Table of Content

20 October 2023, Volume 58 Issue 20

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Special Planning—Gastrointestinal Disease Care

Construction and application of a comprehensive exercise rehabilitation program in elderly patients with cirrhosis and frailty

LI Siyu, YUAN Yuan, AN Ran, JI Yonghui, ZHANG Feng

2023, 58(20):  2437-2445.  DOI: 10.3761/j.issn.0254-1769.2023.20.001

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Objective This study aims to construct a comprehensive exercise rehabilitation program for elderly patients with cirrhosis and frailty，and to explore its application effect. Methods Through literature research and qualitative research，a comprehensive exercise rehabilitation program was drafted. From November to December 2021，16 experts were consulted，and a comprehensive exercise rehabilitation program for elderly patients with cirrhosis and frailty was formed. From January to June 2022，the convenience sampling was used to select the elderly patients with cirrhosis and frailty in the infection department of a tertiary A hospital in Zhengzhou City as the research subjects. The experimental group was given the comprehensive exercise rehabilitation program on the basis of routine care，while the control group was only given routine care. Liver weakness index，quality of life and adverse events were compared between the 2 groups at 1 and 3 months after the intervention. Results The effective questionnaire recovery rates of the 2 rounds of expert consultations were 85.00% and 94.12%；the expert authority coefficients were 0.823 and 0.833；Kendall harmony coefficients were 0.175 and 0.196（P<0.001）. Finally，the comprehensive exercise rehabilitation program included 2 first-level items and 8 second-level items and 24 third-level items. During the application of this program，10 cases dropped，and 58 cases were finally included in the experimental group and the control group respectively. At 1 month after the intervention，the Liver Frailty Index between the 2 groups were statistically significant（P=0.036）. At 3 months after intervention，there were significant differences in the Liver Frailty Index and Quality of Life between the 2 groups（P<0.05）. No adverse events such as falls and fractures occurred in the 2 groups. Conclusion The comprehensive exercise rehabilitation program constructed in this study is safe and effective for elderly patients with frailty cirrhosis，and it can improve the frailty status and quality of life of elderly patients with cirrhosis.

Qualitative study on transition readiness dilemmas of adolescents with inflammatory bowel disease towards adulthood

SUN Suya, SHI Donghui, CHEN Weixian, BO Jin, LIU Xiaohong, LI Dan, HUANG Yan, CHEN Yamei

2023, 58(20):  2446-2451.  DOI: 10.3761/j.issn.0254-1769.2023.20.002

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Objective To understand the dilemmas experience of adolescents with inflammatory bowel disease （IBD） as they transit towards adulthood，and to provide the basis for the development of patient-centered transition nursing intervention program. Methods With the application of phenomenological research method in qualitative research and purposive sampling method，from September to December 2022，15 adolescents with IBD from the department of gastroenterology in 2 tertiary A hospitals in Shanghai for semi-structured in-depth interview，and the interview data were analyzed by Colaizzi 7-step analysis method. Results 4 themes were extracted. ①Self-coping dilemma，including difficulty in adapting to changes in the medical environment，difficulty in adapting to changes in medical roles，difficulty in coping with negative emotional distress，difficulty in meeting the special needs of daily life. ②Family support dilemma，including heavy family financial burden，excessive participation of family caregivers，and insufficient family resilience. ③Medical assistance dilemma，including limited professional assistance and limited information sharing. ④Social support dilemma，including the limited applicability and accessibility of social support，insufficient social cognition and identity. Conclusion Adolescents with IBD face multiple dilemmas as they move towards adulthood. It is suggested that nursing staff should formulate a perfect personalized transition plan，carry out transition-oriented family health education，improve the medical assistance system，further strengthen social support，and improve the level of transition readiness for the adolescents towards adults.

