"Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation" evidence application and effect evaluation / 中国实用护理杂志

Objective:To promote the evidence application of the "Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation" and verify its effectiveness.Methods:This was a quasi-experimental study. A total of 31 ICU nurses from Tianjin Teda Hospital were trained by workshops, in order to help promote the evidence transformation. With the evidence application model of the JBI Evidence-Based Health Care Center, we reviewed the measures for mechanically ventilated patients before and after intervention (51 cases at baseline and 77 cases at second review).Results:No unplanned extubation occurred during the period of two rounds of evidence review, the implementation rate of 9 review indicators had improved, and 6 of them showed statistically significant differences. indicator 1 increased from 3.92% (2/51) to 100.00% (77/77),indicator 3 increased from 86.27% (44/51) to 100.00% (77/77), indicator 5 increased from 27.45% (14/51) to 100.00% (77/77), indicator 7 increased from 45.10% (23/51) to 70.13% (54/ 77), indicator 8 increased from 50.98% (26/51) to 100.00% (77/77), indicator 9 increased from 45.10% (23/51) to 77.92 % (60/77), the difference was all statistically significant ( χ2 values were 8.02-119.87, all P<0.05). Conclusions:The "Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation" can provide guidelines for clinical nursing practice. While preventing unplanned extubation, it can standardize nurses' behavior and promote medical-nursing cooperation.

Construction of early warning indicators of in-hospital cardiac arrest in adult inpatients / 中华危重病急救医学

Objective:To establish early warning indicators for Chinese nurses to recognize in-hospital cardiac arrest (IHCA) of adult inpatients.Methods:Computer retrieval of Chinese and English databases such as CNKI, Wanfang Database, VIP, National Medical Library of the United States PubMed Database, Web of Science, Embase Database of the Netherlands Medical Abstracts, Cochrane Library Database and other international guidelines collaboration network (GIN), National Institute for Health and Clinical Optimization (NICE), Scottish Intercollegiate Guidelines Network (SIGN), BMJ best clinical practice and other guidelines was performed. The retrieval time limit for respiratory and cardiac arrest early warning indicators or risk identification related content of the adult inpatient in the professional website was until June 30, 2020. After literature research and expert group analysis, the research group drew up an expert correspondence questionnaire, and selected 32 medical and nursing experts from Beijing, Tianjin, Jilin, Shandong, Shaanxi, Sichuan, Zhejiang and other grade three first-class general hospitals from July to September 2022. The Delphi method was used to conduct two rounds of expert correspondence, forming the final version of the early warning index of cardiac arrest in adult inpatients.Results:Five first-level indicators, 23 second-level indicators and 41 third-level indicators including vital signs, consciousness and pupils, postoperative blood drainage volume, lab results and other five aspects were initially formed. The effective response rates of the two rounds of expert correspondence were 100% (32/32) and 93.75% (30/32), respectively, the Kendall coordination coefficients W of the first round and the second round were 0.340 and 0.462, respectively, the expert authority coefficients Cr were 0.88 and 0.89, respectively, the mean value of importance assignment was 3.94-5.00, 4.07-5.00, and the coefficient of variation was 0-0.16, 0-0.14, with statistically significant differences (all P < 0.05). Finally, 5 primary indicators, 23 secondary indicators and 43 tertiary indicators were formed, including five aspects of vital signs, consciousness and pupils, postoperative blood drainage, lab results, symptoms and chief complaints. Conclusion:The expert consultation on the early warning indicators of IHCA for adult patients tends to be consistent and scientific, which is applicable to help nurses detect the changes of patients' condition as early as possible.

Influencing factors of patient ventilator associated pneumonia based on package execution / 中国实用护理杂志

Objective:To validate the effectiveness of the "ventilator-associated pneumonia (VAP) cluster nursing package" in Tianjin.Methods:A self-test questionnaire was prepared based on the "Ventilator-associated pneumonitis bundled nursing package", and an electronic questionnaire was used to investigate the comprehensive ICU of 40 hospitals in Tianjin.Results:The average self-examination form of the comprehensive ICU "ventilator-associated pneumonia cluster nursing package" in Tianjin was 28.92 points (out of 30 points), of which the bedside elevation, sedation and wake up, timely extubation, strict hand hygiene, and maintenance Effective airbag pressure, timely dumping of condensate water, timely removal of stagnation, and prevention of the total score of VAP package execution were related to the occurrence of VAP in patients in Tianjin from August 2018 to August 2019 ( r value was 0.101, P <0.01); ICU unit layout, nurse level and prevention of VAP package implementation are the influencing factors of VAP in ICU patients. Conclusion:The "ventilator-associated pneumonitis cluster nursing package" has been well implemented in Tianjin ICU, and the implementation of this package can reduce the incidence of VAP.

