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Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
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Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.
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Objective:To explore the effect of postoperative delirium risk management in elderly patients with hip fragility fracture based on failure mode and effect analysis (FMEA) theory, and to provide a basis for reducing the incidence of postoperative delirium.Methods:A total of 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University due to hip fragility fractures from January to December 2019 were selected as the control group, and 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University for hip fragility fractures from January to December 2020 were selected as the observation group. The control group received routine care, and the observation group implemented risk control intervention measures based on FMEA theory on the basis of the control group. The risk priority number (RPN) value, incidence of delirium, duration of delirium, pain score, satisfaction, and average length of hospital stay were compared between the two groups of patients in each link of failure risk.Results:The RPN values of each link failure risk of the observation group were 100.80 ± 13.39, 103.96 ± 9.96, 103.76 ± 8.04, delirium duration was (36.33 ± 9.07) min, pain scores were 1.86 ± 0.76, 4.16 ± 1.17, average length of stay was (8.98 ± 4.64) days, and incidence of delirium was 6.0% (3/50), the RPN values of each link failure risk of the control group were 274.10 ± 8.48, 291.00 ± 10.10, 287.78 ± 11.64, delirium duration (78.70 ± 20.10) min, pain scores 2.26 ± 1.02, 4.74 ± 1.19, average length of stay was (11.50 ± 7.66) days, and incidence of delirium was 22.0% (11/50). The differences between two groups showed significant differences ( t values were 1.99-93.24, χ2=4.07, P<0.05). The patient satisfaction score of the observation group was 99.36 ± 1.01, which was higher than that of the control group 89.63 ± 2.62, and the difference was statistically significant ( t=24.50, P<0.05). Conclusions:The perioperative implementation of postoperative delirium risk management model based on FMEA theory in elderly patients with hip fractures can reduce the incidence of postoperative delirium, relieve pain, shorten hospital stay, and improve satisfaction degree. It is worthy of clinical promotion.
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Many pathogenic genes have been identified in early-onset Parkinson′s disease, but the early-onset Parkinson′s disease with 22q11.2 deletion has not been reported in Chinese. A case of early-onset Parkinson′s disease with 22q11.2 deletion was confirmed by whole-exome sequencing-based copy number variation detection in Fujian Medical University Union Hospital. This article reports its clinical characteristics and discusses its pathogenesis, diagnosis and treatment management.
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The outbreak of COVID-19 around the world has made more than two millions of confirmed patients and serious shortages of healthcare resources and medical staff in many countries. In the battle of fighting COVID-19 in Wuhan, many microsurgery staff across China were sent to Wuhan and put on duty in the treatment of COVID-19 patients. The purpose of this article is to review the personal experiences of microsurgery staff in fighting against COVID-19 as well as to analyse how to act professionally when facing the challenges and change of roles and meanwhile having to give full play to the professional advantages subject to make contributions to the battle of COVID-19. A reference is hereby provided for the microsurgery staff in dealing with a sudden and major epidemic outbreak in the future.
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Objective To explore the application effect of key indicators of oncology nursing quality evaluation in the continuous improvement of specialist nursing quality. Methods The Delphi method was used to cons-truct 14 key indicators of oncology nursing quality evaluation, and the key indicators were used to control the quality of specialist nursing in the tumor area. Data were collected and a database was established. Based on the data, the quality of the nursing care and continuous quality improvement were carried out. Results The results of the data from the first year (before the intervention in 2016) and the second year (after the intervention in 2017) were compared with the data of the key indicators of the quality evaluation of the specialist nursing. The results showed that the indicators had different degrees of decline. The data before and after intervention were: chemotherapy drug extravasation rate 0.20% (33/16 861) and 0.10% (20/19 957), and the incidence of severe pain was 1.65% (1 747/106 114) and 1.43% (1 521/106 462). The incidence of anxiety was 2.17% (2 305/106 114) and 1.53% (1 633/106 462), and the incidence of depression was 2.27% (2 408/106 114) and 1.28% (1 359/106 462). The difference was statistically significant (χ2=5.80-300.90, P<0.05); The other 9 indicators of process have improved to varying degrees. Conclusions 14 key indicators of oncology nursing quality evaluation are applied to the oncology ward for specialized nursing quality management and quality improvement, which can monitor the quality of key specialist nursing in real time and dynamically. It can accurately select clinical nursing priority improvement projects and improve specialist nursing. Quality;energy evaluation to improve the quality of specialist nursing quality; help improve the quality management of specialist nursing and ensure patient safety.