The nutritional care experience of families of children with intestinal failure secondary to short bowel syndrome：a qualitative study

MEI Lingli, LING Yun, HU Yan, WENG Dongfang, ZHOU Jinyan, CHEN Shuohui

2023, 58(20):  2452-2458.  DOI: 10.3761/j.issn.0254-1769.2023.20.003

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Objective To understand the nutritional care experience of families of children with short bowel syndrome secondary to intestinal failure，and to provide references for developing scientific and effective nutritional care programs. Methods Using the purposive sampling method，a total of 16 parents of children with intestinal failure secondary to short bowel syndrome who were admitted to a tertiary children’s hospital in Zhejiang province from July 1 to December 31，2022 were selected as the research subjects. 2 semi-structured interviews were conducted a day before and 2 to 3 weeks after the discharge of the children. The Colaizzi 7-step analysis method was used to analyze the interview data. Results It could be summarized into 4 themes and 6 subthemes：①Nutritional care distress changes in stages：feeling overwhelmed in the acute phase；there were more problems in tube feeding，tube maintenance，and complementary food production during the compensatory period；the burden of home nutritional care increased during the recovery period. ②The role conflict between nutritional care-parents caused self-blame and guilt. ③Positive experiences from peer and healthcare support were obtained. ④The medical staff was expected to provide more nutritional support services；it is hoped that systematic nutritional care courses will be set up，and it is hoped that home nutrition care guidance will be given during follow-up after discharge. It is hoped to implement home parenteral nutrition support. Conclusion Parents of children with intestinal failure secondary to short bowel syndrome have many difficulties in nutritional care and change in stages. Their care experience is affected by the relationship with peers，spouses and medical staff，and they look forward to family nutrition support services. Medical staff can assess parents’ nutritional care distress at different stages，carry out systematic and phased nutritional care course training，give psychological counseling and support in time，and provide home parenteral nutrition support services，so as to improve the nutritional status of children.

Nursing care of transjugular intrahepatic portosystemic shunt in a child with pyrrolizidine alkaloid associated hepatic sinusoidal obstruction syndrome

JIANG Junmei, YU Zhuowen, ZHOU Yiwen, HUANG Yuyan, GOU Zhaoyang, HUANG Weiwei, LU Yi

2023, 58(20):  2459-2463.  DOI: 10.3761/j.issn.0254-1769.2023.20.004

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This study summarized the experience in caring pediatric pyrrolizidine alkaloid-associated hepatic sinusoidal obstruction syndrome after being treated with a transjugular intrahepatic portosystemic shunt（TIPS）. The key points of before-surgery care include timely implementation of anticoagulant therapy and ensuring the safety of medication administration；dynamic monitoring of disease changes and applying scientific management of ascites. The key points of post-surgery care include solidifying sheath care to maintain catheter function；enhancing monitoring of the patient’s condition and medication instruction to prevent hepatic encephalopathy and intra-stent thrombosis；correcting assessment of nutritional status and formulation of nutritional support programs；conducting health education and establishing a multi-platform follow-up model. After 2 months of careful treatment and nursing，the child made a good recovery at the 6-month follow-up.

The best evidence summary of exercise management of patients with nonalcoholic fatty liver disease

ZHANG Xueling, ZHENG Qirong, WANG Qiaosong, FANG Yan, XIAO Ye, LIN Yan, WANG Bifen, LIN Rongjin

2023, 58(20):  2464-2471.  DOI: 10.3761/j.issn.0254-1769.2023.20.005

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Objective To search and obtain relevant evidence of exercise management in patients with nonalcoholic fatty liver disease（NAFLD） and to provide a reference for clinical practice. Methods UpToDate，BMJ Best Practice，International Guidelines Collaboration（GIN），Scottish College Guidelines Network（SIGN），National Institute for Healthcare Excellence（NICE） website，Cochrane Library，U.S. Agency for Healthcare Research and Quality（AHRQ） website，Canadian Association of Registered Nurses of Ontario（RNAO） website，American Association for the Study of Liver Diseases（AASLD） website，PubMed，Web of Science，CINAHL，DynaMed，Embase，CNKI，Chinese Medical journal full-text database，Wanfang Data Knowledge Service Platform，Sinomed and other databases were systematically searched for all evidence on exercise management of the NAFLD. It includes guidelines，evidence summaries，expert consensuses，best practice information booklets，clinical decisions，recommended practice，and systematic reviews. The retrieval period is from the database inception to November 2022. The quality of the literature was evaluated independently by 2 researchers. Results A total of 18 pieces of literature，including systematic evaluations，expert consensuses，and clinical practice guidelines，were included. 24 pieces of best evidence were collected from 6 aspects，including exercise principle，exercise supervision，exercise type，exercise selection，exercise time and frequency，and exercise intensity. Conclusion This study summarized the best evidence for exercise management of patients with NAFLD，which is comprehensive and scientific. Medical staff can use the best evidence to guide patients with NAFLD to exercise reasonably and improve the scientific nature of the intervention.

