Table of Content

20 July 2024, Volume 59 Issue 14

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Research Paper

Construction and application of muscle strength training program for the elderly frail patlents

WANG Yingjie, LIU Wei, ZHU Hongwei, WANG Yu, QIAO Ran, QIU Haiyan

2024, 59(14):  1669-1677.  DOI: 10.3761/j.issn.0254-1769.2024.14.001

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Objective To verify the application effect of the muscle strength training based on Fogg behavior model for elderly frail patients，and provide references and bases for subsequent related research. Methods This paper constructed a muscle strength training program for elderly frail patients based on the Fogg behavior model. The exercise intervention process includes the stages of cultivating exercise awareness, scientific fitness guidance, and developing exercise habits. 66 elderly frail people aged 60 and above who were hospitalized in 4 geriatric wards of a tertiary A hospital in Beijing from January to March 2022 were recruited，and they were randomly divided into a control group and an intervention group. The intervention group implemented a muscle strength training based on the Fogg behavior model，while the control group was given routine exercise guidance and education for 6 months. The muscle strength，cardiopulmonary function，and glucose and lipid metabolism of the 2 groups were compared at the end of 3 and 6 months of intervention. Results A total of 65 patients with 33 in the control group and 32 in the intervention group completed the study. The muscle strength of the intervention group showed better changes over time at 6 months compared to the control group（P<0.05）. In terms of cardiopulmonary function，the intervention group had better lung capacity than the control group at 3 and 6 months，with statistically significant differences（t=2.166，P=0.034；t=3.385，P=0.001）. There was no statistically significant difference in heart rates and left ventricular ejection fraction between the groups（P>0.05）. In terms of glucose and lipid metabolism，only high-density lipoprotein in the intervention group was found to be superior to it in the control group at 3 and 6 months，with statistically significant differences（t=2.970，P=0.004；t=4.111，P<0.001）. There was no statistically significant difference between blood glucose，low-density lipoprotein，total cholesterol，and triglycerides groups（P>0.05）. Conclusion The muscle strength training based on the Fogg behavior model can effectively improve the muscle strength and lung function of frail elderly patients，and can also improve blood lipid metabolism to a certain extent，while there is no obvious effect on heart function and blood glucose control.

Development and application of a pulmonary rehabilitation training system for children with bronchiolitis obliterans

YI Min, WU Xia, TAN Xiaoyan, ZHONG Lina, YANG Qin, CHEN Yanping, LIU Huayan

2024, 59(14):  1678-1686.  DOI: 10.3761/j.issn.0254-1769.2024.14.002

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Objective To develop a pulmonary rehabilitation training system based on scenario simulation for children with bronchiolitis obliterans，and to explore its application effect. Methods A pulmonary rehabilitation training program for children with bronchiolitis obliterans was constructed，and on the basis of this program，a pulmonary rehabilitation training system based on scenario simulation was developed for children with bronchiolitis obliterans，with real-time monitoring of relevant data. 44 children with bronchiolitis obliterans who were hospitalized in the Department of Respiratory Medicine of a tertiary A children’s specialized hospital in Hunan Province from January to December 2022 were selected by convenience sampling method，and the subjects were divided into an experimental group and a control group with 22 cases in each group. The experimental group adopted a pulmonary rehabilitation training program based on scenario simulation，and the control group implemented pulmonary rehabilitation through nurse demonstration and guidance. At pre-intervention，4 weeks，and 12 weeks of intervention，the 2 groups were compared in terms of clinical symptom severity，pulmonary function，adherence to pulmonary rehabilitation，and the occurrence of pulmonary rehabilitation-related adverse events. Results There were no shedding cases in the experimental group and a case in the control group，and 22 cases were finally included in the experimental group and 21 cases in the control group. The results of repeated measures ANOVA showed that the comparison of clinical symptom severity and pulmonary function between the 2 groups at different time points was statistically significant in terms of time，between groups and interaction（P<0.05）. Simple effect analysis showed that after 4 and 12 weeks of intervention，the severity of clinical symptoms in the experimental group was lighter than that in the control group，and the difference was statistically significant（P<0.001）. At 12 weeks of intervention，pulmonary function indexes，such as exertional expiratory volume in the first second，exertional lung volume，and maximum expiratory flow rate，were higher in the experimental group than those in the control group，and the difference was statistically significant（P<0.001）. At 4 and 12 weeks of intervention，the compliance of pulmonary rehabilitation in the experimental group was higher than that of the control group，and the difference was statistically significant（P<0.05）. At 12 weeks of intervention，the occurrence of adverse events related to pulmonary rehabilitation in the experimental group was less than that in the control group，and the difference was statistically significant（P=0.026）. Conclusion The use of a scenario simulation-based pulmonary rehabilitation training system for children with bronchiolitis obliterans can effectively alleviate the clinical symptoms of children，improve their pulmonary function，increase compliance，and reduce the occurrence of pulmonary rehabilitation-related adverse events.

