment strategy,and patient education. Conclusion The best evidence for the prevention and management of central venous catheter blockage is helpful for clinical nurses to formulate personalized catheter blockage prevention strategies according to the actual situation of patients,to standardize the management strategies of catheter blockage,so as to reduce the incidence of central venous catheter blockage and ensure the safety of patients.

    Specialist Practice and Research
    Application of “Internet+” early rehabilitation training in high-risk patients with exercise rehabilitation after PCI
    YE Lingyan, CHEN Yuanyuan, JIN Lihong, ZHAO Suyu, RAO Huihui, ZHANG Huihong
    2022, 57(23):  2851-2856.  DOI: 10.3761/j.issn.0254-1769.2022.23.005
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    Objective To evaluate the application of "Internet+" early rehabilitation training in high-risk patients with exercise rehabilitation after percutaneous coronary intervention(PCI),and to evaluate its effect. Methods The convenience sampling method was employed to choose PCI patients at high risk of postoperative exercise rehabilitation as the research subjects from the cardiology department of a tertiary A hospital in Zhejiang province,among which 30 cases in March to April,2022 were allocated into the experimental group. The research team formulated and implemented the “Internet+” platform combined with the early rehabilitation training program based on the standard theory through literature review and expert meetings. 30 patients admitted from January to February 2022,were allocated into the control group,and they received routine offline cardiac rehabilitation training. The compliance of offline rehabilitation training,the incidence of adverse events and quality of life in the process of rehabilitation training were compared between the 2 groups after intervention,and the online reading compliance and satisfaction with the use of “Internet+” rehabilitation training platform in the experimental group were evaluated. Results There were 2 cases dropped out from the experimental group,and 4 cases from the control group,and finally there were 28 cases in the experimental group and 26 cases in the control group. After 7 days of intervention,the offline compliance of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.001). There was no significant difference in the incidence of adverse events and quality of life between the 2 groups during rehabilitation training(P>0.05). In the experimental group,the total reading volume of the online platform was 875 times;the total number of articles was 326 times;the active number was 369 times. The reading rate of the patients was 88.35%;the reading time was 14.8 minutes. The overall satisfaction of cardiology nurses and patients in the experimental group with the online platform was(2.69±0.47),(2.79±0.42)points,respectively. Conclusion “Internet +” early rehabilitation training can effectively im-prove the rehabilitation compliance and quality of life of high-risk patients with postoperative exercise rehabilitation after PCI.

    Effect of illness perception intervention on rehabilitation efficacy of patients with functional dyspepsia
    YONG Guizhen, WANG Xiaoxia, OUYANG Yanyan, WANG Ping, HE Guobin
    2022, 57(23):  2857-2863.  DOI: 10.3761/j.issn.0254-1769.2022.23.006
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    Objective To explore the effect of illness perception interventions based on Meleis’s transitions theory on the rehabilitation of patients with functional dyspepsia. Methods 120 patients with functional dyspepsia were selected by convenient sampling in the outpatient department of gastroenterology of a tertiary A hospital in Nanchong,Sichuan Province from July to October 2021. They were divided into a control group and an experimental group with 60 cases in each group by SPSS 22.0 random number table method,and 20 cases were taken as a group to establish a Wechat group respectively. On the basis of routine outpatient care,the experimental group received illness perception interventions based on Meleis’s transitions theory;the control group received routine outpatient care and received relevant health education information through WeChat group. The duration of the intervention was 8 weeks. Data were collected by the Brief Illness Perception Questionnaire,Dyspepsia Symptoms Severity,the Affect Balance Scale,Nepean Dyspepsia Index-Short Form and so on. The cognitive level of disease,dyspepsia symptom severity,emotional balance and health-related quality of life of the 2 groups were compared before and after intervention. Results In the control group,3 cases were lost to follow-up. The cognitive level of disease and health-related quality of life of intra-group comparison and post-intervention comparison between the 2 groups were higher than those before the intervention;the severity of symptoms was lower than that before the intervention;the emotional balance was better than that before the intervention. The difference was statistically significant(P<0.05). After the intervention,the cognitive level of disease and health-related quality of life in the experimental group were higher than those in the control group;the severity of symptoms was lower than that in the control group;the emotional balance was better than that in the control group. The difference was statistically significant(P<0.001). Conclusion The illness perception intervention based on Meleis’s transitions theory is helpful to improve the cognitive level of disease in patients with functional dyspepsia,to reduce symptoms and negative emotions,and to improve health-related quality of life.