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Objective To explore the methods for quality management and continuous improvement of nursing care quality in the orthopedic demonstration ward by taking the hospital accreditation as an opportunity. Methods From July 2012 to June 2013, the continuous care quality improvement in the ward was carried out to find out the problems with PDCA (plan, do, check, action) cycle method, including enhancing the function of orthopedic nursing quality management groups, conducting all-staff training and improving the knowing rate by referring to the standards of hospital assessment standards. Results After the performance of whole-process quality management, the percentage of indexes assessed at level A, B and C was increased from 42.2%to 50.0%, 17.2%to 14.7%and 40.2%to 35.3%, respectively. The score of nurses' responsibility accreditation was increased from 92 to 95. The rates of patient and nursing staff satisfaction were increased from 91.8%to 98.9%and 92.57%to 97.7%, respectively. Conclusion In accordance with the standards for hospital accreditation, the continuous improvement of nursing quality in the orthopedic demonstration wards can improve the specialist care of orthopedic care, improve patients' and nurses' satisfaction, thus making the daily work more scientific and standardized.
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Objective To explore the effect of videos on health education to the spinal surgery patients during perioperative period. Methods About 99 patients with lumbar, cervical vertebra disease were randomized into two groups with random digit number:50 in the experimental group and 49 in the control group. Videos was used in the health education combined with routine health education model of perioperative health education in the former group and the health education was done in regular way in the control group. The two groups were compared in terms of hospital nursing service awareness, rehabilitation knowledge awareness, accuracy in perioperative nursing skill. Result The rate of knowledge about hospitalization nursing and the accuracy of rehabilitation nursing skills were significantly higher than those in the control group (P<0.05). Conclusions Video-assisted health education has changed the traditional way for health education, It is helpful for nurses to better implement health education program. It is beneficial for patients to strengthen memory. It can improve the perioperative knowledge and the accuracy in rehabilitation nursing skills.
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OBJECTIVE:To investigate the characteristic and regularity of antineoplastics-induced ADR,and to provide refer-ence for safety use of antineoplastics in clinic. METHODS:In retrospective study,309 cases of antineoplastics-induced ADR col-lected from a special hospital during Jan.-Dec. 2015 were summarized and analyzed statistically. RESULTS:Among 309 ADR cas-es,female (58.25％) was more than male (41.75％). The patients aged more than 40 years old occupied the highest proportion (78.64％). Main route of administration was intravenous dripping(94.82％). There were 225 cases of severe ADR(72.82％). To-tal 268 cases were improved after drug withdrawal or treatment(86.73％). A total of 24 kinds of antineoplastics were involved in 309 ADR cases;most of ADR were induced by docetaxel,followed by cisplatin,cyclophosphamide. Most common organs/system involved in ADR was hemopoietic system (64.24％),main clinical manifestation was myelosuppression. CONCLUSIONS:It is necessary to strengthen ADR monitoring,prevent,discover and treat antineoplastics-induced ADR timely,in order to reduce the harm to the patients and ensure the safety and effectiveness of drug treatment.