Special Planning-Heart Fuilure Care

Expert consensus on postoperative care of patients with a left ventricular assistant device

Nursing Professional Committee of the National Cardiovascular Disease Expert Committee（Writing Committee： MA Yan, WU Rong, ZHANG Chen, LI Qingyin, HUANG Yujia, ZHAO Mingjing, FU Qiang, LI Yonggang, WANG Jiani）

2024, 59(14):  1687-1690.  DOI: 10.3761/j.issn.0254-1769.2024.14.003

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Objective To standardize nursing management on postoperative patients with a left ventricular assist- ant device（LVAD）. Methods The first draft of the Consensus was formed on the basis of literature review. 2 rounds of expert consultations and a round of online meeting discussion were held for adjustments and modifications the draft of the Consensus. Results The recovery rate of the inquiry questionnaire was 93.75%. The authority coefficients of the 2 rounds of inquiry experts were 0.927 and 0.920. The concentration degree of expert opinions for each indicator was greater than 3.5 score，and the coefficient of variation was less than 0.25. The Kendall harmony coefficients for 2 rounds of correspondence were 0.402 and 0.407（P<0.01）. The final Consensus formed through expert consultations and meetings includes 7 themes：hemodynamic monitoring，LVAD function monitoring，coagulation function monitoring，percutaneous cable and wound care，exercise rehabilitation care，health education and guidance，and pre-discharge assessment. Conclusion The Consensus is scientific，rigorous，and authoritative. The Consensus covers all aspects of postoperative care for patients with LVAD，and it will benefit to clinical practice.

The influence of cumulative fluid balance on volume status in patients with heart failure

WANG Weiyun, LIU Changhong, SUN Guozhen, TANG Yifan, LI Zhenyu, SU Ziwen, GU Zejuan

2024, 59(14):  1691-1697.  DOI: 10.3761/j.issn.0254-1769.2024.14.004

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Objective To analyze the correlation between cumulative fluid balance volume and increasing plasma volume and aggravated clinical congestion symptoms in patients with heart failure on admission for 1~7 d，and to explore the application value of cumulative fluid balance volume in predicting volume overload. Methods Using the convenience sampling method，235 heart failure patients hospitalized from October 2022 to February 2023 in a total of 3 tertiary hospitals in Nanjing，Lianyungang，Jiangsu Province，and Zhumadian，Henan Province，were selected and classified into an increasing/decreasing plasma volume group and an aggravated/alleviated clinical congestion symptoms group. General information，clinical characteristics，and 1~7 d cumulative fluid balance volume of the study subjects were collected to compare the differences in cumulative fluid balance volume between the 2 groups. Logistic regression was used to analyze the effect of cumulative fluid balance volume on plasma volume and clinical congestion symptoms. Receiver operating characteristic curves were used to analyze the optimal cutoff value of cumulative fluid balance volume for predicting increasing plasma volume and aggravated clinical congestion symptoms. Results Excluding 15 patients who were discharged early and 3 patients with inaccurate records of fluid intake and excretion，a total of 217 patients were included. The incidence of positive fluid balance was lowest on day 1，at 65.90%，with the smallest cumulative volume of（0.235±0.983） L；the highest incidence of positive balance occurred on day 6，at 75.58%，with the largest cumulative volume of（2.444±5.445） L. The cumulative fluid balance at 4~7 d in the increasing plasma volume group was higher than that in the decreasing plasma volume group，and the difference was statistically significant（P<0.05）；the cumulative fluid balance at 4~7 d was an independent risk factor for plasma volume elevation，and a cumulative fluid balance of 2.308，3.361，3.518，and 3.702 L at 4~7 d was predictive of a plasma volume elevation，and areas under receiver operating characteristic curve were 0.686，0.721，0.647，and 0.766，respectively. The cumulative fluid balance for 4~7 d in the aggravated clinical congestion symptoms group was higher than that in the alleviated clinical congestion symptoms group，and the difference was statistically significant（P<0.05）；the cumulative fluid balance for 4~7 d was an independent risk factor for the aggravated clinical congestion symptoms，and a cumulative fluid balance for 4~7 d of 2.574，3.383，4.995，and 4.235 L predicted aggravated clinical congestion symptoms，and area under receiver operating characteristic curve was 0.640，0.693，0.654，and 0.720，respectively. Conclusion The incidence of cumulative positive fluid balance in heart failure patients is high，and the amount of cumulative fluid balance can better predict the occurrence of volume overload，and the increase of plasma volume precedes the appearance of clinical congestion symptoms. It is suggested that heart failure patients with more than 3 d of cumulative positive balance should be closely monitored，and when the cumulative positive balance exceeds 2.308 L，measures should be taken in time to drain excessive fluid，so as to avoid the incidence of volume overload.