    Study on the removal of urinary catheter at different times after interventional embolization in patients with unruptured intracranial aneurysm
    LUO Yue, SU Wei, DING Wanyu, LIU Lunxin, LI Wei
    2022, 57(23):  2864-2869.  DOI: 10.3761/j.issn.0254-1769.2022.23.007
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    Objective To investigate the effect of catheter removal at different times on patients with unruptured intracranial aneurysm(UIA) after interventional embolization under the concept of enhanced recovery after surgery. Methods Convenience sampling method was used to select 140 patients with UIA who underwent interventional embolization in an interventional operating room of a tertiary A hospital in Sichuan Province from October 2021 to January 2022 as the research subjects. They were divided into an experimental group and a control group by table method,with 70 patients in each group. After the Aldrete score ≥12 points in the experimental group,the urinary catheter was removed within 2 h after the operation,and the urinary catheter in the control group was removed within 24 h after the operation. Results A total of 135 patients were included in the study,with 68 in the experimental group and 67 in the control group. There was no significant difference in the general data between the 2 groups(P>0.05). The agitation score and agitation rate in the wake-up period before leaving the anesthesia recovery room in the experimental group were lower than those in the control group,and the difference was statistically significant(P=0.013 and P=0.008). The urine output was lower than that of the control group,and the difference was statistically significant(P<0.05).Compared with the control group,there was no significant difference in the first urination in the experimental group(P>0.05). The visual analog scores of pain in the experimental group before,during and 2 hours after the extubation were lower than those in the control group,and the difference was statistically significant(P<0.05). Conclusion Removing the urinary catheter within 2 hours after surgery can help to reduce rate of restlessness during recovery after interventional embolization in patients with UIA,not increase the risk of urinary retention and catheter replacement,and reduce the the pain of the urethra.It is recommended to remove the urinary catheter as soon as possible while ensuring the safety of patients with UIA after interventional embolization.

    Development and application of decision aid for age-related macular degeneration patients
    WAN Junli, ZHANG Feng, GUO Wenmei, WU Xuemei, BIAN Wei
    2022, 57(23):  2870-2876.  DOI: 10.3761/j.issn.0254-1769.2022.23.008
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    Objective To explore the application effect of the nutritional intervention decision-making assistance program in patients with age-related macular degeneration(AMD). Methods By referring to the domestic and foreign literature,expert consultation,topic group discussions and pre-experiment,based on the Three Talk Model of shared decision making,the nutritional intervention decision support scheme for AMD patients was constructed,including 3 steps of team negotiation,selection negotiation and decision negotiation. A total of 110 AMD patients were conveniently selected and randomly divided into an experimental group and a control group with 55 cases in each group. The experimental group was given the decision support program on the basis of routine health education,and the control group was given routine health education. Before and after the intervention,the 2 groups of patients were assessed with the knowledge of risks and benefits of nutrition in AMD,Preparation Decision-making Scale(PrepDM),Decision Making Self-Efficacy Scale(DM-SES),Decision Conflict Scale(DCS),and Hospital Anxiety and Depression Scale(HADS). Results After the intervention,the scores of knowledge of risks and benefits of nutrition in the experimental group were higher than those in the control group(P<0.001),and the scores of PrepDM were significantly higher than those in the control group(P<0.001). DM-SES score was higher than that of the control group(P<0.001);DCS score was significantly lower than that of the control group(P<0.001);the scores of HADS in the experimental group were lower than those in the control group(P<0.05). Conclusion The patient decision-making assistance program developed in this study can improve the knowledge level of nutritional intervention,improve decision-making readiness,improve patient self-efficacy,reduce the level of decision-making dilemma,and alleviate patient anxiety and depression.