Investigation and research on nursing process based on industrial engineering theory / 中国实用护理杂志

Objective@#To explore the current status of nursing work process in Tianjin Third Grade A General Hospital, to interpret the available space of nursing human resources, and to find new ideas for configuration and optimization.@*Methods@#According to the industrial engineering theory and program analysis method, combined with the characteristics of nursing professional, define the name of the activity, build the evaluation index and formula of the nursing process level, the workday practice method was used to investigate and analyze the nurses′ work processes in a total of 48 departments in four hospitals in Tianjin.@*Results@#The overall nursing process level of Tianjin Third Grade A General Hospital was: β = 0.756. Among them, the process utility coefficient was: β1=0.913, and the coherence coefficient is only: β2=0.627. There were differences in the level of nursing processes between different hospitals and departments. Among them, the process coherence level was different and the overall level was low.@*Conclusions@#The level of nursing procedures in Tianjin Third Grade A General Hospital needs to be improved. It is necessary to improve the continuity of nursing work, appropriately increase the reserve talents, strengthen the standardized training of nursing procedures, and explore more flexible scheduling methods. Conditional hospitals and departments can explore the application of information technology in nursing work or implement an unaccompanied mode to reduce the workload of nurses and improve the continuity of the nursing process, thereby improving the level of nursing processes and improving the quality and efficiency of nursing work.

Application status of standardized nursing language in electronic health record / 中国实用护理杂志

Electronic health record is an important part of medical information research and has been widely used in medical institutions to help medical personnel deal with various medical information. However, due to the lack of standardized nursing language, nurses are often unable to reuse nursing data in electronic health records, which hinders the further development of medical information sharing and electronic health records. The use of standardized nursing language can support efficient and complete nursing documents in electronic health records and meet the requirements of clinical and data interoperability. This paper summarizes the definition and significance of electronic health record and standardized nursing language and the application status of standardized nursing language based on electronic health record, so as to provide scientific reference for the development and improvement of electronic health record in China.

Application status of standardized nursing language in electronic health record / 中国实用护理杂志

Electronic health record is an important part of medical information research and has been widely used in medical institutions to help medical personnel deal with various medical information. However, due to the lack of standardized nursing language, nurses are often unable to reuse nursing data in electronic health records, which hinders the further development of medical information sharing and electronic health records. The use of standardized nursing language can support efficient and complete nursing documents in electronic health records and meet the requirements of clinical and data interoperability. This paper summarizes the definition and significance of electronic health record and standardized nursing language and the application status of standardized nursing language based on electronic health record, so as to provide scientific reference for the development and improvement of electronic health record in China.

Investigation and research on nursing process based on industrial engineering theory / 中国实用护理杂志

Objective To explore the current status of nursing work process in Tianjin Third Grade A General Hospital, to interpret the available space of nursing human resources, and to find new ideas for configuration and optimization. Methods According to the industrial engineering theory and program analysis method, combined with the characteristics of nursing professional, define the name of the activity, build the evaluation index and formula of the nursing process level, the workday practice method was used to investigate and analyze the nurses′ work processes in a total of 48 departments in four hospitals in Tianjin. Results The overall nursing process level of Tianjin Third Grade A General Hospital was: β = 0.756. Among them, the process utility coefficient was: β1=0.913, and the coherence coefficient is only: β2=0.627. There were differences in the level of nursing processes between different hospitals and departments. Among them, the process coherence level was different and the overall level was low. Conclusions The level of nursing procedures in Tianjin Third Grade A General Hospital needs to be improved. It is necessary to improve the continuity of nursing work, appropriately increase the reserve talents, strengthen the standardized training of nursing procedures, and explore more flexible scheduling methods. Conditional hospitals and departments can explore the application of information technology in nursing work or implement an unaccompanied mode to reduce the workload of nurses and improve the continuity of the nursing process, thereby improving the level of nursing processes and improving the quality and efficiency of nursing work.

Early conscious sedation as the goal of targeted sedation- to enhance the ability of ICU nurses to regulate / 中国实用护理杂志

Sedation is one of ICU routine treatment, understand the harm to patients caused by deep sedation; by enhancing the ability to regulate the sedation nurse, to help early shallow sedation for goal orientation in the implementation of the program is to reduce sedation, sedation complications, effective means of preventing excessive sedation, is an important measure to promote the development of clinical nursing.