Best evidence application of exercise prescriptions for patients with chronic heart failure

ZHOU Lili, GUO Ge, LI Mei, SHAO Cuimei, MAO Yue, ZHU Beibei, FENG Jia, CHEN Hailian, SONG Jianping

2024, 59(14):  1698-1705.  DOI: 10.3761/j.issn.0254-1769.2024.14.005

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Objective To investigate the best evidence application of exercise prescription in patients with chronic heart failure in clinical practice and evaluate its effectiveness. Methods The best evidence of exercise prescription for patients with chronic heart failure was summarized，and the evidence-based practice plan was developed，and it was implemented in the cardiology department of a tertiary hospital in Zhejiang Province from August to October，2022. Nurses’ exercise prescription knowledge-attitude-practice level，implementation rate of review indicators，the length of hospital stay，exercise endurance，daily living ability and grip strength of both groups before and after the intervention were compared. Results After the application of the best evidence，the score of knowledge dimension was（9.34±0.98） points；the score of attitude dimension was（63.29±1.37） points；the score of practice dimension was（25.49±1.51） points，which were statistically significant compared with the scores before the application of evidence（P<0.05）. After the application of the best evidence，the implementation rate of 16 review indicators was higher than that before the application of evidence（P<0.001）. The length of hospital stay in the evidence application group was shorter than that in the baseline examination group（Z=-2.610，P<0.001）. After intervention，the exercise endurance，daily living ability and grip strength of patients in the evidence application group were improved compared with the baseline review group，and the difference was statistically significant（P<0.05）. Conclusion After the application of the best evidence of exercise prescription in patients with chronic heart failure，it can improve the level of knowledge，attitude and practice of nurses on exercise prescription，standardize the compliance of nurses’ exercise prescription，reduce the number of days in the hospital，and improve patients’ exercise endurance，daily living ability and grip strength.

The status of caregiver readiness of elderly patients with chronic heart failure and its influencing factors

WANG Chaoqun, YU Mengying, LIU Chang, ZHAO Linfang, ZHENG Beibei, LIU Xin, NI Jiajia, JIN Jianfen