Specialist Practice and Research

Establishment of a nursing preplan for emergency laparotomy caused by massive hemorrhage in robot abdominal surgery

YU Xiaofen, ZHANG Chunpeng, HONG Min, HE Mangmang, YUAN Linlin

2023, 58(20):  2472-2480.  DOI: 10.3761/j.issn.0254-1769.2023.20.006

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Objective The aim of the study is to establish the nursing preplan for emergency change of operation mode caused by hemorrhage in robotic abdominal surgery. Methods We constructed the first draft of the nursing preplan through literature review，video analysis and clinical experience. 3 rounds of expert consultations were performed by Delphi method from April to June 2022 to establish the final nursing preplan for emergency change of operation mode caused by hemorrhage in robotic surgery. Results A total of 16 experts were included in the study；the response rates of 3 rounds were 94.12%，100% and 100%，respectively；the authority coefficients of the experts were 0.816，0.851 and 0.878，respectively. The Kendall’s concordance coefficients of the importance of each stage，step，and operation in the 3 rounds were 0.149~0.204，0.163~0.236，0.407~0.436，which were statistically significant （all P<0.05）；the Kendall’s coefficients for operational feasibility were 0.302，0.243 and 0.409，which were statistically significant （all P<0.001）；the coefficient of variation of the importance of each stage，step，and operation in the third round is 0~0.21，and the full mark rate is 25.00%~100%；the coefficient of variation of the feasibility of each item in the third round is 0~0.17，and the full mark rate is 31.25%~100%. The final nursing scheme for emergency change of operation mode caused by hemorrhage in robotic surgery includes 3 stages，10 steps，and 47 operations. Conclusion The constructed nursing preplan for emergency change of operation mode caused by hemorrhage in robot abdominal surgery in this study is scientific，feasible，practical and specific，which provides guidance for robotic surgical care.

Construction of a preoperative risk prediction nomogram model for hypothermia during off-pump coronary artery bypass graftin

LIU Ting, WANG Lin, HAO Yanli, CAO Peng, WANG Ran

2023, 58(20):  2481-2487.  DOI: 10.3761/j.issn.0254-1769.2023.20.007

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Objective To investigate the preoperative risk factors of intraoperative hypothermia in patients undergoing off-pump coronary artery bypass grafting（OPCABG），and to construct a nomogram prediction model. Methods A total of 202 patients undergoing OPCABG in a tertiary hospital in Beijing from January 2019 to June 2021 were selected by convenience sampling. The patients were divided into a hypothermia group（n=103） and a non-hypothermia group（n=99） according to whether they had hypothermia during operation. Relevant preoperative data were collected through the hospital electronic medical record system. Logistic regression was used to analyze risk factors. R software was used to draw a nomogram prediction model for intraoperative hypothermia in patients undergoing OPCABG. Hosmer-Lemeshow test was used to judge the goodness of fit of the model. The area under ROC curve was used to detect the predictive effect of the model. Results The incidence of intraoperative hypothermia in patients undergoing OPCABG was 50.99%. 5 factors were included in the intraoperative hypothermia nomogram prediction model，namely age，body surface area，ejection fraction，operating room temperature and body temperature at the beginning of disinfection. The Hosmer-Lemeshow test results of the model showed that P=0.471； the area under the ROC curve was 0.840（0.787~0.894）；the optimal critical value was 0.344；the sensitivity was 0.903；the specificity was 0.616；the accuracy of external validation was 78.22%. They suggested that the model had good fitting effect and high predictive value. Conclusion The incidence of intraoperative hypothermia in patients undergoing OPCABG is high. The nomogram model constructed based on preoperative risk factors in this study can predict the risk of intraoperative hypothermia in patients undergoing OPCABG early and efficiently. It provides a scientific basis for clinical nursing staff to evaluate and effectively prevent intraoperative hypothermia.