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Objective To investigate the effect of applying specialist nursing assessment indicator system on improving nurse′s health assessment ability in orthopedic department. Methods A specialist nursing assessment indicator system was developed by applying evaluation indicators of nursing care quality. That assessment indicator system consisted of 9 sub-indicators. They were assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, risk of falling down and assessment on anal sphincter function, etc. In addition, standard assessment process was developed and applied to train 54 nurses in orthopedic department, in order to standardize and improve their ability on specialist nursing assessment. Furthermore, the assessment process was transferred into specific nursing interventions to improve nurse′s health assessment ability, too. The accurate rate on those 9 indicated assessments were evaluated and analyzed regularly, pre and post the indicator system application. In the present study, each of the 54 nurses was required to assess five patients basing on the items in the assessment indicator system. The total assessment times were 270. Results After applying the indicator system, the accurate rates of assessments on local blood circulation, sensation and motion, muscle strength, pain, risk of developing pressure ulcer, anal sphincter function and assessment on developing deep venous thrombosis were 98.89% (267/270), 99.63% (269/270), 99.26% (268/270), 97.41% (263/270), 98.15% (265/270), 91.85% (248/270), 98.15% (265/270), which were higher than 95.19%(257/270), 92.96%(251/270), 96.30%(260/270), 90.37%(244/270), 92.22%(249/270), 85.56%(231/270), 92.22%(249/270) of the time when the system was not used, and the difference was significant (χ2=5.34-16.82, P 0.05). Conclusions Applying the specialist nursing assessment indicator system was able to standardize nursing assessment behavior and improve nurse′s assessment ability. In addition, it was beneficial to improve the quality of specialist nursing care in orthopedic department.
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Objective To explore the reasons and preventive measures of early dislocation after total hip arthroplasty in elder patients. Method A retrospective study was done to analyze dislocation time, reason and time of 168 elderly patients with early anti-dislocation after total hip arthroplasty in joint surgery. Results Only 7 patients (4.1%) had type I joint dislocation, including 2 male and 5 female patients aged 65~89 years. The dislocation happened in 4~5 weeks postoperatively, mainly resulting from hip joint over flexion when urinating in bed, sleep-turning, loaded-moving, walking and stoop and diachoresis. Conclusions For the elderly patients after total hip replacement, it is type I dislocation which happened 4 ~ 5 weeks after operation, more femal than male, reasons including over-exercrse. Effective prevention measures includes regular rehabilitation training, early precautions enhanced mental support and safety nursing.
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Objective To systematically assess the efficacy of memantine on moderate to severe Alzheimer's disease (AD).Methods With the evaluation method of the Cochrane system,searches were made in the Cochrane Library,MEDLINE,Embase,Forest Laboratories,CNKI,Wanfang Data,and VIP Data up to February 2013 for double blind,randomized,and placebo-controlled trials (RCTs) evaluating the efficacy of memantine for moderate to severe AD.A meta-analysis of included clinical trials was conducted using the Revman 5.2 software to evaluate the efficacy of memantine on overall clinical status,cognitive function activities of daily living,and behavioral and psychological disturbances.Results A total of 8 RCTs were included (2 527 patients with moderate to severe AD).Results of the meta-analysis showed that,for patients with moderate to severe AD,memantine had better efficacy than placebo on overall clinical status,cognitive function,and activities of daily living (MD=-0.24,95％CI:0.340.15;SMD=-0.26,95％CI:-0.340.18;SMD=-0.13,95％CI:-0.21-0.05),but there was no significant difference in efficacy on behavioral and psychological function between memantine and placebo (P =0.08).Analysis of subgroups showed that memantine had better efficacy than placebo on cognitive function in moderate AD patients (SMD =-0.22,95％CI:-0.37 0.06) and on overall clinical status,cognitive function,and activities of daily living in severe AD patients (MD-0.29,95％CI:-0.40 0.18;SMD=-0.31,95％CI:0.46-0.15;SMD=-0.16,95％ CI:-0.25 0.06;MD=-3.13,95％ CI:-4.88-1.39;respectively).Conclusions Memantine has efficacy on overall clinical status,cognitive function and activities of daily living in patients with moderate to severe AD,especially in patients with severe AD.
