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Objective To explore the effect of the rehabilitation self-efficacy of patient with total knee arthroplasty on the first time of ambulation after operation.Methods Totally 110 patients undergoing total knee arthroplasty were recruited,they were investigated with self-designed general information and disease situation questionnaire and recorded the first time of ambulation.The self-efficacy was measured by the Self-Efficacy for Rehabilitation outcome scale(SER).Results The earliest time of ambulation was 7.5 hours after surgery.The latest time of ambulation was 54.0 hours after surgery.The median time of the first ambulation was 46.0 h.The mean score of self-efficacy for rehabilitation therapy exercises was (28.58 ± 9.18) points,and the mean score of self-efficacy in overcoming barriers was (43.07 ± 11.04) points,and the mean score of SER was (71.65 ± 18.47) points.The total score of self-efficacy for rehabilitation therapy exercises,self-efficacy in overcoming barriers,and the score of SER were negatively correlated with the first time of ambulation (r=-0.442,-0.299,-0.399,P＜ 0.01).The self-efficacy of rehabilitation was one of the influencing factors of patient's first time of ambulation(P ＜ 0.05),which explained 9.7％ of total variance of early ambulation of patients with total knee arthroplasty.Conclusions The self-efficacy of rehabilitation after total knee arthroplasty was significantly correlated with the first time of ambulation,and the higher self-efficacy of rehabilitation,the earlier the first time of ambulation.The self-efficacy of rehabilitation was one of the important factors that affect the first time of the patient's ambulation after total knee arthroplasty.
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Objective To investigate the effects of different target blood glucose control on postoperative complications during fasting after abdominal surgery by Meta-analysis. Methods From January 1990 to May 2016 the computer retrieval of related Chinese and foreign literature into surgery during the fasting blood glucose control in different range of patients, were randomly divided into control group and intervention group, from two independent data extraction and document evaluation. Meta-analysis using RevMan5.3 software. Results A total of 6 articles were included. Meta-analysis results showed that after abdominal surgery during the fasting of different target blood glucose control on the incidence of hypoglycemia, the incidence of postoperative complications of surgical incision infection after operation, the differences were statistically significant (P<0.05), However, there was no significant difference in postoperative mortality rate (P>0.05). Conclusions After abdominal surgery in patients with intensive glycemic control during the fasting ,value at the lower range (4.4-6.1mmol/L) can effectively reduce the incision infection and the incidence of postoperative complications, is conducive to the rehabilitation of patients, but increase the risk of hypoglycemia, and it has little effect on the mortality of patients during hospitalization. The control group included blood glucose range is too large or lack of continuity and included in the study Chinese literature is too small, leads to a limitation of the research, the analysis results still need more clinical nursing practice and a large number of high quality documents to support.
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Objective To summarize the reason and nursing experience of one pulmonary embolism patient after total knee arthroplasty easily misdiagnosed coronary heart disease. Methods For the patient to implement risk assessment of venous thromboembolism and develop prevention plan in preoperation, then carry out anticoagulation prevention and physical prophylaxis after operation. Nurse observe the patient changes of clinical symptom and signs,focus on the complain of patient and the changes of laboratory examination results, implement the diagnosis process of pulmonary thromboembolism. Pulmonary thromboembolism patient was definitely diagnosed and got standardized treatment. Results Through the treatment and nursing, the patient finely discharged from hospital. Conclusions To develop the system of VTE risk assessment and implement prevention measures.Nurses need to distinguish the high risk pulmonary thromboembolism patient according to the clinical observation, it is better for the pulmonary thromboembolism patient to be early diagnosed and treated, meanwhile, to implement the effective nursing measures will contribute to the prognosis of pulmonary thromboembolism patient.