Influencing factors of the gestational weight gain for singleton pregnant women and nursing countermeasures

LIU Hongyan, WANG Xiaojiao, SUN Liping, GU Chunyi

2023, 58(20):  2488-2493.  DOI: 10.3761/j.issn.0254-1769.2023.20.008

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Objective To explore the current situation and influencing factors of gestational weight gain for singleton pregnant women. Methods From June to October 2020，a total of 393 pregnant women who had registered for antenatal checkups at an obstetric clinic of a tertiary obstetrics and gynecology hospital in Shanghai and planned to give birth at the same hospital were selected through convenience sampling. The General Information Questionnaire，Pregnancy Health Literacy Questionnaire and Childbirth Self-Efficacy Questionnaire were used to collect data. Multivariate logistic regression analysis was used to analyze the influencing factors of weight gain during pregnancy. Results A total of 393 women were included in the analysis. Participants’ average gestational weight gain was（13.66±6.10） kg. The proportion of women with inadequate，appropriate and excessive gestational weight gain were 35.6%，32.3% and 32.1%，respectively. Logistic regression analysis showed that the influencing factors for gestational weight gain included education background，previous medical history，pre-pregnancy body mass index，and attending midwife’s clinic（P<0.05）. Conclusion The proportion of abnormal gestational weight gain was relatively high among singleton pregnant women. Those who had a master degree or above，a previous medical history，a normal pre-pregnancy body mass index，and attended midwife’s clinic during pregnancy were at lower risks of abnormal gestational weight gain. Obstetric nurses should pay more attention to gestational weight management，giving full play to midwife’s antenatal clinic，and implementing health education and counseling related to gestational weight management，in order to promote appropriate gestational weight gain and to improve maternal-fetal outcomes.

Analysis of influencing factors and nursing countermeasures of delayed nausea and vomiting in children with tumor chemotherapy

YU Luyan, LIN Nan, ZHOU Ying, BAI Guannan, HE Xinyu, CHU Xiaoyi, ZHANG Yiran, WU Qian, ZHAO Dan, GUO Mengying, ZHU Jihua

2023, 58(20):  2494-2502.  DOI: 10.3761/j.issn.0254-1769.2023.20.009

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Objective To explore the occurrence and influencing factors of delayed nausea and vomiting in children with tumor chemotherapy，so as to provide bases for doctors and nurses to formulate home care plans. Methods A prospective cohort study was conducted，and a toll of consecutive children who received chemotherapy and their caregivers in a tertiary A Children’s Hospital in Zhejiang Province from August to October 2022 were enrolled as the subjects of investigation. Baxter Retching Faces Scale and United States Department of Health and Human Services Common Adverse Event evaluation criteria were used to evaluate the incidence of delayed nausea and vomiting. The influencing factors of delayed nausea and vomiting were collected by questionnaire and analyzed by binary logistic stepwise regression. Results A total of 378 children with tumor chemotherapy were included，of which 229（60.6%） developed delayed nausea and 144（38.1%） developed delayed vomiting. Delayed vomiting mainly occurred 1-2 days after chemotherapy（50.7%）. Logistic regression analysis showed that body surface area，negative emotion，history of delayed nausea and vomiting，and smoking environment were the influencing factors of delayed nausea in children with tumor chemotherapy. Body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，vomiting risk of chemotherapeutic drugs，smoking environment and tumor type were the influencing factors of delayed vomiting in children with tumor chemotherapy （P<0.05）. Conclusion The incidence of nausea and vomiting associated with delayed chemotherapy was high in children with tumor，especially at 1~2 days after chemotherapy. Large body surface area，negative emotion and history of delayed nausea and vomiting are the high-risk factors of delayed nausea in children with tumor chemotherapy；large body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，high vomiting risk of chemotherapeutic drugs and solid tumors are high risk factors for delayed vomiting in children undergoing tumor chemotherapy. It is suggested that medical staff should formulate preventive measures according to relevant risk factors and carry out home care guidance to reduce the incidence of delayed nausea and vomiting in children undergoing tumor chemotherapy.