Effect of different positions on endotracheal cuff pressure in mechanically ventilated patients / 中国实用护理杂志

Objective To measure endotracheal cuff pressure in different positions for mechanically ventilated patients, to provide clinical evidence in choosing suitable body position and measuring time. Methods A total of 40 orally intubated and sedated patients were positioned in a neutral starting position (30°of semirecumbent position)with cuff pressure at 25 cmH2O(1 cmH2O=0.098 kPa),then 6 changes in position were performed:45°of semirecumbent position,and left and right lateral positioning over 30°and 45°, horizontal position. Once a patient was correctly positioned, cuff pressure was measured and recorded. Results The cuff pressure of different position were 30°of semi recumbent position (25 cmH2O, 45°of semi recumbent position (28.55 ± 5.41) cmH2O, 30°of left lateral position (31.43±7.42)cmH2O,45°of left lateral position(32.20±6.85)cmH2O,30°of right lateral position(29.43± 5.84)cmH2O,45°of right lateral position(29.20±6.42)cmH2O,horizontal position(27.15±4.05)cmH2O. The cuff pressure of semi recumbent position at 30°and horizontal position was no statistical significance in the difference (t=-1.70, P=0.09), but horizontal position had 8 patients' cuff pressure more than 30 cmH2O. The cuff pressure of semi recumbent position at 30°was significantly lower than those of semi recumbent position at 45°,left and right lateral position(t=-5.71-3.33,P<0.01).When the cuff pressure of 30°of semi recumbent position was 25 cmH2O, the other body positions had some patients' cuff pressure more than 30 cmH2O. Conclusions Changing body position can affect the endotracheal tube cuff pressure,suggesting that endotracheal tube cuff pressure should be measured after changing patient's position and adjusted within the recommended range.

Review on Post-ICU follow-up care / 中国实用护理杂志

After leaving the ICU, many ICU patients and their families will be affected by the long-term effects of physical, psychological and social dysfunction, which will affect their recovery and quality of life.Therefore, it is necessary to provide follow-up care services for this group. The follow-up of ICU after more than 20 years of development has a positive effect on helping patients and their families cope with various problems after ICU and promoting comprehensive rehabilitation of patients. This article reviews the development of follow-up care after ICU, the follow-up care model after ICU, and the common tools for follow-up care after ICU, which provides reference and basis for follow-up nursing practice in domestic ICU.

Effects of comprehensive restraint reduction program on preventing unplanned extu-bation among ICU patients with tracheal intubation / 中华护理杂志

Objective To explore the effects of comprehensive restraint reduction program on preventing un-planned extubation among ICU patients with tracheal intubation. Methods Totally 266 cases of ICU patients with tracheal intubation in our hospital were selected as the research objects using the convenient sampling method.They were divided into two groups by time: the experimental group of 130 cases implementing a comprehensive reduction constraint program and the control group of 136 cases using conventional physical restraint in nursing process.The constraint rate, constraint length, UEX incidence, skin and satisfaction of the two groups were compared. Results In the experimental group, the rate of physical restraint and UEX decreased, the average restraint length of each patient was shortened, skin integrity at the site of restraint improved, and the satisfaction of patients increased. Compared with the control group, the differences were statistically significant(P<0.01 or P<0.05). Conclusion The com-prehensive restraint reduction program can reduce the rate of physical restraint and the incidence of unplanned ex-tubation among ICU patients with tracheal intubation.

Extraction Technology of Volatile Oil from Qingjie Granules and Optimization of Inclusion Technology by Box-Behnken / 中国中医药信息杂志

Objective To optimize the extraction of volatile oil from Qingjie Granules and process of inclusion compound of beta-cyclodextrin. Methods Water Distillation was used for extraction. Extraction time, grinding degree, and the amount of water were set as inspection factors, and volatile oil volume was set as the evaluation index to inspect extraction process of volatile oil from Qingjie Granules. With inclusion rate as the evaluation index, the single factor test and the Box-Behnken combined with the response surface method were used to choose the optimum inclusion process. Results The optimum extraction process for Schizonepetae Herba, Saposhnikoviae Radix and Forsythiae Fructus coarse powder should be with 10 times amount of water, extracting 3 h. Inclusion method should be saturated water solution method, and the inclusion process of volatile oil as feed and beta-cyclodextrin inclusion ratio was 1:12; the temperature was 40 ℃; inclusion time was 3.5 h. By means of TLC, UV and IR spectra, the formation of the inclusion compound of volatile oil in clear solution particles was preliminarily proved. Conclusion The optimum extraction and inclusion process of volatile oil from Qingjie Granules are stable and feasible, which can be used in industrial production.

