Table of Content

10 October 2024, Volume 5 Issue 10 Previous Issue    Next Issue

Research Paper

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Development and application of a risk scoring tool for pulmonary infection in patients with acute-on-chronic liver failure WANG Lijingzi, LI Pei, ZHANG Lan, WU Shasha, DU Hong, DANG Xiao 2024, 5 (10):  869-875.  doi: 10.3761/j.issn.2096-7446.2024.10.001 Abstract ( )   PDF (1227KB) ( )   Save Objective To develop and validate a risk scoring tool for pulmonary infection in patients with acute-on-chronic liver failure（ACLF）. Methods 585 patients with ACLF in a tertiary Class A hospital from January 2009 to September 2022 were selected and assigned to the modeling group（411 cases） and the validation group（174 cases） in a 7 ∶ 3 ratio. We used univariate and multivariate logistic regression to analyze the risk factors for pulmonary infection in ACLF patients. We constructed a predictive model for pulmonary infection risk in ACLF patients using modeling group data,and validated the model using validation group data. The discriminability and calibration of the constructed model were evaluated using receiver operating characteristic curves and H-L test. Then we developed a risk scoring tool based on a risk prediction model and applied it in clinical practice. Results 585 patients with ACLF were included,and a total incidence of pulmonary infection was 36.41%. The incidence rates of pulmonary infection in modeling group and validation group were 37.71% and 33.33%,respectively. The results of multivariate logistic regression showed that fever,cough,concomitant infections,combined use of antibiotics≥2,femoral vein catheterization treatment,and Child-Pugh grading were risk factors for pulmonary infection in ACLF patients（P<0.05）. The area under the ROC curve of the prediction model is 0.949（0.928~0.970）,with a sensitivity of 96.1% and a specificity of 80.5%. The H-L test result was（χ2=9.850,P=0.276）. The results showed that the model has good prediction and calibration. The maximum value of the developed scoring tool‘s Youden index wss 0.766,with a critical score of 16. Based on the probability comparison chart of ACLF patients with pulmonary infection,the patients were divided into four levels：low,medium,medium high,and high risk. The corresponding sensitivity was 96.1%,the specificity was 80.5%,and the H-L test result was（χ2=6.005,P=0.650）. And the risk scoring tool was initially applied to clinical practice,with an accuracy of 86.8%. Conclusion The risk scoring tool for pulmonary infection has a high degree of discrimination and calibration,which can help medical staff quickly,conveniently,and early identify the risk of pulmonary infection in ACLF patients. References | Related Articles | Metrics

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Analysis of risk factors for postoperative hypothermia in patients undergoing craniocerebral surgery and prediction model development and validation SUN Xueli, ZHANG Xiaojiao, LIU Ting, WANG Ran, LI Qing, HAN Binru 2024, 5 (10):  876-881.  doi: 10.3761/j.issn.2096-7446.2024.10.002 Abstract ( )   PDF (996KB) ( )   Save Objective To analyze the risk factors of postoperative hypothermia in patients undergoing craniocerebral surgery and construct a prediction model to provide reference for early clinical screening of high-risk groups and intervention. Methods By retrospective analysis method,407 patients from a tertiary Grade A hospital in Beijing from January 2021 to December 2022 were selected as the research objects,which were divided into modeling group（285 cases） and model testing group（122 cases） according to the ratio of 7：3. Univariate analysis and binary Logistic regression analysis were conducted in the modeling group and used to build the prediction model,and the prediction efficiency of the prediction model was evaluated. The data of model testing group was used to validate the model. Results The incidence of postoperative hypothermia in patients undergoing craniocerebral surgery was 40.7%. Logistic regression analysis showed that preoperative use of midazolam（OR=2.464）,operation time less than 3 hours（OR=3.287）,intraoperative use of colloidal fluid（OR=3.399） were independent risk factors for postoperative hypothermia in patients undergoing craniocerebral surgery. The prediction model was：Logit（P）=-2.124+0.902* preoperative use of midazolam +1.190* operative time less than 3 hours + 1.224* intraoperative use of colloidal fluid. The Hosmer-Lemeshow（H-L） test for the modeling group was（χ; 2=2.634,P=0.955）, the area under the ROC curve was 0.720. The H-L test for the modeling testing group was（χ; 2=13.911,P=0.084）,and the area under the ROC curve was 0.705. Conclusion The prediction model has good results and can provide reference for medical staff to screen high-risk groups with postoperative hypothermia in craniocerebral surgery patients. References | Related Articles | Metrics

