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Objective@#To construct an evidence-based nursing plan for stroke patients with dysphagia for nursing by searching guidelines and using Delphi method.@*Methods@#The evidence-based nursing plan for stroke patients with dysphagia was constructed by literature review and guideline search. 15 experts from neurology, rehabilitation and nursing were selected to participate in two rounds Delphi consultation.@*Results@#The two-round response rates were 15/15. The expert authority coefficient was 0.877. The coordination coefficients were 0.180, 0.132 and 0.185 (P<0.05). The final plan included 4 first-grade indicators, 14 second-grade indicators and 20 third-grade indicators.@*Conclusion@#The evidence-based nursing intervention plan for stroke patients with dysphagia based on Delphi method is reliable, which can provide reference for the rehabilitation nursing of stroke patients with dysphagia.
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Objective@#To analyze the clinical features of inpatients infected with influenza A virus, and then to provide evidence for the diagnosis, treatment and prevention of influenza A in primary hospital.@*Methods@#The clinical data of inpatients with influenza A in one district hospital from Dec 2016 to Mar 2017 were collected to analyze retrospectively.@*Results@#A total of 21 665 patients were admitted to hospital from Dec 2016 to Mar 2017. Among them 647 flu-like cases accepted influenza A nucleic acid detection, and 203 cases were positive, the positive rate was 31.4%. The median age of influenza A positive patients was 64.25 years, and 20.2% were 0 to 4 years, 49.26% were 65 years of age or older. 58.13% patients had at least one underlying medical condition. Fever, Cough and Sputum were the most symptoms of patients infected with influenza A. Compared with the patients under 60 years old, non-fever symptoms were more common in those 60 years or older, the difference was statistically significant (χ2=15.43, P<0.001). Laboratory examination indicated that lymphocytopenia were detected in 54.27% of patients, and increased level of C-reactive protein and procalcitonin (PCT) in 74.83% and 11.76% of patients respectively. Moreover, 75.58% of patients had high erythrocyte sedimentation rate (ESR), 8 patients (97.3%) had findings consistent with pneumonia. 78.33% of patients received anti-viral treatment with oseltamivir, the rate of antibiotic utilization was as high as 85.22%. The median of hospitalization expense of patients infected with influenza A was 4 280 (interquartile range 2 792-9 565) yuan, and the cost of inpatients who had combined underlying diseases were higher than that in inpatients who had no coexisting medical conditions, the difference was statistically significant (Z=7.106, P<0.01). No death occurred in this study.@*Conclusions@#Children and old people were at high risk for influenza A infection. Fever, cough and lymphocytopenia were the common clinical features of patients infected with influenza A. It is especially noteworthy for the patients who were 60 years of age or older with flu-like symptoms but without fever, or the patients who had one or more underlying medical conditions, and such patients should receive influenza virus nucleic acid tests as early as possible.
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Objective To construct an evidence-based nursing plan for stroke patients with dysphagia for nursing by searching guidelines and using Delphi method. Methods The evidence-based nursing plan for stroke patients with dysphagia was constructed by literature review and guideline search. 15 experts from neurology, rehabilitation and nursing were selected to participate in two rounds Delphi consultation. Results The two-round response rates were 15/15. The expert authority coefficient was 0.877. The coordination coefficients were 0.180, 0.132 and 0.185 (P＜0.05). The final plan included 4 first-grade indicators, 14 second-grade indicators and 20 third-grade indicators. Conclusion The evidence-based nursing intervention plan for stroke patients with dysphagia based on Delphi method is reliable, which can provide reference for the rehabilitation nursing of stroke patients with dysphagia.
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Objective To analyze the content of clinical practice guidelines and provide references for developing Chinese clinical practice guideline of dysphagia with stroke. Methods Content analysis was used to analyze the contents of clinical practice guideline related to dysphagia with stroke which were searched from Internet. Results Ten guidelines were included which were consisted of 2 Chinese guidelines and 8 English guidelines. These guidelines' themes were stroke involving dysphagia, and only two of them were targeted on dysphagia. And one of them was targeted on dyshagia with stroke. Only one guideline hadn't been revised yet, and the rest had been updated. Twenty items were identified from 10 guidelines as been concerning to dysphagia with stroke. Conclusions Current clinical practice guideline about dysphagia with stroke can be used to guide clinical practice. However, some recommendations of guidelines are not clear and not updated in time which can't provide specific references for dysphagia. A clinical practice guideline which is suitable for dysphagia with stroke in China should be developed based on best evidece and Chinese actual conditions.