Case Study

Nursing care of an elderly patient with ovarian thecoma-fibroma tumors complicated with amyotrophic lateral sclerosis

GUO Liwen, HONG Wenjing, HU Meihua, LI Xuying

2023, 58(20):  2503-2507.  DOI: 10.3761/j.issn.0254-1769.2023.20.010

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To summarize the nursing experience of a 74 year old patient with ovarian thecoma-fibroma tumors complicated with amyotrophic lateral sclerosis. Nursing points include：prevention of respiratory failure，good airway care；to master the indications of extubation and strengthen observation after extubation；to monitor temperature changes of patients to prevent respiratory tract infection；to strengthen the exercise，promote the recovery of respiratory function；to identify nutritional risks，provide nutritional support，and maintain body metabolism；to improve functional rehabilitation training and psychological nursing. Through personalized nursing measures，the patient recovered well and was discharged after 15 days in hospital.

Nursing care of a patient with Kartagener’s syndrome after double lung transplantation

ZHANG Ping, WENG Fengxia, SANG Ming, WEI Jianhua

2023, 58(20):  2508-2512.  DOI: 10.3761/j.issn.0254-1769.2023.20.011

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To summarize the nursing experience of a patient with Kartagener’s syndrome after double lung transplantation. The key points of nursing care are as follows. Being alert to postoperative arrhythmias and grasping the best time for emergency treatment；closely monitoring respiratory function and optimizing airway management in phases；implementing multi-faceted infection prevention and control measures to reduce the risk of infection；initiating blood glucose management process to avoid excessive blood glucose fluctuations；carrying out individualized functional rehabilitation and strengthening limb functional exercise. After 72 d of active treatment and careful care，the patient improved and was discharged from the hospital.

Evidence Synthesis Research

Evidence summary of non-pharmacological interventions for chemotherapy-related cognitive impairment among breast cancer patients

YUAN Xiaoyi, ZHANG Xuehui, HE Jing, QIU Jiajia, XING Weijie

2023, 58(20):  2513-2520.  DOI: 10.3761/j.issn.0254-1769.2023.20.012

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Objective To retrieve，evaluate and summarize the available evidence on non-pharmacological interventions for chemotherapy-related cognitive impairment among breast cancer patients. Methods We searched UpToDate，BMJ best practice，Guidelines International Network，National Institute for Health and Care Excellence，Scottish Intercollegiate Guidelines Network，Registered Nurses’ Association of Ontario，National Comprehensive Cancer Network，Cochrane Library，Joanna Briggs Institution Library，PubMed，Web of Science，CINAHL，SinoMed，CNKI and Wanfang to collect relevant literature including clinical decision support，evidence summaries，clinical practice guidelines，expert consensuses and systematic reviews published from database construction to May 14 of 2023. 2 researchers independently evaluated the quality of literature，extracted and summarized the best evidence. Results A total of 21 articles were included，including 1 clinical decision support，1 evidence summary，1 guideline and 18 systematic reviews. Finally，16 items of evidence were summarized into the following 6 categories：safety and effectiveness，self-management education，cognitive rehabilitation，physical activities，mindfulness-based interventions and multimodal intervention. Conclusion The best evidence summarized in this study is generally with high quality，which can serve as a guidance for clinical staff to provide evidence-based and effective non-pharmacological interventions to breast cancer patients with chemotherapy-related cognitive impairment. We should also take the characteristics of clinical environment and patients’ individual differences into consideration during the application of evidence.

Effect of inspiratory muscle training on clinical outcome of patients with chronic heart failure：an overview of systematic reviews

WANG Qiansha, MING Yue, XIE Yusheng, HUANG Rongrong, YANG Qian, ZHENG Xiaoxiang, ZOU Yang

