Design and development of clinical decision support system for unplanned extubation / 中国实用护理杂志

Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.

Role of bispectral index monitoring in Intensive Care Unit mechanical ventilation patients: a Meta-analysis / 中华神经医学杂志

Objective To use Meta-analysis to compare the roles of bispectral index (BIS) monitoring and subjective rating scale in Intensive Care Unit (ICU) mechanical ventilation patients, and to provide a reference for selecting better sedation assessment tools in clinical practice. Methods Randomized controlled trials in ICU mechanical ventilation patients were collected from Scopus, Web of Science, PubMed, CNKI, Cochrane Library, VIP, WanFang Date, and CBM from database establishing to 2018 by BIS monitoring. The literatures were selected according to inclusion and exclusion criteria, data were extracted and the quality of the trials was evaluated. Meta-analysis was performed using RevMan5 software. Results Eleven randomized controlled studies were screened out. The total sample had 1354 cases, including 664 in the BIS group and 690 in the subjective rating scale group. Meta-analysis showed that sedative drug use (standardized mean difference [SMD]=0.28, 95％CI: -0.20-0.76), duration of sedation (mean difference [MD]=0.84, 95％CI: 2.00-3.67), arousal time after discontinuation (MD=-6.20, 95％CI: 19.76-7.35), mechanical ventilation time (MD=-0.33, 95％CI:-1.20-0.54]), ICU hospitalization stay (MD=-0.82, 95％CI: -3.94-2.30), and mortality (odds ratio [OR]=0.83, 95％CI: 0.52-1.32) showed no significant differences between the two groups (P>0.05). The incidence of unplanned extubation in the BIS group (OR=0.20, 95％ CI: 0.10-0.42) was significantly lower than that in the subjective rating scale group (P<0.05). Conclusion There is currently insufficient evidence to show that BIS monitoring is superior to subjective rating scale in sedative drug use and disease prognosis in ICU mechanical ventilation.

Self-made uniform drainage device in continuous lumbar drainage of cerebrospinal fluid / 中国实用护理杂志

Objective To investigate the clinical value of homemade uniform drainage system and application results in continuous lumbar drainage of cerebrospinal fluid. Methods A total of 75 patients underwent continuous lumbar cistern drainage of cerebrospinal fluid in patients with mechanical sampling were randomly divided into two groups, the control group (35 cases) using the traditional methods of continuous lumbar cistern drainage, the test group (40 cases) with self-designed uniform drainage device, compared with two groups of 24 hours from fluid volume flow control and the incidence of adverse reactions and the workload of nurses. Results The drainage rate equilibrium, the frequency of inspections and time respectively and the incidence of adverse reaction were (1.07 ± 0.35)/h, (23.67 ± 7.23) min/d and 5.00%(2/40) in the test group, less than that in the control group (2.14 ± 0.83)/h, (48.54 ± 11.69) min/d and 25.71%(9/35), there were significant differences (t=8.547, 7.641, χ2=16.347, all P <0.05). Conclusions In order to control the workload of nurses and reduce the incidence rate of adverse reactions, it is worth to promote the application of the continuous lumbar cistern drainage.

Construction of standardization process for using physical restraint / 中国实用护理杂志

Objective To establish a scientific and normative process for using physical restraint,and to increase the safety and efficiency of physical restraint.Methods On the basis of the previous studies,combined with the literature and clinical,we drafted a process framework of using physical restraint and then conducted consultation from 11 experts by using the Delphi technique.Results After 2 rounds of consulting,an evaluation form,consisted of 4 first-dimensions and 11 second-dimensions,and a process,consisted of 4 first-dimensions and 26 second-dimensions,were established.Kendall's W were 0.37 and 0.38 respectively,and expert authority coefficient was 0.84.Conclusions The results from the study is valid,feasible and reliable,however it still need to be further perfected.