2024, 59(14):  1706-1712.  DOI: 10.3761/j.issn.0254-1769.2024.14.006

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Objective To explore the current situation and influencing factors of caregiver readiness of elderly patients with chronic heart failure. Methods From March 2021 to April 2022，the convenient sampling method was used to select 335 caregivers of elderly patients with chronic heart failure who were hospitalized in 6 hospitals in Hangzhou as the survey subjects. The general information questionnaire，Caregiver Readiness Scale and Caregiver Burden Scale were used to investigate the caregivers of elderly patients with chronic heart failure. Results A total of 326 valid questionnaires were collected.The score of Caregiver Readiness Scale for elderly patients with chronic heart failure was（18.88±6.36），and 61.04% of the caregivers had mild to moderate burden. The results of multiple linear regression analysis showed that the caregiver’s age，education level and cumulative care time were the positive influencing factors of the caregiver readiness，and the caregiver burden was the negative influencing factor of the caregiver readiness（P<0.001）. Conclusion The caregiver readiness of elderly patients with chronic heart failure is at a medium level. Caregivers who are older, more educated, have a longer cumulative caregiving time, and have a lighter caregiving burden are more prepared. Medical staff should pay attention to the motivation of caregivers，provide professional support from multiple aspects，and reduce the burden of care，increase readiness level.

Influencing factors of home medication safety in patients with chronic heart failure：a qualitative study

CHENG Ling, ZHENG Feng, HUI Mengyuan, ZHONG Zhuqing

2024, 59(14):  1713-1718.  DOI: 10.3761/j.issn.0254-1769.2024.14.007

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Objective Based on the Integrated Theory of Health Behavior Change（ITHBC），the influencing factors of home medication safety were explored in patients with chronic heart failure（CHF）. Methods This qualitative description，involving a semi-structured in-depth interview of 22 CHF patients based on purposive sampling，was conducted from December 2022 to May 2023，at 3 hospitals in Changsha，Hunan. NVivo 11.0 software was used to organize and code data，and content analysis was performed to analyze data. Results Totally 9 generic categories belonging to 4 categories were extracted. These were knowledge（knowledge of disease and knowledge of medication safety），attitude and belief （attitude towards diseases and medication belief），self-regulation （participation in medication safety self-management and growing through experience），and social facilitation（hospital consultation services，family support and objective situation interference）. Conclusion Knowledge，belief，self-regulation and social facilitation were interrelated to influence medication safety behavior of patients with CHF at home. Medical workers，family members and society should work together to provide medication safety information，create a supportive environment，focus on improving patients’ awareness and ability of self-regulation，strengthen their belief in taking medication，and ultimately ensure the home medication safety for CHF patients.

Research progress of unplanned readmission in patients after left ventricular assist device implantation

SHEN Peiye, LAN Lan, SHEN Xinyi, WANG Jiaqi, WANG Junhui, CHEN Xiaomin, YAO Jinlan, XU Dongping, QIAN Zhengxian

2024, 59(14):  1719-1725.  DOI: 10.3761/j.issn.0254-1769.2024.14.008

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Unplanned readmission is one of the adverse outcomes of patients after left ventricular assist device implantation，which seriously affects the prognosis of patients. This article reviews the incidence，causes，influencing factors and intervention measures of unplanned readmission of patients after left ventricular assist device implantation，in order to improve the attention of nursing staff，early identify high-risk groups of unplanned readmission of patients after left ventricular assist device implantation and provide references for formulating personalized intervention measures.

Specialist Practice and Research

Analysis of clinical implementation of nursing group standard for oxygen therapy in adult patients

QI Xiaojiu, WANG Huiting, XU Yu, HUANG Zheng, ZHANG Zhixia, MA Hongwen, XIANYU Yunyan, ZHANG Su

2024, 59(14):  1726-1731.  DOI: 10.3761/j.issn.0254-1769.2024.14.009

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Objective To understand the implementation of the nursing group standards for oxygen inhalation therapy in clinical practice，and to provide a reference for improving the nursing practice of oxygen therapy. Methods A convenience sampling method was used to investigate nurses from 902 hospitals in 24 provinces and municipalities directly under the central government using a self-designed questionnaire from December 15th，2022，to January 14th，2023. The content of questionnaire included whether they had implemented the recommendations of the oxygen therapy standards，the knowledge of safety related to oxygen therapy，and the components of oxygen therapy prescriptions，the indications used for patients receiving oxygen therapy and practice status of oxygen therapy. Results A total of 10 481 questionnaires were returned，of which 10 447 were valid，with a valid questionnaire recovery rate of 99.68%. 63.14% of the nurses indicated that the hospital had organized training on oxygen therapy standards. Only 47.82% of nurses know the correct use of the Venturi mask. 41.90% of nurses could indicate the correct indicator of flow adjustment. 31.88% of the nurses stated that they will adjust the oxygen flow rate based on the oxygenation status of carbon dioxide storage patients. Only 19.56% of nurses indicated that humidification is applied in oxygen therapy based on the oxygen flow and duration. Conclusion Even though nurses had received training related to oxygen therapy standards，the level of knowledge of oxygen therapy standards was still low；therefore continuous systematic training was needed，and the implementation of the content of oxygen therapy standards needed to be further standardized. Healthcare institutions would focus on organizing systematic training and maintaining the training effect，enhancing infrastructure and providing support for implementation. Recommendation to the nursing administration is to explore how to comprehensively and continuously implementing the oxygen therapy nursing standards with the ultimate goal of providing patients safer and more accurate oxygen therapy.

