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Objective:To construct a preoperative rehabilitation program for gastric cancer patients, aiming to provide scientific and reasonable preoperative guidance for gastric cancer patients.Methods:On the basis of literature research and expert group meeting, the first draft of the preoperative rehabilitation program for gastric cancer patients was constructed. From October 2021 to January 2022, the Delphi method was used to conduct 2 rounds of expert letter inquiries to 16 experts in related fields from 11 hospitals in Jiangsu Province, and the entries were revised according to the experts′ inquiries.Results:In the two rounds of expert correspondence, the positive coefficients of experts were 88.89% and 100.00%, and the authority coefficients of experts were both 0.88. The coordination coefficients of the items in the two rounds of inquiry were 0.279 and 0.290, respectively. The final program consisted of 3 first-level entries, 11 second-level entries and 32 third-level entries.Conclusions:The scheme constructed in this study is scientific, reliable and applicable, and is worth being promoted further in clinical practice.
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Objective To analyze the effect of stratified nursing intervention based on aspiration risk assessment strategy in ICU mechanical ventilation patients. Methods Totally 156 patients with ICU mechanical ventilation admitted between January 2016 and December 2017 were selected as study subjects, and 78 patients were divided into treatment group and control group by random number table method. The control group was given routine nursing interventions for ICU patients undergoing mechanical ventilation, and the treatment group was combined with stratified nursing interventions based on aspiration risk assessment strategy. Compare the two groups of nurses'knowledge, attitude and practice of aspiration prevention, the complications of patient aspiration, patient satisfaction and other indicators. Results The scores of nurses′knowledge, attitude and practice of prevention of aspiration in the treatment group were (46.32 ± 3.24), (51.41 ± 3.56), and (49.36 ± 4.85), respectively, which were significantly higher than those of the control group (41.25 ± 5.32), (47.12 ± 5.45), (44.42 ± 5.46), The difference was statistically significant (t=4.815, 3.899, 4.002, P<0.05);The rate of aspiration, reflux, asphyxia, aspiration pneumonia in the treatment group was 7.69％ (6/78), 19.23％ (15/78), 1.28％ (1/78), 2.56％ (2/78), which were significantly lower than 29.49％ (23/78), 39.74％ (31/78),12.82％ (10/78),20.51％ (16/78) in the control group. The difference were statistically significant (χ2=7.892-12.309, P<0.05 or 0.01);Patient satisfaction 97.87％ (74/78) was significantly higher than the control group 83.33％ (65/78), The difference was statistically significant (χ2=5.347, P<0.05). Conclusion The stratified nursing intervention based on the aspiration risk assessment strategy can help develop nurses′ability in knowledge, attitude and practice of aspiration prevention, reduce the occurrence of complications such as aspiration, and improve patient satisfaction.
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Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.
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This paper summarized key points of nursing care of 14 patients with acute iliofemoral vein thrombosis undergoing endovascular therapy via rheolytic thrombectomy system,including:assessing risk of acute pulmonary artery embolism with amendatory Geneva scale,perioperative refined management of hydrotherapy and protecting renal function,nursing care to prevent tissue and organ bleeding at different levels during catheterdirected thrombolytic therapy,and evaluating clinical effects of treatment and nursing with patented circumference measurer of lower extremity.The average duration of hospitalization was 4.42 d.Ten patients had hemoglobinuria and one had renal function impairment.Acute pulmonary artery embolism happened in one patient before surgery and catheter-directed thrombolytic therapy were performed in four patients due to unsatisfactory results of thrombectomy.
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Coverage of internal iliac artery during endovascular abdominal aortic aneurysm repair may cause ischemic complications in buttock,intestine,lower extremity and genital.We reported nursing care of 72 patients in our center to investigate the key points of nursing.Our experience were as follows:individualized blood pressure management and doctor-nurse cooperation in pain management were key points in preoperative nursing;close postoperative observation was focused on ischemic colitis,buttock claudication and ischemic buttock skin;cooperation with ostomy care group improved pertinency of nursing care;rounding by integration of doctors and nurses obtained high satisfaction and improved patients' compliance.