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Objective To explore the relationship between heart rate variability (HRV),heart rate turbulence (HRT) and blood pressure (BP) control in hypertensive patients.Methods Hypertensive patients with controlled BP group (n =50) and uncontrolled BP group (n =40) and control group non-hypertensive patients (n =52)were enrolled in this study in our hospital during June 2015 to June 2016.HRV and HRT as well as clinical characteristic of the three groups were analyzed.Results (1) Body mass index was significantly higher in the controlled BP group than in the control group.There was no statistical difference in proportions and categories of antihypertensive medication between the uncontrolled and controlled BP groups (P ＞ 0.05).(2) VLF,LF and TS were significantly lower in the uncontrolled BP group than the control group,and HF was significantly lower in the uncontrolled BP group than in the controlled BP group (P ＜ 0.05).(3) Results of muhiple logistic regression analysis showed that lower rMSSD,pNN50,VLF,LF,HF and TS were risk factors for BP control after adjusting for gender,age,EF value,creatinine,blood lipids,Beta-blockers and history of smoking,coronary heart disease and diabetes mellitus.(4) Spearman correlation analysis of the hypertensive patients showed that LF was negatively correlated with TO,and SDNN,SDANN,rMSSD,pNN50,VLF,LF,HF were positively correlated with TS.Conclusion The present results demonstrate that uncontrolled BP is associated with abnormal HRV and HRT,which suggested autonomous nervous imbalance was existed in uncontrolled hypertensive patients.
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Objective To investigate the symptom clusters and their effect on daily life among the adolescents with osteosarcomaduring chemotherapy. Methods A total of 127 adolescents with osteosarcoma undergoing chemotherapy were enrolled and investigated by using the Chinese version of the M.D.Anderson Symptom Inventory (MDASI-C).Then exploratory factor analysis and regression analysis were used to identify symptom clusters and the associations of symptom clusters and daily life respectively. Results For adolescents with osteosarcoma during chemotherapy, the high incidence of symptoms are loss of appetite[96.06％(122/127)], nausea[94.49％(120/127)] and fatigue[91.33％(116/127)], the severe sympyoms are loss of appetite[4.00(3.00,5.00) points], fatigue [4.00(3.00,5.00) points] and nausea[3.5(3.00,5.00) points]. Four symptom clusters were identified: gastrointestinal symptom cluster, pain-related symptom cluster, respiratory symptom cluster and neuro symptom cluster. Symptom clusters except neuro symptom cluster were predictors of distress in daily life. Conclusions The incidence of symptoms in adolescents with osteosarcoma during chemotherapyis high. Several symptom clusters significantly affect their daily life . Medical staff should pay attention to the symptom clusters and provide effective symptom management to improve patients'quality of life.
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Objective To explore district nurses' experience with hospital-community-family integrated management of chronic diseases.Methods Fifteen district nurses were interviewed by semi-structured interviews,and data were analyzed by Colaizzi's seven-step method.Results Three themes emerged:Theme 1,integration of chronic diseases was accepted by patients gradually,but collaboration with tertiary hospitals was needed;theme 2,government's guidance contributed to the development of integrated management of chronic diseases;theme 3,integrated management of chronic diseases still faced challenges.Theme 3 contained four sub-themes:limited self-preparedness;limited community medical resources and authority;unsatisfied residents' medical service and dispensing;imperfect information sharing platform.Conclusion Integrating existing medical resources,enhancing collaboration with tertiary hospitals,solving conflicts between residents' needs and primary health care resources,enhancing competency of district nurses are main tasks for advancing management of chronic disease.
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Objective To explore the influencing factors of job stress of clinical nursing teachers in order to provide information for nurse managers formulating targeted stress management.Method Toally 185 clinical nursing teachers were evaluated with the Chinese nurses stressors scale (CNSS).Results The scores by CNSS was 75.4 ±23.6.Age,working experience,job rank,education background,working department,marriage status and demission intention were found to be adverse impacts on CNSS's scores (all P＜0.01).Conclusion Clinical nursing teachers have middle working pressure.Effective intervention should be provided by nursing managers to prevent and relieve job stress and negative psychological conditions of these teachers.
