Purpose The study aims at exploring the impact of dietary intake on the relief of bowel dysfunction among patients with rectal cancer after the sphincter-saving surgery. Methods A prospective cohort design was used. A total of 299 patients were followed up at a tertiary hospital in East China between April 2020 and July 2021. Postoperative food intake was assessed with a food frequency questionnaire, and bowel dysfunction was assessed with Memorial Sloan Kettering Cancer Center’s bowel function scale. The generalized estimating equation and the generalized additive mixed model were used to analyze the collected data. Results The average daily intake of livestock and poultry meats and dairy products during the first 6 months after sphincter-saving surgery was significantly associated with the relief of bowel dysfunction. Bowel dysfunction was relieved most quickly among patients who consumed 40.81 to 59.1 g/d of livestock and poultry meat during the first 3 months after surgery. Bowel dysfunction improved more slowly during the first 6 months after surgery among patients who consumed greater than 107.11 g/d dairy products than among patients who consumed 0 g/d dairy products. Conclusion The impact of dietary factors on bowel dysfunction observed in this study added to the limited evidence about the specific effects of consuming foods and nutrients on defecation dysfunction, and these results provided a theoretical basis for the use of dietary modification programs aimed at relieving bowel dysfunction as soon as possible.

In China, high-risk pregnancies of women with gestational diabetes mellitus were formally all treated by obstetricians. Comprehensive care during the gestational period was lacking. In hospitals in China, the nurse practitioner in gestational diabetes mellitus management is a completely new role. This study explored the implementation of this role and revealed its advantages. To further improve the implementation of this role, more studies are needed to address the related issues, such as how to develop a reasonable scope of practice, how to establish targeted educational programs, and how to evaluate the work to guarantee the safety of provided care.

目的 探讨心脏外科手术患者术前舌压对术后获得性吞咽障碍的预测价值.方法 纳入心脏外科手术患者 387 例,收集患者一般资料、围手术期资料,采用吞咽舌肌评估训练仪测量其术前最大舌压,并评估术前术后的吞咽功能.采用分层 logistic回归分析探索患者术后获得性吞咽障碍的危险因素,以术后 4 h吞咽障碍发生为金标准,绘制术前最大舌压预测心脏术后获得性吞咽障碍的LOC曲线.结果 共 32 例患者发生术后获得性吞咽障碍,发生率为 8.3%.在控制一般资料及围手术期资料后,术前最大舌压是心脏术后获得性吞咽障碍的独立影响因素(OL=0.938,95%CI:0.881～0.999).最大舌压预测心脏术后获得性吞咽障碍发生的曲线下面积 0.722(95%CI:0.630～0.814),最佳临界值 43.13 kPa,敏感性 71.9%,特异性 65.1%.结论 心外科患者术前最大舌压对术后获得性吞咽障碍的发生有良好预测价值.术前最大舌压越大,术后获得性吞咽障碍发生越少,当术前患者最大舌压低于 43.13 kPa时,应高度关注患者术后是否有吞咽功能的异常.

The labor markets for care professionals are a perennial topic of discussion. Advanced practice nurses (APN), as an advanced role in nursing, arose to solve the shortage of primary health care professionals. Prior research has advanced several areas of exploration for APNs' training or employing methods in Chinese hospitals. However, this leaves a key imperative unexplored: the management strategy of APNs in hospitals. The present study seeks to explore the management strategy of APNs in Chinese hospitals. The resource orchestration theory served as the guide as the multi-case study method investigated 18 case hospitals, gathered information from a variety of case data sources, and summarized the management strategies for hospitals' advanced practice nurses. Four types of APN management strategies-expert customized type, hierarchical linkage type, multidisciplinary benefit type, and professional penetration type-have been identified through resource orchestration. Hospitals can utilize the APN management strategy model as a guide to manage APNs in accordance with the unique characteristics of APN resources.