2023, 58(20):  2521-2529.  DOI: 10.3761/j.issn.0254-1769.2023.20.013

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Objective To evaluate the systematic reviews of the effect of inspiratory muscle training on clinical outcome of patients with chronic heart failure. Methods PubMed，Embase，CINAHL，Cochrane Library，CNKI，Wanfang Database，Chinese Biomedical Literature Database，and VIP Database were searched by computer to find systematic reviews/meta analysis on the effect of inspiratory muscle training on patients with chronic heart failure. The search time limit was from the establishment of the database to January 2023. 2 researchers who were trained in evidence-based knowledge system independently screened the literature and extracted the data. AMSTAR 2 scale was used to evaluate methodological quality，and GRADE system was used to summarize and grade the evidence. Results A total of 14 systematic reviews were included. AMSTAR 2 evaluation results showed that there were 1 paper of high quality and 1 paper of medium quality，and the other 12 papers were of low quality or very low quality. The evidence quality evaluation results of 40 outcome indicators in 14 systematic reviews using GRADE system showed that 3 pieces of evidence were of medium quality，and 31 pieces of evidence were of low quality，and 6 pieces of evidence were of very low quality. The meta-analysis results showed that inspiratory muscle training can improve the maximum inspiratory pressure，6 min walking distance，peak oxygen uptake and dyspnea in patients with chronic heart failure（P<0.05），but the intervention effect on quality of life needs further confirmation. Conclusion Inspiratory muscle training plays a positive role in the clinical outcomes of patients with chronic heart failure. However，considering the overall research quality and the quality of evidence of outcome indicators included in the current systematic reviews are generally low，it is still necessary to further conduct strict，standardized and comprehensive high-quality randomized controlled trials to provide stronger evidence support for the effect of inspiratory muscle training in patients with chronic heart failure in the future.

Fear of cancer recurrence in cancer patients：a qualitative Meta-synthesis

YE Chenglin, LIU Hongyan, ZHANG Xiuwei, CHEN Qiuqiang, ZHANG Xiaoxu, ZHANG Mengtian

2023, 58(20):  2530-2537.  DOI: 10.3761/j.issn.0254-1769.2023.20.014

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Objective To systematically evaluate and analyze the qualitative research about the fear of recurrence in cancer patients，in order to help medical workers to provide the psychological support for cancer patients. Methods Qualitative studies about the fear of recurrence in cancer patients were systematically searched from Cochrane Library，PubMed，Embase，Web of Science，PsycINFO，CINAHL，SinoMed，Wanfang Database，CNKI and VIP database，and the search time limit was from the establishment of the databases to June 2022. The quality of the literature was evaluated according to the JBI Critical Appraisal Checklist for Qualitative Research，and the included literature was integrated and analyzed using the integrating method. Results A total of 13 pieces of the literature were included，and 59 research results were extracted，which were finally summarized into 14 categories and 3 integrated results：multiple typical manifestations of the fear of cancer recurrence，complex triggering factors of the fear of cancer recurrence，and diverse coping strategies of the fear of cancer recurrence. Conclusion On the basis of understanding the multiple manifestations，triggers and individual coping differences of cancer patients’ fear of recurrence，medical staff can cooperate with patients，family members and social workers to construct a comprehensive support model of hospital-family-society integration，so as to correct irrational cognition，eliminate the uncertainty of recurrence，face the fear bravely and positively，so as to improve the quality of life.

Review

Research progress of mobile health in drug inhalation technology management of patients with respiratory diseases

DUAN Jilong, ZHANG Xiaona, CHANG Yan, ZHANG Xue, ZHANG Wenyue, LIU Zhiping, LU Hongyan

2023, 58(20):  2538-2542.  DOI: 10.3761/j.issn.0254-1769.2023.20.015

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Mastery of correct inhalation technique is crucial for the effective completion of inhalation therapy. Mobile healthcare can promote the management of drug inhalation techniques among patients with respiratory diseases. This article introduces the forms of mobile healthcare applications in the management of inhalation techniques in patients with respiratory diseases，summarizes the effects of mobile healthcare applications in the management of inhalation techniques in patients with respiratory diseases，and analyzes the shortcomings and challenges of mobile healthcare applications in the management of inhalation techniques among patients with respiratory diseases. The aim is to provide references for the development of mobile healthcare equipment or applications in China.