    Construction of a rehabilitation nursing program for total knee arthroplasty patients based on Behavior Change Wheel Theory
    SUN Xiangyu, XU Yuan, YANG Xu, CAO Jing, LI Jiamin, ZHU Liyun, WU Xinjuan
    2022, 57(23):  2877-2883.  DOI: 10.3761/j.issn.0254-1769.2022.23.009
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    Objective To construct a rehabilitation exercise nursing program for total knee arthroplasty (TKA) patients based on Behavioral Change Wheel (BCW) Theory and mobile health technology,and to provide a reference for the rehabilitation exercise nursing program for patients with TKA. Methods From March to June 2022,the first draft of evaluation indicators was constructed through literature review and brainstorming method with experts based on the BCW Theory. Delphi technique method was used to modify,add or delete items of the program,and then Analytic Hierarchy Process was used to determine the weight of each item. Results 2 rounds of Delphi consultations were conducted among 20 experts,and the effective recovery rate of the questionnaire was 100%. The expert authority coefficient was 0.925,and the Kendall harmony coefficients of the 2 rounds of consultations were 0.445 and 0.362,respectively (P<0.001). The mean value of importance assignment of indicators at all levels was 4.75-5.00. The final program contained 3 first-level items,7 second-level items,and 26 third-level items. Conclusion The rehabilitation nursing program based on BCW Theory for TKA patients constructed in this study is scientific and applicable,with reference significance for guiding the rehabilitation nursing of TKA patients with the help of mobile health technology.

    Construction of a self-management program for patients with type 2 diabetes mellitus
    WEI Xiuxia, LI Qinghe, CHEN Ping, GAO Xiaohua
    2022, 57(23):  2884-2890.  DOI: 10.3761/j.issn.0254-1769.2022.23.010
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    Objective To construct a self-management program for patients with type 2 diabetes mellitus. Methods Through the literature review,qualitative interviews and 2 rounds of expert consultations,the health care program for type 2 diabetes patients was constructed during August 2021 and February 2022. Results The response rates of 2 rounds of the questionnaire were both 97.62%;the experts authority coefficients in 2 rounds were both 0.921. The final program includes 2 time periods of hospitalization and home care period. For the hospitalization period,there were 3 first-level items,20 second-level items and 54 third-level items. For the home care period,there were 3 first-level items,10 second-level items and 26 third-level items. Conclusion The study was reliable and scientific,and the program could provide references for the development and research of health care for patients with type 2 diabetes mellitus.

    Investigation of symptom clusters and sentinel symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease
    CHEN Qingmei, CUI Miaoling, MA Yuee, JIANG Diandian, CAI Mengqian
    2022, 57(23):  2891-2897.  DOI: 10.3761/j.issn.0254-1769.2022.23.011
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    Objective To explore the current status of symptom clusters and sentinel symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),to analyze the correlation between the severity of sentinel symptoms and inflammatory indexes,and to provide a basis for symptom cluster interventions. Methods From October 2021 to March 2022,165 patients with AECOPD hospitalized in the Department of Respiratory and Critical Care Medicine of a tertiary care hospital in Nanning were conveniently selected. The questionnaires were administered using a revised version of the Memory Symptom Assessment Scale,and the results of inflammatory indexes were collected from the patients’ first tests after admission. Principal component analysis was used to extract symptom clusters,and the results of association analysis based on the Apriori algorithm were used to determine the sentinel symptoms within symptom clusters,and correlation analysis was used to explore the relationship between patients’ sentinel symptoms and inflammatory indexes. Results 3 symptom clusters existed in AECOPD patients,including respiratory symptom cluster,affective symptom cluster,and fatigue symptom cluster. Correlation analysis by the Apriori algorithm showed that lack of energy was the sentinel symptom of respiratory symptom cluster,feeling sad was the sentinel symptom of affective symptom cluster,and inattention was the sentinel symptom of fatigue symptom cluster. Correlation analysis showed that neutrophil-to-lymphocyte ratio and calcitoninogen were positively correlated with the severity of energy deficiency(r=0.179,P<0.05;r=0.246,P<0.01),and prealbumin was negatively correlated with it(r=-0.167,P<0.05);monocyte count was positively correlated with the severity of feeling sad(r=0.236,P<0.01);eosinophil count was negatively correlated with the severity of inattentiveness(r=-0.197,P<0.05). Conclusion Sentinel symptoms exist within the symptom cluster of AECOPD patients,and their severity correlates with inflammatory indicators neutrophil-to-lymphocyte ratio,calcitoninogen,prealbumin,monocyte count,and eosinophil count. It is recommended that healthcare professionals can use sentinel symptoms as an entry point for symptom cluster management and develop individualized interventions for patients.

    Analysis on the status and influencing factors of dysphagia in elderly patients with chronic obstructive pulmonary disease
    ZHANG Rui, CHANG Yan, ZHANG Xiaona, ZHAO Jie, LI Xindan, LU Lu, LU Hongyan
    2022, 57(23):  2898-2903.  DOI: 10.3761/j.issn.0254-1769.2022.23.012
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    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.