Analysis of the development trajectory and influencing factors of endocrine therapy associated arthralgia in breast cancer patients

WANG Lijie, PENG Siyi, CHEN Jiejun, WEI Tao, LIU Jiahui, HU Meihong, LI Xuying

2024, 59(14):  1732-1738.  DOI: 10.3761/j.issn.0254-1769.2024.14.010

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Objective To analyze the development trajectory and predictors of endocrine therapy associated arthralgia in breast cancer patients. Methods From January 2022 to July 2022，breast cancer patients in the breast medicine department or outpatients of a tertiary cancer hospital in Hunan Province were selected as respondents using a convenience sampling method. A baseline survey was conducted using the General Information Questionnaire，the Symptom Assessment Scale for Patients Treated with Endocrine Therapy for Breast Cancer，and the Self-Rating Anxiety Scale within 1 week prior to patient treatment. The Symptom Assessment Scale for Patients Treated with Endocrine Therapy for Breast Cancer was used to assess patients’ arthralgia levels at 3，6，and 9 months after treatment，and data were analyzed using growth mixed model，univariate analysis of variance，and multiple logistic regression. Results A total of 418 breast cancer patients completed the follow-up，with 235 cases（56.22%） developing arthralgia. 3 potential categories of arthralgia develop-ment trajectories were identified：high level-slowly increasing group（11.48%），low level-slowly increasing group（44.74%），and asymptomatic group（43.78%）. The results of multifactorial analysis showed that anxiety，history of bone and joint disease，sleep duration，place of residence，monthly household income，and frequency of exercise were predictors of potential categories for the development of trajectory of arthralgia levels associated with endocrine therapy in breast cancer patients（P<0.05）. Conclusion Arthralgia levels associated with endocrine therapy in breast cancer patients exhibit different trajec-tories，and clinical staff should emphasize the assessment and intervention of pain levels in patients with the anxiety，a history of bone and joint disease，poor sleep，poor finances，living in urban areas，and low frequency of exercise.

A mixed study of factors influencing medication experience in patients with schizophrenia based on benefit-risk perception

SUN Yujing, YU Hong, ZHANG Jing, ZHOU Yuqiu, WANG Zhengjun, JIANG Wenlong

2024, 59(14):  1739-1745.  DOI: 10.3761/j.issn.0254-1769.2024.14.011

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Objective To explore the influencing factors of medication experience in patients with schizophrenia based on benefit-risk perception. Methods Patients with stable schizophrenia who were hospitalized in 2 tertiary psychiatric hospitals in Heilongjiang Province from September to December 2023 were selected by convenience sampling method. A convergent mixed method was adopted. In quantitative study，data of 400 patients were collected by general situation questionnaire，Subjective Well-being Under Neuroleptic Treatment Scale，the Living with Medicines Questionnaire，Beliefs about Medication Questionnaire，Positive and Negative Syndrome Scale. Binary logistic regression analysis was used to explore the influencing factors of medication experience in patients with schizophrenia. 15 patients with adverse medication experience in quantitative study were selected for qualitative study，and the interview data were sorted and analyzed according to the topic frame analysis method. Results Quantitative results: medication burden, medication beliefs, and psychiatric symptoms of patients with schizophrenia were influential factors of medication experience（P<0.05）. Qualitative results: the medication experience of schizophrenia patients includes 4 themes，namely perceived necessity of medication，perceived benefit of medication， perceived risk of medication, and the need for multi-party cooperation to improve the medication experience. The results of quantitative and qualitative research are complementary in terms of perceived benefit，consistent in terms of perceived risk，and expansive in terms of perceived value. Conclusion Psychiatric nurses can reduce patients’ perceived risk of medication，enhance the perceived benefit of medication，and then improve patients’ adverse medication experience and promote mental rehabilitation.