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Objective To explore the feasibility and safety of early ambulation in patients with acute deep ve-nous thrombosis. Methods The literatures about early ambulation for acute venous thrombosis were collected and the quality of the literature was evaluated by two investigators independently. Results Thirteen published studies were recruited for systematic review,including 10 RCTs and 3 CCTs. The meta-analysis showed that compared with bed rest,early ambulation did not increase the incidence of secondary pulmonary embolism in patients with acute DVT[early activity:22/1408;bed rest:34/1417;RR=0.62,95%CI(0.37,1.03),and the incidence of DVT progression [early activity:48/1523;bed rest:45/1525;RR=0.85,95%CI(0.58,1.24)]. There were no statistically significant differ-ences in mortality,swelling,and pain relief in acute DVT patients. Conclusion Early ambulation did not increase the incidence of thrombus progression and secondary pulmonary embolism in patients with acute DVT compared with bed rest. Besides,early ambulation cannot relieve symptoms of swelling and pain in DVT patients. However,it can relieve the acute pain of DVT patients with moderate to severe pain.
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Objective To compare the consistency between interstitial fluid glucose and arterial blood glucose in septic shock patients with different tissue perfusion levels.Methods A prospective investigative study was conducted. Sixty-one septic shock patients with ages above 18 years old admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2013 to December 2013 were enrolled. The real-time continuous glucose monitoring system (RTCGMS) and arterial blood gas analyzer were used to measure the patients' interstitial fluid glucose and arterial blood glucose, and according to the criteria of International Organization for Standardization (ISO) and the median of relative absolute difference (Median RAD), the consistency between interstitial fluid glucose and arterial blood glucose was calculated. Based on the lactate (Lac) level and pulse oxygen perfusion index (PI), the septic shock patients were divided into groups with different degrees of tissue perfusion, the consistency between the interstitial fluid glucose and arterial blood glucose among septic shock patients with different degrees of tissue perfusion was compared by using Bootstrap re-sampling technique.Results Negative correlation existed between PI and Lac (r= -0.272,P 8 mmol/L, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with Lac > 2-4 mmol/L, and the 95% credibility intervals (CI) of ISO standardized deviation value was 0.026-38.710 (P 0.7%-1.4%, the 95%CI of median RAD difference value was 0.002-0.076, and the 95%CI of ISO standardized deviation value was -27.000 to -0.583 (allP 3.0%, their consistency between interstitial fluid glucose and arterial glucose was better than that in those with PI ≤ 0.7%, PI > 0.7%-1.4% and PI > 1.4%-3.0%, and the 95%CI of ISO standardized deviation values were 3.322-28.302, 11.988-40.265 and 5.170-33.333 respectively (allP 8 mmol/L or PI ≤ 0.7%), the worse the tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose; when septic shock patients were under normal local tissue perfusion (PI > 3.0%), the better the local tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose.
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Objective To observe the effect of the application of peripherally inserted central catheter (PICC) network platform in the information management of the patients with PICC.Methods Altogether 17 254 outpatients receiving PICC maintenance in Peking Union Medical College Hospital from April 2012 to April 2013 were enrolled as the control group,including 7 227 males and 10 027 females,with the median age of 58 years (12-85 years).A total of 20 384 outpatients from April 2013 to April 2014 with PICC were selected as the observation group,including 8 188 males and 12 196 females,~th the median age of 59 years (13-86 years).Those patients all received PICC maintenance in outpatient clinic during the intermission of therapy after PICC insertion.The time of data entry,the integrity of the data,description accuracy about complications,and normalization of wording were compared between the two groups.Results The average time of data entry in the control group was (46 ± 6) seconds,significantly longer than that in the observation group [(12 ± 5) seconds,t =562.660,P ＜ 0.05].In terms of the integrity of the data,there were 11 732 cases of complete data,3 623 cases of less complete data,and 1 899 cases of incomplete data in the control group;while the numbers of cases of complete data,less complete data,and incomplete data in the observation group were 19 568,725,and 91,respectively,showing significant difference compared with the control group (x2 =5 312.000,P ＜ 0.05).In the description accuracy about complications,the control group had 11 840 accurately described cases and 5 414 inaccurately described cases,while the observation group had 18 427 accurately described cases and 1 957 inaccurately described cases (x2 =2 814.000,P ＜ 0.05).The wording was standard in 15 280 cases but not standard in 1 974 cases in the control group,and standard in 19 659 cases and not standard in 725 cases in the observation group,with significant inter-group difference (x2 =872.600,P ＜0.05).Conclusion Simple and convenient data summary could help quality control and quality analysis,preferably guarantee the safety of catheter insertion and reduce the incidence of complications.