    Community Care
    Effect of chain management on insulin injection management ability of rural empty nest elderly diabetic patients
    LÜ Zhongmei, YANG Xiaohua, XI Wei, GE Chunyan, CHU Hongmei, ZHAO Yangqiu, WANG Xu, SHI Aihua
    2022, 57(23):  2904-2911.  DOI: 10.3761/j.issn.0254-1769.2022.23.013
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    Objective To evaluate the effects of chain management on insulin injection management ability of rural empty nest elderly diabetic patients. Methods The randomized controlled study was conducted to select 96 elderly diabetic patients who started insulin therapy in county alliance units from January 2021 to December 2021 by convenient sampling method. They were divided into an experimental group and a control group by random number table method,with 48 cases in each group. The control group was given routine outpatient care and follow-up management,and the experimental group was given insulin injection chain management. The insulin injection management ability,blood glucose metabolism index,quality of life and incidence of insulin injection complications were compared between the 2 groups after intervention. Results A total of 91 patients completed the study. The scores of insulin injection management ability in the experimental group increased gradually 3 months and 6 months after intervention,and the difference was statistically significant(P<0.05). There were significant differences in fasting blood-glucose and 2-hour postprandial blood glucose between the 2 groups before intervention,3 months after intervention and 6 months after intervention(Pgroup<0.001,Ptime=0.002,Pinteraction=0.002,Pgroups<0.001,Ptime=0.015,Pinteraction=0.016). There was significant difference in HbA1c between the 2 groups. There were significant differences in DSQL items and total scores between the 2 groups after intervention(P<0.05). There were significant differences in the incidence of lipohypertrophy and pain between the 2 groups at 6 months after intervention(P=0.020,P=0.040). Conclusion The implementation of chain management can improve the management ability of insulin injection in rural empty nest elderly diabetic patients,help to control blood glucose smoothly,improve the quality of life of patients,and improve the safety of injection.

    Clinical Practice
    Nursing care of 3 elderly patients undergoing mitral valve median valve surgery at the cusp of the heart after mitral valve replacement surgery
    GAO Xin, WENG Fengxia, SANG Ming, JIANG Chunyan, WEI Jianhua, ZHOU Yuqiong
    2022, 57(23):  2912-2916.  DOI: 10.3761/j.issn.0254-1769.2022.23.014
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    To summarize the nursing care of 3 elderly patients undergoing mitral valve middle valve surgery at the cusp of the heart after mitral valve replacement surgery. The nursing content is as follows:Forming a multidisciplinary care team and developing preoperative assessment strategies;postoperative hemodynamic monitoring to improve cardiac function;optimize airway management and reduce pulmonary complications;monitor coagulation function and kidney function,implement blood glucose management,nursing temporary pacemakers,and actively prevent the occurrence of corresponding complications;implement multifaceted interventions to improve patient outcomes. 3 patients were successfully discharged from the hospital under careful treatment and care. The follow-up results at 1 month after discharge were good.

    Nursing care of a patient undergoing emergency coronary artery bypass grafting in the period of targeted drug therapy after lobectomy
    LI Xinhui, CHEN Lili, GAO Xueqin, CUI Congcong, XU Tingting, WANG Lulu, KUANG Yanmei
    2022, 57(23):  2917-2920.  DOI: 10.3761/j.issn.0254-1769.2022.23.015
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    The nursing experience of a patient undergoing emergency coronary artery bypass grafting in the period of targeted drug therapy after lobectomy. The patient,who was complicated with multiple drug-resistant bacterial infections and other lesions,had acute myocardial infarction during the targeted drug therapy. The main points of nursing include the assessment and care of cardiac function,proper measures of excessive drainage fluid,protection and rehabilitation of lung function,prevention and control of infection,protection of liver and kidney function,targeted psychological care and health education to help him build confidence in overcoming disease. After the comprehensive management of a multidisciplinary team,tracheal intubation was removed 38 hours after surgery,and the patient was discharged 15 days after emergency operation.