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The development and validation of two prediction models of skin infection affected with multidrug-resistant organism in patients with pemphigus ZHANG Xiaoying, LI Baizhang, FANG Hui, YANG Tingting, FENG Jiaxing, WANG Lu 2024, 5 (10):  882-888.  doi: 10.3761/j.issn.2096-7446.2024.10.003 Abstract ( )   PDF (1326KB) ( )   Save Objective To construct and compare Logistic regression model and classification decision tree model of skin infection affected with multidrug-resistant organism（MDRO） in patients with pemphigus. Methods A total of 165 inpatients with pemphigus admitted to a tertiary class A hospital in Xi‘an from October 2015 to August 2023 were included and divided into the MDRO group and the control group according to the results of secretion culture and drug sensitive test from skin lesions. The factors were compared between the two groups and were used to established Logistic regression model and decision tree model. The discrimination（area under the curve） and accuracy（sensitivity and specificity） were committed to evaluate and compare between the two models. The two prediction models were validated by a verification group of 42 patients with pemphigus from September 2023 to March 2024. Results The skin infection rate of MDRO in pemphigus was 38.8%. Absolute neutrophil count （ANC）,hypoproteinemia and season of hospitalization were included in Logistic regression model. The model formula was P=1/[1+exp（-4.168+0.207 × ANC+2.913 × hospitalization in spring+1.256 × hospitalization in summer+1.508 × hospitalization in autumn+1.340 × hypoproteinemia）]. ANC,systemic glucocorticoid treatment and season of hospitalization were included in decision tree model,among which ANC was the most important predictor. There was no significant difference in area under the curve（AUC）（0.820 vs. 0.795） between the two models（P=0.438）. The results of accuracy showed that the sensitivity and the specificity of Logistic regression model was 0.609 and 0.871,and that of decision tree model was 0.422 and 0.970 respectively. The model validation results showed that AUC of Logistic regression model was 0.784,with a sensitivity of 0.625,and a specificity of 0.769 and that AUC of decision tree model was 0.804,with a sensitivity of 0.500,and a specificity of 0.885. Conclusion Both Logistic regression model and decision tree model have good predictive value and there is no significant difference between them. The two models should be combined in nursing application to improve the accuracy of prediction. References | Related Articles | Metrics

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Investigation of the current situation of pre-examination and triage of aortic dissection among emergency medical staff in general hospitals ZHANG Jingyue, XIAO Yaru, LI Miqi, HUANG Sufang, SHANG Weiwei, CHEN Ling 2024, 5 (10):  889-893.  doi: 10.3761/j.issn.2096-7446.2024.10.004 Abstract ( )   PDF (830KB) ( )   Save Objective to investigate the current situation of emergency pre-examination and triage for acute aortic dissection（AAD） in emergency departments of domestic general hospitals,and to provide reference for the establishment of standardized pre-examination and triage process for AAD. Methods Using convenient sampling method,613 emergency department medical staff from five regions across the country,including the eastern,southern,western,northern,and central regions,were selected as the research subjects from June to July 2022. The Current Survey of Acute Aortic Dissection based on HIRAID Evaluation Framework was used to analyze the current situation of emergency pre-examination and triage for AAD in the emergency department nationwide. Results In terms of medical history and identification of risk factors,16.80% of the emergency department medical staff said that they would use AAD related screening tools for initial triage screening. In the evaluation session,45.84% of the emergency department medical staff said that they did not actively measure the limb blood pressure of suspected patients with symptomatic typical AAD. There were significant differences in the application of screening tools related to AD,blood pressure measurement of limbs in suspected AAD patients with typical symptoms,and screening of acute coronary syndrome in patients with chest pain among different regions and different grades of hospitals（all P<0.05）. Conclusion The use rate of relevant screening tools was low in domestic general hospitals. There are significant differences in the quality of pre-examination and triage for AAD in hospitals of different regions and levels. It is necessary to establish a management mechanism suitable for pre-examination and triage of AAD in hospitals at all levels,and promote standardized management of emergency pre-examination and triage of AAD. References | Related Articles | Metrics