Dilemmas in decision-making：a qualitative study of family surrogate decision-makers of severe stroke patients

GUO Zining, LING Keyu, CHEN Shufan, LI Haihan, YAO Ting, ZENG Sining, XU Ling, ZHU Xiaoping

2024, 59(14):  1746-1751.  DOI: 10.3761/j.issn.0254-1769.2024.14.012

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Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making，and to provide a basis for developing decision support strategies. Methods From April to December 2023，through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing’an District, Shanghai. semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate. Data were analyzed via Braun’s style of thematic analysis. Results 4 themes and 10 sub-themes were identified. Theme 1：negative emotional dilemmas（urgent decision-making leads to anxiety，fear，and unknown stroke trajectory increases the sense of uncertainty）. Theme 2：supportive environment dilemmas（lack of information support delays decision-making； lack of family support increases decision-making stress； insufficient economic support increases the burden of decision-making）. Theme 3：the dilemma of weighing the pros and cons（difficult trade-offs between risk and reward，tough decisions between reality and ethics，conflicting choices of life and dignity）. Theme 4：preference management dilemmas（practical difficulties in adhering to patient preferences，impediments to decision-making due to unknown patient preferences）. Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas. Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers，as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

Intractable Diseases Care

Nursing care of a postoperative patient with esophageal cancer complicated by severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula

HU Yinyan, ZHAO Linfang, HE Xiaoying, LIU Minjun

2024, 59(14):  1752-1756.  DOI: 10.3761/j.issn.0254-1769.2024.14.013

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This report presents the nursing care for a surgical patient with esophageal cancer who received immunotherapy before surgery and developed severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula postoperatively. Key points of nursing：establishing a multidisciplinary case management team to develop personalized intervention programs；vigilantly monitoring disease progression，promptly identifying and treating immune checkpoint inhibitor-related pneumonia；early identification of anastomotic fistula and standardized management to reduce the risk of septic shock；assessing nutritional risks and providing sequential nutritional support；implementing a phased individualized pulmonary rehabilitation strategy based on Kanowski’s health status score. After 88 days of comprehensive treatment and meticulous nursing care，the patient was discharged in a recovered state. Regular follow-up was conducted after discharge，and the patient recovered well.

Nursing care after segmental small bowel resection in a patient with acute mesenteric vein embolism： a case report

ZHU Huidi, ZHANG Meiyun, JIANG Yuehong, XU Qiaoying, CHEN Yehong

2024, 59(14):  1757-1760.  DOI: 10.3761/j.issn.0254-1769.2024.14.014

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To summarize the nursing experience of a patient with multiple enterostomies after segmental small bowel resection for acute mesenteric vein embolism. Nursing points：early identification of necrosis of retained intestinal tubes and improvement of early warning care；active improvement of tissue perfusion for retained indeterminate necrotic intestinal tubes；relay enteral nutritional support for 4 stomas based on the collaborative care model；implementation of combined dressing changes for surgical incisions and stomas，control of incisional infections and peristoma dermatitis；attention to the psychological aspects of the patients and their families and provision of psychological support. The patient successfully underwent stoma retraction on the 42nd day after surgery，and no obvious short bowel syndrome occurred in the postoperative period.