    Evidence Synthesis Research
    The effect of 9 types of exercise in improving the dialysis adequacy on patients undergoing hemodialysis:a network meta-analysis
    LUO Xiju, DENG Siyan, CHEN Jing, LIU Yixiu, HU Huagang, YU Xiang
    2022, 57(23):  2921-2929.  DOI: 10.3761/j.issn.0254-1769.2022.23.016
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    Objective To systematically evaluate the effect of different types of exercise in improving the dialysis adequacy of patients undergoing hemodialysis. Methods The databases of PubMed,Cochrane Library,Embase,Web of Science,WanFang,CNKI,VIP,and CBM were searched for the articles related to the effectiveness of exercise on the dialysis adequacy of patients undergoing hemodialysis,from inception to 1st January,2022. After literature screening and data extraction,Cochrane risk of bias tool 2.0 was used for quality evaluation. RevMan 5.3 and STATA 16.0 software were used for statistical analysis. Results 30 studies with 1 216 participants and 9 types of exercise were included. The results of the network meta-analysis showed that intradialytic combined aerobic and resistance exercise and intradialytic aerobic exercise were the top 2 types in improving the single pool clearance index on hemodialysis patients. Intradialytic aerobic exercise and intradialytic combined aerobic and resistance exercise were the top 2 types in improving the urea reduction ratio of hemodialysis patients. Conclusion The dialysis adequacy of hemodialysis patients can be improved by a variety of exercise,especially intradialytic combined aerobic and resistance exercise,and intradialytic aerobic exercise.

    Summary of the best evidence of constipation management in peritoneal dialysis patients
    LIANG Liping, FU Rong, LI Chenghui, XU Pengfei, WANG Yixin
    2022, 57(23):  2930-2936.  DOI: 10.3761/j.issn.0254-1769.2022.23.017
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    Objective To extract and summarize the best evidence related to constipation management in peritoneal dialysis patients,so as to provide bases for clinical medical staff to formulate peritoneal dialysis constipation assessment process and management plan. Methods We searched relevant guideline networks,UpToDate,BMJ,JBI,Cochrane Library,Web of Science,PubMed,Embase,CNKI,Wanfang databases to collect relevant guidelines,expert consensuses,best practices,recommended practices and systematic evaluations related to constipation management in peritoneal dialysis from the establishment of the database to March 18,2022. There were 2 researchers who independently evaluated the literature quality and extracted data. Results A total of 14 pieces of literature were included,including 4 guidelines,3 expert consensuses,2 best practices,2 systematic evaluations and 3 evidence summaries. Finally,22 pieces of best evidence including 4 dimensions were summarized,namely evaluation,health guidance,medication management and other treatments. Conclusion This study summarized the best evidence of constipation management in peritoneal dialysis patients,which can provide evidence-based bases for formulating constipation evaluation process,management plan and practice standard of peritoneal dialysis patients.

    Summary of the best evidence for self-management in patients with chronic heart failure
    LIU Mengdie, XIONG Xiaoyun, SUN Xinglan, XIAO Dan, SONG Yujie, WANG Ying, YANG Ying
    2022, 57(23):  2937-2944.  DOI: 10.3761/j.issn.0254-1769.2022.23.018
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    Objective To retrieve,evaluate and summarize the evidence of self-management of patients with chronic heart failure,and to provide evidence-based bases for medical staff to conduct self-management health education and standardize patients’ self-management behavior. Methods We searched UpToDate,BMJ Best Practice,Joanna Briggs Institute(JBI),National Institute for Health and Clinical Excellence(NICE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),Scottish Intercollegiate Guidelines Network(SIGN),Cochrane Library,PubMed,SinoMed,CNKI,Wanfang Database to collect relevant clinical decisions,evidence summaries,syste-matic reviews,guidelines,expert consensuses and original articles published from the databases establishment to July 14,2022. There were 3 researchers who evaluated the quality of the literature that met the quality standards,and 2 researchers extracted and integrated evidence. Results A total of 18 pieces of literature were included,including 1 clinical decision,10 guidelines,2 systematic reviews,3 randomized controlled trials and 2 expert consensuses. Finally,39 pieces of evidence were summarized in 9 aspects,including multidisciplinary team cooperation,learning disease-related knowledge,medication management,symptom monitoring,exercise training,dietary and nutrition,lifestyle,psychological adjustment,medical treatment and follow-up. Conclusion This study summarizes the best evidence of self-management of patients with chronic heart failure,which can provide references for clinical medical staff to guide self-management of patients with chronic heart failure in a more comprehensive and scientific way.