Special Planning—Pain Management of Critically lll Patients

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Application of nurse-led continuous adductor canal block analgesic management process in patients after knee replacement LÜ Bifang, YU Xiaoling, CHEN Jie, CHEN Shuyi, WANG Wenna 2024, 5 (10):  894-899.  doi: 10.3761/j.issn.2096-7446.2024.10.005 Abstract ( )   PDF (1129KB) ( )   Save Objective To investigate the effect of continuous adductor canal block analgesia management process led by pain specialist nurses in patients after knee replacement. Methods According to the implementation strategy of consensus-action-feedback-discussion,the management process of continuous adductor canal block for analgesia was developed with pain specialist nurses as the main body. By convenient sampling method,172 patients who underwent continuous adductor canal block for analgesia after knee replacement in a tertiary grade A hospital in Zhejiang Province from August to November 2023 were selected as the study objects,and the differences in the incidence rate of inadequate analgesia and timeliness indicators of analgesia within 48 hours were compared before and after the application of procedure. Results After the application of nurse-led procedure,the incidence of inadequate analgesia,the incidence of adverse reactions and the waiting time for anesthesiology treatment in the experimental group were significantly lower than those in the control group（P<0.05）. Conclusion The application of nurse-led continuous adductor canal block analgesia management process can significantly reduce the incidence of postoperative inadequate analgesia,reduce the incidence of adverse reactions after catheterization,and improve medical efficiency. References | Related Articles | Metrics

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Construction of training knowledge system of traditional Chinese medicine pain management for pain specialist nurses RUAN Xiaofen, YAO Meiqi, WANG Linghua, CHEN Jie, YU Xiaoling, HAN Xiaoxu 2024, 5 (10):  900-906.  doi: 10.3761/j.issn.2096-7446.2024.10.006 Abstract ( )   PDF (1348KB) ( )   Save Objective To establish a training knowledge system of traditional Chinese medicine（TCM） pain management for pain specialist nurses,and to provide references for TCM pain management training in Chinese pain care professionals. Methods Following the core competence theory,items of training knowledge system of TCM pain management were established by literature review and semi-structured interviews,then 17 experts were invited to participate in a 2-round consultation by Delphi method. Results The positive coefficients of two rounds of consultation were 100%,94.12%,respectively. Authority coefficient of two rounds consultation was 0.899,and the Kendall coordination coefficients were 0.406~0.606（P<0.001）. The final determined training knowledge system of TCM pain management for pain specialist nurses included 5 primary indexes,12 secondary indexes and 35 tertiary indexes. Conclusion The training knowledge system of TCM pain management for pain specialist nurses based on core competence is scientific and reliable,and can provide reference for standard and homogenous training of TCM pain management for pain care professionals in China. References | Related Articles | Metrics

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The influencing factors of prehospital pain management：a qualitative meta-synthesis HE Guobao, FAN Luo, JI Li, JING Chenyang, WANG Tuohong, WANGYUAN Yunzi, LI Beibei, CHEN Shan, LIU Luling 2024, 5 (10):  907-913.  doi: 10.3761/j.issn.2096-7446.2024.10.007 Abstract ( )   PDF (1136KB) ( )   Save Objective To systematically evaluate the attitudes and experiences of paramedics and patients towards pre-hospital pain management,identify the influencing factors,and provide references for formulating improvement measures. Methods The PubMed,Embase,CINAHL,Web of Science,Cochrane Library,CNKI,Wanfang and CBM were searched to retrieve the qualitative studies on pain management of paramedics and patients. The search limit was from the inception of each database until May 31,2023. The quality of included literature was evaluated according to the Joanna Briggs Institute（JBI） Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers. Meta-integration was employed to integrate the research results. Results A total of 70 research findings were extracted from 22 literature sources and categorized into 15 categories. Five synthesis results were summarized,including paramedics‘ factors,organizational factors,patients‘ factors,environmental factors,and scarcity of analgesic resources. Conclusion The influencing factors of prehospital pain management involve multiple dimensions and levels. It is necessary to comprehensively consider various factors such as paramedics,organizations,patients,environment,and analgesic resources in order to develop effective strategies for improving pre-hospital pain management. References | Related Articles | Metrics