Narrative intervention for patients living with breast cancer：a scoping review

XIA Ying, WANG Ying, HU Luhong, QIU Yan, WANG Fengming, YANG Qing

2023, 58(20):  2543-2551.  DOI: 10.3761/j.issn.0254-1769.2023.20.016

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Objective The scope of literature review correlated to narrative intervention for patients living with breast cancer was conducted to define the object，form，content，timing/duration and patient outcomes. It can provide references for future research and development of efficient，scientific，and rigorous narrative intervention programs for breast cancer patients and guide clinical practice. Methods According to the scoping review methodology，we systematically searched PubMed，CINAHL，Embase，Web of Science，Cochrane library，CNKI，WanFang database and VIP database. The search period is from the establishment of the database to December 31，2022. There are 2 researchers who analyzed the included studies independently. Results A total of 25 papers from 6 countries were included，and 12 of which coming from China. The results found that the narrative intervention runs throughout the treatment of breast cancer patients. Patients at different treatment stages have different needs for narrative intervention. Less attention had been paid to breast cancer survivors. The forms of narrative intervention include “telling story”，“writing story” and “watching/reading story”. Most of narrative practice forms were “telling story”. Overall，the narrative intervention had significant improvements in psychological，physical，cognitive and life quality，family relationship/social support for breast cancer patients. Conclusion Narrative intervention has positive effects on patients with breast cancer. Currently，the forms of narrative practice for patients with breast cancer need to be further enriched. More attention should be paid to breast cancer survivors，and narrative intervention programs should be individualized according to patient characteristics to enhance intervention effects.

Research progress on nursing measures of neurological complications in patients undergoing extracorporeal cardiopulmonary resuscitation

LIU Machao, HANG Ying, FEI Zhenzhen

2023, 58(20):  2552-2557.  DOI: 10.3761/j.issn.0254-1769.2023.20.017

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Extracorporeal cardiopulmonary resuscitation provides cardiopulmonary support for patients with cardiac arrest，ensures tissue perfusion of brain，heart and important organs，reduces ischemia and hypoxia of patients，provides support for follow-up treatment，and improves survival rate of patients. With the wide application of extracorporeal cardiopulmonary resuscitation，the incidence of neurological complications has increased，which has brought great burden to patients，their families and society. This article summarized the influencing factors and nursing measures of neurological complications in patients undergoing extracorporeal cardiopulmonary resuscitation，providing references for effective nursing intervention in patients undergoing extracorporeal cardiopulmonary resuscitation.

Nursing Instruments Innovation

The design and application of an adjustable tracheal cannula occlusion device

HE Xue, TIAN Tian, WANG Feng, LIU Wendai

2023, 58(20):  2558-2561.  DOI: 10.3761/j.issn.0254-1769.2023.20.018

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Objective This study designed and modified an adjustable tracheal cannula occlusion device，and explored its efficacy in occlusion operation on patients undergoing tracheotomy. Methods The novel adjustable tracheal cannula occlusion device was composed of 2 segments which is an occlusion cap and a connecting cannula，with an overall length of 30 mm. The cannula was made of hard medical silicone rubber with a Shore hardness of 70° to 80°. From February 2022 to September 2022，60 tracheotomy patients with occlusion cannula in a tertiary care hospital in Chongqing were enrolled as the research subjects. Random grouping was performed using SPSS 24.0 statistical software to assign the patients into an experimental group and a control group，with 30 patients in each group. The control group was fully plugged with a sterile single-use syringe piston cap，whereas the experimental group was plugged applying the modified adjustable tracheal cannula occlusion device. The 2 groups were compared for the numbers of dislodgements of the 2 occlusion devices and successful extubation of the tracheal cannulas，time of occlusion，and tightness during complete occlusion. Results The number of dislodgement of the device per patient was 0（0，1） in the control group and 0（0，0） in the experimental group. The rate of suc-cessful tracheal cannula extraction was 66.67% in the control group and 100% in the experimental group. In average，the occlusion duration of tracheal cannula was （3.45±1.10） days in the control group and （2.37±1.83） days in the experimental group. The air flow rate of the cannula during complete occlusion was（18.70±5.58） L/min in the control group and（12.85±2.46） L/min in the experimental group. The comparison of the 2 groups showed statistically significant differences（P<0.001）. Conclusion Applying the modified adjustable tracheal cannula occlusion device can effectively reduce dislodgement of the occlusion device，as well as the occlusion time required per patient，while at the same time it improves the plugging of the device and promotes the success rate of tracheal cannula extraction.