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@#Objective To explore the effect of workshop on postoperative function of affected limb in patients with breast cancer. Meth-ods From August, 2015 to June, 2016, 70 patients with breast cancer after modified radical mastectomy were randomly divided into control group (n=35) and observation group (n=35). The control group was instructed by the primary nurse bedside based on the traditional method, while the observation group was guided with workshop mode. Results Ten days and one month after surgery, the range of motion of the shoulder joint in the observation group was superior to the control group (t>2.030, P<0.01);the incidence of lymphedema of the affected limb in the observation group was lower than that in the control group (u=2.195, P<0.05). Conclusion Functional exercise guided with work-shop mode could improve postoperative function of affected limb in patients with breast cancer.
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Objective To evaluate the postoperative imaging features of lung ultrasound on patients undergoing lung transplantation ,and to provide the evidence for diagnosis and therapy . Methods Between October 2016 and March 2017 ,51 patients undergoing lung transplantation ( unilateral:37 ,bilateral:14 ) admitted to the ICU in Wuxi People′s Hospital were examined by bedside lung ultrasound ,and imaging features were analyzed . Results The main features on ultrasound of 51 patients undergoing lung transplantation were:①Pneumothorax :The A-line arising at the pleural line was shown in all of 51 patients , mainly on anterolateral parts of the chest wall initially ,then fade away towards anterosuperior parts over time . ② Hydrothorax :An anechoic fluid collection was detected ( up to 50 mm in width ) ,and became narrow over time in most patients . A mass of floccules or progressive growth of pleural effusion indicated the need for emergency surgery ,and were confirmed bleeding after surgery . ③Subcutaneous emphysema:The E-line was detected mainly in anterior and lateral parts around the surgical incision of postoperative patients ,and gradually fade away over time . ④Pulmonary edema:On the first postoperative day ,multiple B-lines were shown in 49 cases ,lung consolidation in 36 cases ( mainly in the inferior and inferoposterior parts) ,lung consolidation sonographic air bronchogram in 12 cases . Then the area of consolidation and B-lines reduced ,the air bronchogram sign became more prevalent ,and the shred sign appeared on the border of consolidation over time . Conclusions The imaging features of lung ultrasound provides clinic diagnostic and therapeutic value for postoperative patients undergoing lung transplantation .
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<p><b>OBJECTIVE</b>To screen out the sonogram features for the differential diagnosis of benign and malignant thyroid small nodules (≤ 1.0 cm) by Logistics regression analysis, to establish the binary Logistic regression model of sonogram features as independent variable and investigate the value of wall configuration of ultrasonogrophic nodules in the differential diagnosis of benign and malignant thyroid small nodules.</p><p><b>METHODS</b>A total of 208 thyroid nodules ≤ 1.0 cm in diameter in 190 patients were evaluated. With postoperative pathological examination or fine needle aspiration biopsy, 106 nodules were confirmed as benign and 102 as malignant. Ultrasonic features of thyroid nodules were evaluated for the differential diagnosis of benign and malignant small thyroid nodules based on pathological diagnosis as a gold standard, a Logistic model was obtained, and the odds ratio of variables were compared. The margin of thyroid nodule was divided into regular or irregular margin, and the latter was divided further into four subtypes: strip, triangular, antler and papillary. The border was divided into clear, fuzzy or both. The periphery was divided into those with normal and abnormal echo;. The calcification included no calcification, microcalcification and non-microcalcification.</p><p><b>RESULTS</b>Four statistically significant features were obtained finally by Logistics regression analysis, including margin, border, periphery and calcification. A formula was constructed by two-variables logistic regression analysis and probability of malignancy = 1/(1 + e - z), in which z = 5.026 × margin + 4.218 × border + 4.024 × periphery + 3.892 × calcification - 15.247. The odds ratio of margin was higher than the other independent variables.</p><p><b>CONCLUSIONS</b>Logistics regression analysis indicates that the calcification, border, periphery, and especially margin of thyroid nodules are significant features for differentiating benign and malignant thyroid nodules. The margin score was more intuitionistic for the differentialtion of benign and malignant thyroid nodules.</p>