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Best evidence of preoperative pain management for patients with aortic dissection ZHANG Yanjuan, TIAN Qing, PANG Ran, ZHAO Rui, KANG Xiaofeng, REN Hua, ZHANG Zhixin, WEI Wenyu, WANG Fei, ZHANG Chen 2024, 5 (10):  914-920.  doi: 10.3761/j.issn.2096-7446.2024.10.008 Abstract ( )   PDF (1622KB) ( )   Save Objective To retrieve,evaluate and summarize the best evidence of preoperative pain management for aortic dissection,and to provide references for clinical practice. Methods We searched the guideline websites,association official websites and databases to collect literature including guidelines,consensus,clinical decisions,recommend practice,evidence summaries,systematic reviews. The search period was from the establishment of the databases to June 30,2023. Two researchers independently evaluated quality of literature and extracted data. Results Totally 18 articles were enrolled,including 5 guidelines,9 expert consensuses,1 evidence summary,1 clinical decision,1 recommended practice and 1 systematic review. Finally 19 pieces of best evidence on pain management principles,pain management objectives,pain assessment tools,medication interventions,non-pharmacological interventions were summarized. Conclusion This study summarized the best evidence of preoperative pain management for aortic dissection,which can provide references for medical staffs to conduct more scientific and effective preoperative pain management in patients with aortic dissection. References | Related Articles | Metrics

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Research progress and insights into pain induced by airway suction in adult patients with invasive mechanical ventilation YU Tianhao, CHEN Xiangping, YIN Jinyu, LIU Qian, WANG Tao, LI Wenli 2024, 5 (10):  920-925.  doi: 10.3761/j.issn.2096-7446.2024.10.009 Abstract ( )   PDF (1466KB) ( )   Save Endotracheal suctioning is a common and essential invasive nursing procedure for adult patients with invasive mechanical ventilation. However,it has increasingly been associated with pain,a problem that has received insufficient attention from scholars in China. In light of the aforementioned issues,this article aims to provide a comprehensive review of the current state of pain occurrence,influencing factors and assessment tools in adult invasive mechanical ventilation patients. This review is intended to serve as a reference for healthcare professionals seeking to gain a more nuanced understanding of the pain induced by airway suction experienced by adult invasive mechanical ventilation patients and to inform the development of more effective management strategies. References | Related Articles | Metrics

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Research progress and enlightenment of evaluation and prediction tools for chronic ICU-related pain YIN Jinyu, CHEN Xiangping, LAO Yuewen, YU Tianhao, WANG Tao 2024, 5 (10):  926-931.  doi: 10.3761/j.issn.2096-7446.2024.10.010 Abstract ( )   PDF (1060KB) ( )   Save Chronic pain is one of the common symptoms of patients transferred from ICU,which not only affects the physical function of patients,but also causes negative emotions such as anxiety and depression,which seriously affects the quality of life of patients and causes huge social and economic burden. Through early prediction and accurate evaluation of pain,preventive measures can be taken in time to improve patients‘ comfort and quality of life. In this paper,the evaluation and prediction tools for chronic ICU-related pain（CIRP） of patients transferred from ICU are reviewed,aiming at providing reference for clinical medical staff to choose appropriate evaluation and prediction tools for CIRP and improve the incidence of CIRP. References | Related Articles | Metrics

Emergency Care Research

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Nursing care of a patient with anaphylactic shock caused by peripherally inserted central venous catheter JIANG Nan, SUN Hongling, GUO Xi, KE Yu, ZHAO Ruiyi 2024, 5 (10):  931-933.  doi: 10.3761/j.issn.2096-7446.2024.10.011 Abstract ( )   PDF (501KB) ( )   Save To summarizes the nursing experience of a breast cancer patient with anaphylactic shock caused by peripherally inserted central venous catheter（PICC） placement. In view of the unclear allergic source in the early stage of the onset,the similarities between the allergic symptoms and PICC-related stress reaction,arrhythmia,and anaphylactoid reaction,early identification of catheter allergy,activating a rapid response team,actively cooperating with anti-allergic and anti-shock treatment,close monitoring,psychological care and other measures were taken. The patient was discharged from the hospital in the stable condition 3 days after the treatment. The patient was followed up for 2 months after discharge and was in good condition. References | Related Articles | Metrics