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Aim To explore the effect of N-acetyl-L-cysteine ( NAC ) on β amyloid peptide 25 - 35 ( Aβ25-35 )-induced the increase of calpain activity and its possible mechanism. Methods The activity of cal-pain was induced by 20μmol·L-1 Aβ 25-35 in primary cortical neuron. Neurons were incubated in the absent or present Aβ25-35 , or pre-incubated NAC ( 10 mmol ·L-1 ) , then co-incubated with Aβ25-35 . The meas-urement of calpain activity, H2 O2 level and mitochon-drial membrane potential was performed on a micro-plate fluorometer. The ATP level was detected using a luciferin/luciferase based ATP assay kit. Results In Aβ25-35 treated group, the activity of calpain and H2 O2 was obviously higher than that in control group. How-ever, in neurons pre-incubated in NAC and then co-in-cubated in Aβ25-35 , the calpain activity and H2 O2 level were significantly decreased compared with that in Aβ25-35 group. Upon Aβ25-35 exposure for 12 h, corti-cal neurons showed a significant decrease in mitochon-drial membrane potential and ATP level when com-pared to the control group. Pre-treatment with NAC showed an increase in mitochondrial membrane poten-tial and ATP level as compared to neurons treated with Aβ25-35 alone for 12h. Conclusion This result sug-gests that NAC can attenuate calpain activity induced by Aβ25-35 through protecting mitochondria.
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Objective To investigate the possible effect of ginsenoside Rg1 and oligo Aβ1-42 on PKA/CREB pathway.Methods The damage was induced by oligomeric Aβ1-42 in primary cortical neuron.Neurons were incubated with or without glutamate,or incubated in Aβ,or pre-incubated in Rg1 and then co-incubated in Aβ.The proteins of p-CREB,t-CREB,PKA Ⅱ α and BDNF were detected by Western blot.Results After the treatment with Oligo Aβ1-42 for 2 h,the p-CREB/t-CREB level induced by glutamate was obviously lower (P＜ 0.001).However,in neurons pre incubatedwith 2.5,5.0,10.0 μmol/L of ginsenoside Rg1 and then co-incubated with 5μmol/L of oligo Aβ1-42,the p-CREB/t-CREB induced by glutamate was significantly increased as compared with that of Aβ1-42 group (P＜0.05).Upon Aβ1-42 exposure for 2 h,cortical neurons showed a statistically significant increase in PKA Ⅱ α as compared to the control group (P ＜ 0.001).Pre-treatmentwith varying doses of ginsenoside Rg1 (2.5,5,10μmol/L) showed a decrease in PKA Ⅱ α as compared to neurons treated with Aβ1-42 alone for 2 h (P＜0.001).Furthermore,BDNF level significantly increased in Rgl-pretreated cells as compared to cells treated with Aβ1-42 alone for 24h (P＜0.05).Conclusions Ginsenoside Rg1 attenuates the oligo Aβ142 inhibition of PKA/CREB pathway.
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Aim To explore the possible protective effect of ginsenoside Rg1 on oligomeric Aβ1-42 induced apoptosis and its possible mechanism. Methods The damage was induced by oligomeric Aβ1-42 in primary cortical neurons. Cells were incubated in the absence or presence of Aβ, or co-incubated in sp600125 with Aβ, or pre-incubated in ginsenoside Rg1 then co-incu-bated in Aβ. The p-JNK, JNK, caspase-3 activity and TUNEL-positive cells were detected. Results In Aβ1-42 treated group, the ratio of p-JNK/JNK level was increased more than that in non-treated group for 15 min. However, in neurons preincubated with (2. 5, 5, 10 μmol·L-1 ) ginsenoside Rg1 and then co-incuba-ted with 5 μmol·L-1 oligomeric Aβ1-42 , the p-JNK/JNK ratio, caspase-3 activity and TUNEL positive neu-rons were significantly decreased compared with those of Aβ1-42 treated group. Conclusion Ginsenoside Rg1 can attenuate the oligomeric Aβ1-42-induced apop-tosis by JNK pathway.
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Objective To explore the establishment and implementation of nursing quality evaluation system in department of orthopedics. Methods Randomly 527 patients hospitalized in the department of orthopedics from December 2011 to December 2012 were selected and assigned into the control group, where a traditional evaluation system was used. Another 528 patients hospitalized from April 2013 to June 2014 as the observation group, where orthopedics specialist evaluation system was used. The two groups were compared in terms of hospital evaluation accuracy, observation accuracy, accuracy rate of specialist intervention complications, the qualified rate of nursing records and patient satisfaction. Result The hospital evaluation accuracy, observation accuracy, the accuracy rate of specialist intervention complications, the qualified rate of nursing records and patients satisfaction of the observation group were significantly higher than those of the control group (P<0.01) and there was no incidence in two groups. Conclusion The establishment of orthopaedic nurse quality evaluation system can make up the shortage of traditional evaluation system and improve the quality of the orthopaedic nursing management.