Preliminary Study on Moisture Absorption and Related Components of Aqueous Extract of Salviae Miltiorrhizae Radix et Rhizoma / 中国中医药信息杂志

Objective To explore the moisture absorption and related components of aqueous extract of Salviae Miltiorrhizae Radix et Rhizoma. Methods The hygroscopicity of aqueous extract of Salviae Miltiorrhizae Radix et Rhizoma and its water and alcohol elution parts separated by macroporous resin was measured, and the contained low molecular sugars (monosaccharides, oligosaccharide), polysaccharide, protein, amino acid, tannins and salvianolic acid B, etc. were analyzed. Results D101 macroporous resin was used for separation and purification of aqueous extract of Salviae Miltiorrhizae Radix et Rhizoma. The hygroscopicity of water elution parts was enhanced;carbohydrate, protein and other hydrophilic substances content increased; the content of salvianolic acid B was reduced to 1.76 mg/g. While the hygroscopicity and hydrophilic substances of alcohol elution parts were greatly reduced; the content of salvianolic acid B increased to 146.57 mg/g. Conclusion The hygroscopicity of aqueous extract of Salviae Miltiorrhizae Radix et Rhizomais closely related to the contained strong hydrophilic components, such as low molecular sugars, etc. Using D101 macroporous resin to purify aqueous extract of Salviae Miltiorrhizae Radix et Rhizoma can not only effectively gather the contain phenolic acids active ingredients, but also sharply decrease the extract yield and extract moisture absorption.

Study on Silibinin Preformulation / 中国中医药信息杂志

Objective To study the physical and chemical properties of silibinin; To lay foundation for optimal formulation design.Methods The high performance liquid chromatography method was used to detect the equilibrium solubility of silibininin in various solutions. The partition coefficients of silibinnin in the n-octalution-water and n-octalution-buffer solution systems were determined by shaking flask method. The destructive tests were carried out on silibinin.Results The equilibrium solubility of silibininin at 25℃ was 1.352 mg/L in water and the largest in acetonitrile, and increased in basic buffer solutions and after adding surfactants, of which sodium dodecyl benzene sulfonate was the strongest in solubilizing ability. The apparent oil-water partition coefficient of silibinnin was 61.39. Silibinnin was unstable in the acidic, basic, oxidizing and reducing solutions.Conclusion The experiment results can provide references for designing new preparations of silibinin.

HPLC Characteristic Chromatogram and HPLC-MS/MS Analysis ofKanglao Qingfei Granules / 中国中医药信息杂志

Objective To establish HPLC characteristic chromatogram ofKanglao Qingfei Granules.Methods HPLC analysis of samples was performed on Kromasil C18 column (4.6 mm × 250 mm, 5μm), with acetonitrile-1% glacial acetic acid as the mobile phase of gradient elution (0-50 min, 5%→15% acetonitrile;50-70 min, 15%→25% acetonitrile;70-80 min, 25%→40% acetonitrile;80-90 min, 40%→65% acetonitrile, 90-120 min, 65%→95% acetonitrile);the volume flow rate was 1.0 mL/min;detection wavelength was set at 290 nm;column temperature was 30℃. Chromatographic peaks were identified by HPLC-MS/MS method.Results The similarity degrees of 10 batches of samples were all greater than 0.995, and 13 chromatographic peaks were determined as common characteristic peaks, of which 10 peaks were confirmed in the source attribution and 8 peaks were identified in chemical component.Conclusion The established HPLC characteristic chromatogram can be used for the quality control ofKanglao Qingfei Granules.

Study on HPLC Characteristic Chromatogram of Shenshitong Granules / 中国中医药信息杂志

Objective To establish the HPLC characteristic chromatogram of Shenshitong Granules. Methods The chromatographie fingerprints were obtained through Thermo Hypersil GOLD-C18 column (4.6 mm×250 mm, 5μm) with the gradient elution solvent system composed of acetonitrile-0.2% phosphoric acid (0-20 min, 5%→10% acetonitrile;20-40 min, 10%→12%acetonitrile;40-60 min, 12%→14%acetonitrile;60-90 min, 14%→20%acetonitrile;90-120 min, 20%→28%acetonitrile). The detective wavelength was set at 280 nm;the flow rate was 1.0 mL/min;the column temperature was maintained at 30 ℃;the analysis time was 120 min. Results The HPLC characteristic chromatogram was built on basis of 10 batches of Shenshitong Granules, including 27 common peaks which contain the characteristic peaks of 6 Chinese herbal medicines, such as Radix Salvia Miltiorrhizae, Herba Lysimachiae, etc. Conclusion The established HPLC fingerprint has high sensitivity and good repeatability, and can be available for quality evaluation of Shenshitong Granules.