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Nursing care of a patient with lymphoma complicated with hemophagocytic syndrome and spontaneous splenic rupture WANG Xin, SHUAI Qinyan, WU Yanfeng, SUN Caihong 2024, 5 (10):  934-936.  doi: 10.3761/j.issn.2096-7446.2024.10.012 Abstract ( )   PDF (555KB) ( )   Save To summarize the nursing experience of a patient with children systemic EB virus positive T-cell lymphoma complicated with hemophagocytic syndrome and spontaneous splenic rupture,whose initial symptom was fever. To address the urgent and critical issues of the patient with hemophagocytic syndrome and sudden spontaneous splenic rupture,we implemented the nursing measures,including early identification and management of spontaneous splenic rupture,strengthening perioperative management to prevent massive abdominal bleeding,risk management of postoperative pancreatic fistula,evaluation and prevention of venous thrombosis,special medication care of oxaliplatin and psychological support. The patient was discharged smoothly on the 33rd day after splenectomy and underwent allogeneic hematopoietic stem cell transplantation a month after discharge,with good recovery during follow-up to date. References | Related Articles | Metrics

Critical Care Research

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Nursing care of hyperfibrinolysis during extracorporeal membrane oxygenation therapy for a puerpera with congenital heart disease LU Yuping, ZENG Fei 2024, 5 (10):  937-940.  doi: 10.3761/j.issn.2096-7446.2024.10.013 Abstract ( )   PDF (773KB) ( )   Save To summarize the nursing experience of hyperfibrinolysis during extracorporeal membrane oxygenation （ECMO） therapy in a puerpera with congenital heart disease. In view of the rapid progression of the disease,the patient could not be immediately treated with surgery,and the veno-arterial ECMO（VA-ECMO） assisted supportive treatment was used,during which the patient‘s coagulation system was abnormally activated and secondary hyperfibrinolysis occurred. Nursing points included early warning of VA-ECMO hyperfibrinolysis,rapid and seamless replacement of ECMO oxygenator,target volume-oriented capacity management,individualized nursing with the puerperal as the main body. ECMO oxygenator replacement was the difficulty and focus of this case. After careful treatment and nursing,the patient‘s condition tended to be stable. ECMO was successfully removed on the 38th day supported by VA-ECMO,and tracheal intubation was successfully removed on the 41st day after admission. The patient‘s condition was stable and discharged after 72d admission. References | Related Articles | Metrics

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One-stop integrated care for a patient with multiple skin ulcers leading to secondary cranial bone exposure and diabetic foot complications CHEN Jie, CHEN Yuanyuan, HUO Yujia 2024, 5 (10):  940-943.  doi: 10.3761/j.issn.2096-7446.2024.10.014 Abstract ( )   PDF (714KB) ( )   Save To summarizes an one-stop integrated care approach for a patient with multiple skin ulcers leading to,secondary cranial bone exposure and diabetic foot complications. Based on the one-stop nursing model of integrated wards,we developed a targeted nursing plan for the entire course of treatment,including the flap care after head expansion fascial flap transfer surgery,recurrence prevention care after foot expansion negative pressure and other personalized wound care plans to help wound healing and prevent ulcer recurrence,whole-process blood sugar control and management,improving nutrition promotion programs,problem-oriented out-of-hospital continuous care. After multidisciplinary one-stop integrated nursing,the patient‘s condition improved and was discharged. After 3 months of follow-up,the patient‘s blood glucose was well controlled and the foot and crown ulcers healed. References | Related Articles | Metrics