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Objective To explore the relationship between blood glucose level and blood pressure variability in hypertensive patients. Methods A total of 125 hypertensive patients hospitalized in the department of cardiology in our hospital during May 2015 to October 2016 were retrospectively analyzed. Patients were divided into hypertension with diabetes mellitus group (n=59) and hypertension without diabetes mellitus groups (n=66). Data of blood pressure, blood pressure variability and blood glucose levels were analyzed in the two groups. Results (1) Hyperlipidemia, low density lipoprotein and cholesterol levels were significantly lower in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group. Level of glycosylated hemoglobin (HbA1c), 24 h diastolic pressure variability coefficient (24 hDBPCV), daytime systolic blood pressure variability coefficient (dSBPCV), and daytime diastolic pressure variability coefficient (dDBPCV) were significantly higher in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group (P<0.05). (2) Spearman correlation analysis showed that hypertension with diabetes mellitus was positively correlated with 24 hDBPCV, dSBPCV and dDBPCV. (3) ROC curves of HbA1c for diagnosis of non-dipper blood pressure in hypertensive patients showed that the cut-off value of HbA1c was 5.85%and the area under curve was 0.692 (P<0.05). The sensitivity was 71.1% and the specificity was 63.7%. Conclusion The present results demonstrate that blood pressure variability is increased in hypertension patients with higher blood glucose. HbA 1c level has potential clinical value for diagnosis of non-dipper blood pressure in hypertensive patients.
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Objective:To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in the adults aged 40 years old and over in Changchun urban area,and to clarify the important significance of early application of pulmonary function examination.Methods:With the help of community workers,10 communities which around Second Hospital of Jilin University were selected and the participants aged 40 years old and over were randomly collected.COPD questionnaire and pulmonary function examination were conducted in all subjects.The patients with COPD were diagnosed according to the criteria established by the Global Initiative for COPD (GOLD).The patients with COPD were divided into the diagnostic group and undiagnostic group,then the patients with COPD who had smoking history were divided into smoking cessation group and smoking group.The pulmonary function of each groups were compared.Results:A total of 1 392 participants aged 40 years old and over were recruited in this survey,including 568 males and 824 females,and their average age was (59.59±6.60) years.Totally 176 subjects were diagnosed as COPD,and the prevalence was 12.64％.Furthermore,160 of them were newly diagnosed,which showed the undiagnostic rate of COPD was 90.91 ％.Among the 176 patients with COPD,16 had been confirmed before,which meant only 9.09％ patients got the accurate diagnose before.The analysis of high-risk factor (smoking) showed that the population had an increased prevalence of COPD (20.71％) compared with non-smokers (8.8％) (P＜ 0.05).The correlational analysis between smoking index and the pulmonary function of the patients with COPD showed that all of the pulmonary function indexes except forced vital capacity (FVC％) and maximum midexpiratory flow (MMEF％) in smoking cessation group were descended along with the increase of smoking index (P＜0.05).All of the pulmonary function indexes except FVC％ in smoking group were descended along with the increase of smoking index (P ＜ 0.05).Conclusion:The high prevalence and underdiagnostic rate of COPD are found in the residents aged 40 years old and over in Changchun urban area.More patients with COPD should be screened by performing pulmonary function examination to treat them at an early stage.