Optimization of Extraction Process of Kanglao Qingfei Granules by Orthogonal Test with Multi-indexes / 中国中医药信息杂志

Objective To optimize the extraction process of Kanglao Qingfei granules. Methods Orthogonal test design was used to study the influence of soaking time, water content, extraction time on extraction technology with bergenin's extraction rate, total polysaccharides's extraction rate and extract yield as evaluation indexes. Results The optimum extraction process conditions were as follows:the raw materials were immersed in water for 1.0 h and extracted two times under reflux, and the ratio of water volume to raw materials weight was 10 and 8 (mL/g), and extraction time was 2.5 h and 2.0 h, respectively. Conclusion The optimized extraction process was simple and stable, which can provide foundation for industrial production of Kanglao Qingfei granules.

Extraction of Volatile Oil from Camphor Tree and Study on Prepration and Identification of ;Its β-cycoldextrin Inclusion Compound / 中国中医药信息杂志

Objective To study the content of volatile oil from old leaves, tender leaves, fallen leaves and seeds of cinnamomum camphora tree in Hunan, China. To prepare and identify the volatile oil of its β-cycoldextrin inclusion compound. Methods The volatile oil was extracted by water-steam distillation. With inclusion rate as the index, trituration method, saturated water solution method and ultrasound method were compared. The optimum conditions were investigated by the orthogonal test. The inclusion compound was identified by thin-layer chromatography (TLC), ultraviolet visible spectrum (UV-Vis) and differential scanning calorimetry (DSC). Results From June to July, the average content of volatile oil extracted from old leaves, tender leaves, fallen leaves and seeds were 1.58%, 1.52%, 0.84% and 1.39%, respectively. The optimum preparation conditions were as follows:the ratio of β-cyclodextrin and volatile oil was 10∶1, the adding water was 4 times and inclusing time was 2 h. Before and after inclusion, the spectrum of TLC and UV-Vis of volatile oil showed no obvious change. The DSC of inclusion compound,β-cycoldextrin, volatile oil and the mixture had significant differences. Conclusion The amount of the volatile oil from old leaves is higher. The optimized condition of inclusion is stable and reasonable.

Research on good usage practice for Chinese Materia Medica (I): chemical equivalence of different prepare procedures and optimal conditions for good clinical usage of rhubarb / 中国中药杂志

<p><b>OBJECTIVE</b>To probe into the influences of different granule sizes and to prepare procedures on rational clinical usage of rhubarb based on chemical equivalence.</p><p><b>METHOD</b>The effects of particle size, extract solvent, extract time and repeat times, and pre-extract or pro-extract of rhubarb on the extract amounts of the anthraquinones (AQs) were compared.</p><p><b>RESULT</b>The different prepare procedures investigated in the paper revealed significant influence on the extract amounts of the AQs and those extracts were not chemical equivalent. Ethanol extracted more AQs than water did, when other conditions were same. When extracted with water, the rhubarb of piece size 0.8-1.2 cm could extract relatively high amount of AQs nearly equal to superfine grinded powders, and the former was cheap. The water extraction of AQs showed an increasing trend with the extraction time extended. And pro-extract manner with water could extract more AQs than pre-extract manner with a extraction time of 30, 60 min. The water extraction of AQs repeated two times exceeded half of the amount of totally six times. When extracted with ethanol, the rhubarb of fine powders could extract relatively high amount of AQs nearly equal to superfine grinded powders. And pre-extract manner with ethanol could extract more AQs than pro-extract manner. The ethanol extraction of AQs increased in 30 min and then increased slower. The ethanol extraction of AQs repeated two times exceeded 70% of the amount of totally six times. So, the optimal conditions for water extraction rhubarb were pro-extract, two times repeated and 30 min per time; and the optimal conditions for ethanol extract were pre-extract, two times repeated and 30 min per time.</p><p><b>CONCLUSION</b>The different prepare procedures showed significant influence on the extraction of rhubarb AQs. There is great need to establish a good usage practice (GUP) for Chinese Materia Medica to maintain rational clinical usage.</p>

Study on the Alcohol Extraction Process of Rhizoma Polygoni cuspidati and Radix angelicae sinensis / 中国中医药信息杂志

Objective To ascertain the optimum condition for extracting Rhizoma polygoni cuspidati and Radix angelicae sinensis with alcohol. Method With extract yield and the amount of polydatin as index,the primary factors of affecting the extraction were optimized. Result The optimum extraction condition was as follows:taking 60% alcohol as solvent,the meterials were refluxed and extracted two times with 10 and 8 times volume of alcohol for 1.5 h and 1.0 h,respectively. Conclusion The optimum extraction process provides an experimental basis for industrial production.