Evidence Synthesis Research

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Comparing CAM-ICU and ICDSC for the screening of delirium in critically ill patients：a meta-analysis XIE Lingli, SUN Jianhua, ZHAO Mingxi, LUO Hongbo, LI Zunzhu 2024, 5 (10):  944-949.  doi: 10.3761/j.issn.2096-7446.2024.10.015 Abstract ( )   PDF (845KB) ( )   Save Objective To evaluate the screening efficacy of Confusion Assessment Methodof Intensive Care Unit（CAM-ICU） and Intensive Care Delirium Screening Scale（ICDSC） for the occurrence of delirium in critically ill patients,and to provide evidence for the selection of tools for the screening of delirium in critically ill patients. Methods Comparative studies on accuracy of diagnostic tests between CAM-ICU and ICDSC were searched by computer in Pubmed,Web of Science,Embase,The Cochrane Library,CNKI,Wanfang Database,VIP database and Chinese Biomedical Literature database,respectively from the establishment of the database to February 24,2023. After literature screening,literature quality assessment and data extraction,Rev Man 5.3 and meta-DiSc software were used for data analysis. Results A total of 10 studies were included. The combined sensitivity of CAM-ICU and ICDSC were 0.73 and 0.77,respectively. The combined specificity was 0.93 and 0.91. The odds ratios of combined diagnosis were 37.62 and 36.95. Conclusion Both CAM-ICU and ICDSC have good diagnostic validity in screening patients with moderate and severe delirium. However,based on the fluctuation characteristics of delirium,CAM-ICU may be more suitable for delirium assessment in patients in the ICU environment. References | Related Articles | Metrics

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Summary of the best evidence of patient- and family-centered care in adult ICUs GUO Qiying, DONG Yanyan, LING Donglan, YU Tingting, LU Murong, YU Hongjing 2024, 5 (10):  950-956.  doi: 10.3761/j.issn.2096-7446.2024.10.016 Abstract ( )   PDF (1101KB) ( )   Save Objective The evidence of patient- and family-centered care in the adult ICUs was retrieved,screened and evaluated,and the best evidence summary was formed,so as to provide references for clinical practice. Methods In accordance with the "6S" evidence model,domestic and international computerized decision support systems,guideline networks,databases,and websites of related societies were systematically searched,and the types of literature included clinical decisions,best practices,guidelines,evidence summaries,systematic reviews and expert consensuses,with a timeframe from the establishment of the database to June 14,2023. Two researchers screened the literature,assessed quality and extracted information,and the evidence was categorized and integrated by the research team. Results Thirteen publications were ultimately included,including three clinical decisions,two guidelines,seven systematic reviews and one consensus. A total of 24 pieces of best evidence with 6 dimensions were summarized,including improving the environment,holding communication meetings between health care providers and families,increasing family companionship,improving support for families,providing palliative care for patients and offering continuous care. Conclusion The best evidence summary of patient- and family-centered care in the adult ICUs was summarized in this study. It is recommended for ICU medical staff to formulate an individualized intervention protocol based on the clinical context,the patient and the family,so as to improve ICU patient-family outcomes. References | Related Articles | Metrics

Forum

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The role of nurses in precise management of gastrointestinal dysfunction in critically ill patients ZHOU Xinyi, DENG Haibo, SUN Jianhua, XU Yuan, GUO Shuli, MA Yufen 2024, 5 (10):  957-960.  doi: 10.3761/j.issn.2096-7446.2024.10.017 Abstract ( )   PDF (624KB) ( )   Save The prevention and management of gastrointestinal dysfunction in critically ill patients is very important,and nursing staff participate in the whole process of gastrointestinal function assessment,symptom management,nutritional support and complication monitoring of patients,which plays a pivotal role. In recent years,a lot of new evidence and new ideas have emerged in the management of gastrointestinal dysfunction in critically ill patients at home and abroad,showing a new trend of symptom-oriented and precise nursing management. This paper introduced the management of gastrointestinal dysfunction in critically ill patients from three aspects,namely early identification of high-risk patients with gastrointestinal dysfunction,ultrasound-guided precision monitoring of gastrointestinal function and standardized implementation of evidence-based nursing programs. And it also summarized the responsibilities of nurses in the precise management of gastrointestinal function in critically ill patients,put forward the suggestions on how to exert the value of nurses. References | Related Articles | Metrics