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Objective:To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in the adults aged 40 years old and over in Changchun urban area,and to clarify the important significance of early application of pulmonary function examination.Methods:With the help of community workers,10 communities which around Second Hospital of Jilin University were selected and the participants aged 40 years old and over were randomly collected.COPD questionnaire and pulmonary function examination were conducted in all subjects.The patients with COPD were diagnosed according to the criteria established by the Global Initiative for COPD (GOLD).The patients with COPD were divided into the diagnostic group and undiagnostic group,then the patients with COPD who had smoking history were divided into smoking cessation group and smoking group.The pulmonary function of each groups were compared.Results:A total of 1 392 participants aged 40 years old and over were recruited in this survey,including 568 males and 824 females,and their average age was (59.59±6.60) years.Totally 176 subjects were diagnosed as COPD,and the prevalence was 12.64％.Furthermore,160 of them were newly diagnosed,which showed the undiagnostic rate of COPD was 90.91 ％.Among the 176 patients with COPD,16 had been confirmed before,which meant only 9.09％ patients got the accurate diagnose before.The analysis of high-risk factor (smoking) showed that the population had an increased prevalence of COPD (20.71％) compared with non-smokers (8.8％) (P＜ 0.05).The correlational analysis between smoking index and the pulmonary function of the patients with COPD showed that all of the pulmonary function indexes except forced vital capacity (FVC％) and maximum midexpiratory flow (MMEF％) in smoking cessation group were descended along with the increase of smoking index (P＜0.05).All of the pulmonary function indexes except FVC％ in smoking group were descended along with the increase of smoking index (P ＜ 0.05).Conclusion:The high prevalence and underdiagnostic rate of COPD are found in the residents aged 40 years old and over in Changchun urban area.More patients with COPD should be screened by performing pulmonary function examination to treat them at an early stage.
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Objective To explore the effect of multimodal analgesia methods on postoperative pain in patients with calcaneal fracture. Methods Totally 96 cases of the patients with calcaneal fracture were divided into the control group and the observation group, there were 48 cases in each group. The control group was treated with conventional methods of postoperative analgesia, the observation group was given with the multimodal analgesia method. The VAS scores,functional exercises compliance and the incidence of adverse reaction for patients between the two group were observed and compared. Results The scores of pain at different time points in the observation group was 3.40 ± 0.41, 2.50 ± 0.75, 2.10 ± 0.84, 2.00 ± 0.52 respectively, while in the control group was 5.50 ± 0.35, 4.50 ± 0.55, 3.60 ± 0.62, 3.10 ± 0.45 respectively, the difference between the two groups was significant, t=6.85-11.62, P < 0.01. The good functional exercises compliance in the observation group was 87.5%(42/48), which was higher than the 68.8%(33/48) in the control group, the difference between the two groups was significant (χ2=7.571, P<0.05). The occurrence of nausea and vomiting was lower than the control group (χ2=4.800 and 4.360, P<0.05). Conclusion Multimodal analgesia method can improve analgesia effect obviously, improve functional exercises compliance, reduce the incidence of adverse reaction.
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Perioperative hyperglycemia become more common nowadays, it will bring adverse effect to the prognosis of patients if it was poorly controlled. Proper perioperative blood glucose monitoring is very important to hyperglycemic management. This article will be reviewed from the different types, harm and monitoring status of perioperative hyperglycemia.
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Aim Toinvestigatethepro-angiogenic effects of Danshensu derivative ADTM and explore its underlying possible signaling pathway using zebrafish embryosasinvivomodels.Methods Theangiogenesis activities of ADTM were determined in experimental models of normal and VEGFR tyrosine kinase inhibitorⅡ(VRI )-induced vascular defective zebrafish embry-os.Embryos were treated with various concentrations (50,100,200 μmol · L-1 ) of ADTM for indicated time.The diameter and the numbers of endothelial cells of zebrafish SIVs were evaluated,respectively.In VRI model,the number of intact and defective ISVs in each zebrafish embryo was counted.The total RNA of zebrafish embryos was extracted and transcriptional profiling was analyzed by deep sequencing.Quantita-tive real-time PCR(qPCR)was performed to 4 genes selected from transcriptional profiling to validate the data collected from transcriptome analysis.Results ADTMsignificantlyincreasedsubintestinalvessels (SIVs)diameter in a concentration-dependent manner in normal zebrafish as well as restored VRI-induced blood vessels defect in VRI-exposed zebrafish. The transcriptome data analysis demonstrated that 19 signif-icantly changed genes were mapped to insulin signaling pathway.The qPCR data are in good agreement with those obtained by deep sequencing and support the consistency between the two methods for determining relative expression levels in the zebrafish model.Con-clusion Inzebrafishmodel,ADTMexhibitsthe effects of angiogenesis and blood vessel restoration. The underlying mechanism may be involved in the acti-vation of insulin signaling pathway.