Evidence Synthesis Research

The best evidence summary of wound procedural pain management in patients with chronic wounds

ZHANG Yuan, GUO Jinli, LIU Hong, GUO Caixia, LIU Xiang

2024, 59(14):  1761-1768.  DOI: 10.3761/j.issn.0254-1769.2024.14.015

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Objective To search，evaluate and integrate the best evidence of wound procedural pain management in patients with chronic wounds，and to provide evidence-based references for clinical practice. Methods Following the“6S” evidence model，we systematically searched relevant literature of wound procedural pain management in patients with chronic wounds，including clinical practice guidelines，clinical decisions，expert consensuses，evidence summaries，recommended practice and systematic reviews，with the search period from the datebase establishment to December 2022. The quality evaluation，extraction and integration for evidence were conducted independently by 2 researchers，respectively. Results A total of 17 articles were involved，including 2 guidelines，1 expert consensus，3 clinical decisions，6 evidence summaries，2 recommended practice，3 systematic reviews. 34 pieces of best evidence were synthesized into 9 categories，including general principles，pain assessment and documentation，replacement and selection of the wound dressing，wound cleaning，wound debridement，negative pressure wound therapy，drug intervention strategies，non-drug intervention strategies，education and training. Conclusion The best evidence of wound procedural pain management in patients with chronic wounds in this study is scientific and practical. Medical staff can select and apply the best evidence based on clinical situation and patient willingness to reduce wound procedural pain.

Exercise experience of maintenance hemodialysis patients： a meta-synthesis of qualitative research

YU Xintao, CHANG Yan, NI Tingting, YU Chuanshan, LIANG Shuang, XU Jun, HU Deqing, JI Xiaojing

2024, 59(14):  1769-1776.  DOI: 10.3761/j.issn.0254-1769.2024.14.016

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Objective To systematically evaluate and analyze the qualitative research on the experience of maintenance hemodialysis patients，so as to provide references for the implementation of exercise interventions in maintenance hemodialysis patients. Methods We searched databases including PubMed，Embase，Web of Science，Cochrane Library，PsycINFO，CINAHL，CBM，CNKI，WanFang Database and VIP from inception to September 30，2022，to collect qualitative studies about exercise experience of maintenance hemodialysis patients. The quality of included studies was evaluated according to JBI Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by integrating methods. Results A total of 14 studies were included. 47 completed findings were grouped according to their similarities to form 12 categories. These categories resulted in 4 synthesized findings. Integration results 1：recognizing the positive effects and potential risks of intradialytic exercise. Integration results 2：barriers and facilitators of intradialytic exercise. Integration results 3：needs of intradialytic exercise.Integration results 4：exercise experience on non-dialysis day. Conclusion The experience and needs of maintenance hemodialysis patients should be considered to ensure patient compliance and continuity when exercise programs were designed.

Review

De-implementation strategies of low-value care：a scoping review

LI Jiamin, HAO Yufang, WU Xinjuan

2024, 59(14):  1777-1785.  DOI: 10.3761/j.issn.0254-1769.2024.14.017

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Objective To search and summarize the de-implementation strategy of low-value care and describe the specific elements of de-implementation strategies. Methods PubMed，ProQuest，CINAHL，China Biomedical Literature Service System database，CNKI，Wanfang and VIP database were searched until May 10，2023. Literature of de-implementation strategies was screened. Specific elements of the de-implementation strategies （i.e.，actors，actions，temporality，dose，action target，affected implementation outcome and justification） were extracted. Results A total of 20 pieces of the literature were included，of which 18 used multiple strategies and 2 used single strategy. A total of 65 strategies were extracted，and the education strategy was applied 15 times，the assessment and feedback strategy were applied 14 times，and the specific elements of only 3 strategies were fully described. Conclusion Education，assessment and feedback strategies are commonly used in de-implementation of low-value care studies. Future studies should clearly describe the specific elements of de-implementation strategies，in order to promote replication，improvement，and clinical application of strategies.

Research progress of screening tools for palliative care needs in emergency patients before referral at home and abroad

WU Xuefei, ZOU Shengqiang, GE Chunhua, MAN Changfeng, LI Jiahui, XIE Jing, LIU Xiyang

2024, 59(14):  1786-1793.  DOI: 10.3761/j.issn.0254-1769.2024.14.018

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The timely use of screening tools to assess the palliative care needs of emergency patients can provide decision-making basis for patient referral and help patients receive palliative care in a timely manner. This paper reviews the palliative care needs screening tools for emergency patients at home and abroad，describes their development methods，scoring criteria and application status，compares and analyzes their characteristics and shortcomings. It aims to provide references for the localized development and application of palliative care needs screening tools in emergency patients.