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Objective To understand the prophylactic use of antimicrobial agents in the patients undergoing I incision surgery from 2011 to 2013 in a tumor hospital,to explore the the effects of intervention management measure for antibacterial agents using in the perioperative period.Methods The cases of tumor surgical patients of 2011-2013 were selected and divided into the three intervention groups and non-intervention group.The data of medication after three-stage continuous integrated intervention were collected and compared.Results The percentage of antibiotics use was much lower,from 61.73%pre-intervention to 47.03%,26.78%and 24.85%after three stage intervention. The course of preventive medication treatment was significantly decreased from 81h to 53h,33h,21h,respeetively.The reasons of their rationally utilizing antibiotics were significantly improved after intervention management.Conclusion Rational antibiotics utilization can be improved by intervention management during perioperative period of typeⅠinci-sion operations,which can achieve the goal of health department.
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Objective To investigate the relationship between activation of gliacytes , mitogen-activated protein kinase (p38MAPK) and neuronal apoptosis after microinjecting aggregated Aβ25-35 into hippocampus.Methods The model was established by using stereotaxic technique to inject 10μg aggregated Aβ25-35 into dorsal hippocampus in rats .The rats were grouped as the control , vehicle and model groups .Immunohistochemistry and Western blotting were used for detection of activation of microglia(MG), atrocytes (AS) and expression of p-p38MAPK in the hippocampus.ELISA was used to evaluate the level of TNF-αand IL-1β.The survival neurons were observed by Nissl staining and the apoptotic neurons were identified by tunnel staining .Results Expression of ox-42, GFAP, p-p38MAPK were up-regulated in hippocampus, as well as TNF-α、IL-1β, which reached a highest value on the 7th day after injection of Aβ25-35.However, the number of neuron with Nissl positive decreased gradually , and the tunnel positive neurons increased highly and reached a peak value on the 7th day.There were significant differences between the control and vehicle group ( P <0.01). Conclusion Apoptosis of the neuron caused by Aβ25-35 injection may result from activation of gliacytes , p38 MAPK and increase of TNF-αand IL-1βlevel.
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Objective To investigate the impact of pain care standard training on the pain-related knowledge and attitude of junior nurses in orthopedics department.Methods The standard pain care training was done for the junior nurses in the orthopedics department. The scores of questionnaires related to pain-related knowledge and attitude were collected and compared between pre-and post-training. Result There was significant statistical difference in the measurements related to the junior nurse’s knowledge and attitude between pre-and post-standard training(P<0.05).Conclusion The standard pain care training can enhance junior nurses knowledge,improve the attitude towards pain,and set up apporiate pain management behavior.
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Objective To investigate the quality of life of patients with chronic diseases as well as the influencing factors. Method Two hundred and fifty five elderly patients with chronic disease from 3 hospitals in Guangzhou involved in the survey by adopting WHO quality of life-old(WHO OQOL-OLD)to investigate the quality of life and influencial factors.Results The quality of life of the elderly patients was in middle level.In the dimension of Past,Present and Future Activities,the quality of life was statistically different between the patients with different chronic diseases(P<0.05);In the dimension of Autonomy and Death&Dying, the quality of life was statistically different between those with and without cerebrovascular diseaseor(all P<0.05);In the dimensions of Autonomy,Social Participation,Death and Dying and Intimacy,the quality of life was statistically different between those needing care and no care after discharge(all P<0.05).Conclusions The quality of life of the elderly patients with chronic diseases is in middle level.The influencing factors for the quality of life include contracting multiple diseases,needing care after discharge and cerebrovascular diseases.At discharge,nurses should regulate instructions for them for the purpose of improving their autonomy,social participation and adaptability after discharge. Thus,their quality of life can be improved.