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Objective To observe the effect of ligustrazine injection combined with chemotherapy on common immunological parameters in patients with advanced hepatocellular carcinoma.Methods Eighty cases diagnosed with advanced hepatocellular carcinoma from January 2013 to January 2015 in the hospital were randomly divided into observation group and control group, 40 patients in each group.The control group received only conventional treatment of chemotherapy and observation group received ligustrazine injection on the basis of control group.The levels of interleukin-1 (IL-1), IL-4 and transforming growth factor beta ( TGF-β) wwere compared based on the record between two groups pre-and post-treatment.Results There were no significant differences between two groups in IL-1,IL-4 and TGF-βlevels pre-treatment.After treatment, the IL-1, IL-4 and TGF-βlevels in observation group were lower than those in control group [(41.4 ±11.8)vs (76.0 ±12.2)ng/L,(118.5 ±39.9)vs(223.0 ±47.3)ng/L,(6.7 ±3.2)vs(11.7 ± 2.6)ng/mL, respectively, all P<0.05].Conclusion Ligustrazine injection combined with chemotherapy has an exact effect on improving the immunological parameters associated with advanced hepatocellular carcinoma without significantly increasing side effects, it is worthy of further research and application.
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Objective To study the effect of comprehensive interventions on anxiety of nursing students at internship. Methods Comprehensive educational interventions were practiced at the beginning,middle-term and end of their internship. The Self-Rating Anxiety Scale(SAS)was adopted to assess their level of anxiety.Results There were differences in SAS scores between the three phases(F=2.680,P<0.05).The scores were decreased from the beginning to the end.Conclusion Targeted comprehensive educational interventions can reduce anxiety and stress of nursing students.
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Objective To explore the stress perception among acute myocardial infarction (AMI) patients during acute stage.Methods Phenomenological method of qualitative study was adopted.18 AMI patients during the acute stage of 3～4 days after the onset of the disease were interviewed.Results Stress made AMI patients hard to accept the fact of illness,worry about the treatment of illness and the impact on future life,be difficult to alter living habits,be hard to relieve negative emotion.Conclusions AMI patients during acute stage will experience different levels of psychological stress.Stress management should be fabricated and effective measures should be adopted to relieve their negative emotions in terms of inducing factors.
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Zhisou powder is a famous TCM prescription of Qing dynasty great physician Cheng Zhongling in treating cough caused by exogenous pathogenic factor.Author respects ancient TCM prescriptions,but don't adhere to it.Author believes that with proper modification of the prescription based on correct syndrome differentiation,Zhisou powder is effective for various kinds of cough including acute and chronic cases,and is satisfactory for good clinical result.This article mainly introduces author's experience in treating various kinds of cough which embodies the holism concept and thought of treatment based on syndrome differentiation in TCM.
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Objective To evaluate the factors affecting the treatment of old persons diagnosed hypertension. Method A sample of 55566 persons from the community of Yanji area of Shanghai was recruited. Results Among the 19295 persons over sixty there are 5842 patients with hypertension, the morbidity was 30.3%. Among the 36271 persons aged fifteen to fifty-nine there are 3536 patients with hypertension, the morbidity is 9.7%. The ratio of non-treatment in the old age group is 3.1% and in younger group is 8.8%. However,the compliance to the treatment was better in the younger than in old group(73.7% vs 56.2%). The age,hypertension grade and sex were all accounted for the differences in the regularity of the hypertension treatment. Conclusion Further effort on the education of non-old hypertensive patients is essential to decrease the damage from hypertension.
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OBJECTIVE:To study the effects of taurine on oxidative stress and calcium overload induced by cerebral cortex contusion.METHODS:SD rats were randomly divided into normal control group,brain contusion model group,taurine groups(high dose,middle dose and low dose respectively),and nimodipine group.After being fed with corresponding drugs for7days,all rats were subjected to modeling by brain contusion.For intracellular calcium detection,rats were sacrificed2h after modeling,and the brain slices were prepared to fluorescence labeling and confocal microscopy detection.For the detection of oxidative stress,rats were sacrificed24h after modeling,the cortex of contusion side was homogenated and then the activity of superoxide dis?mutase(SOD)and content of malondialdehyde(MDA)were detected through biochemical method.RESULTS:Compared with model group,all taurine groups were shown to have markedly less MDA and intracellular calcium content,and the high dose group had markedly stronger SOD activity.CONCLUSION:Taurine is effective in counteracting the oxidative stress and calcium overload caused by brain contusion.