目的 了解专科护士工作获得感的源泉,为专科护士使用和管理提供依据.方法 采用现象学研究方法,选取我国11所医院33名专科护士进行半结构式访谈,应用Colaizzi七步分析法对资料进行分析、归纳、提炼主题.结果 提炼出专科护士工作获得感源泉的4个主题及12个亚主题,包括工作回报获得感(能力提升、发展晋升、薪酬激励)、价值认同获得感(患者认同、职业归属、社会认可)、组织支持获得感(医院支持、文化塑造、管理赋能)、自我超越获得感(自主决策、挑战创新、职业期望).结论 医院通过健全管理体系、增强职业认同、加强医院支持与获得环境等方面的优化提升,激发专科护士工作获得感,进而增强其工作投入度、主动性与创造力,最终实现医院专科护理队伍高质量发展.

The mechanisms underlying the negative associations between pre-pregnancy body mass index (BMI) and exclusive breastfeeding remain poorly understood. Thus, the study aimed to determine whether the negative associations between high pre-pregnancy BMI and exclusive breastfeeding at six weeks postpartum are mediated by components of the capability, opportunity, and motivation behaviour (COM-B) model. In this prospective observational study, we assigned 360 primiparous women to a pre-pregnancy overweight/obese group (n = 180) and a normal-BMI group (n = 180). A structural equation model was designed to study how capabilities (onset of lactogenesis II, perceived milk supply, breastfeeding knowledge, and postpartum depression), opportunities (probreastfeeding hospital practices, social influence, social support), and motivations (breastfeeding intention, breastfeeding self-efficacy, and attitudes towards breastfeeding) affected exclusive breastfeeding at six weeks postpartum in groups of women with different pre-pregnancy BMIs. In all, 342 participants (95.0%) possessed complete data. Women with high pre-pregnancy BMI were less likely to exclusively breastfeed at six weeks postpartum than women with a normal BMI were. We observed a significant negative direct effect of high prepregnancy BMI on exclusive breastfeeding at six weeks postpartum and a significantly negative indirect effect of high pre-pregnancy BMI via the explanatory mediating variables of capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy) on exclusive breastfeeding at six weeks postpartum. Our findings support certain capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy), partially explaining the negative association between high pre-pregnancy BMI and exclusive breastfeeding outcome. We suggest that interventions aimed at promoting exclusive breastfeeding among women with high pre-pregnancy BMI should address the capacity and motivation factors specific to this population.

Purpose To explore the experience of controlling defaecation dysfunction among patients with rectal cancer after sphincter-saving surgery.Methods This study applied a descriptive qualitative design. Thirty-six patients with rectal cancer were given semi-structured interviews in mainland China from February to July in 2019 after sphincter-saving surgery. Participants were recruited by purposive sampling. The thematic analysis approach was applied to analyse the transcripts.Results Three major themes emerged from the data were "having motivations of controlling defecation dysfunction", "using strategies of controlling defecation dysfunction" and "facing barriers of controlling defecation dysfunction".Conclusion Defaecation dysfunction makes obvious problems for patients after sphincter-saving surgery, although patients tried some self-care methods to cope with the defaecation dysfunction, some barriers still exist in the process of self-controlling of bowel symptoms. There is a strong demand for a systematic and scientific guideline for the self-management of defaecation dysfunction.

Background Fatigue is one of the most prevalent symptoms among pregnant women. In patients with various diseases, pro-inflammatory cytokines are associated with fatigue; however, such associations are unknown in pregnant women. Objectives The objective of this study was to examine the associations between pro-inflammatory cytokines and prenatal fatigue. Methods A cross-sectional study was conducted on 271 pregnant Chinese women in their third trimester of pregnancy. Patient-reported Outcome Measurement Information System (PROMIS) was used to evaluate women’s prenatal fatigue. Using enzyme-linked immunosorbent assay (ELISA), the serum concentrations of four pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8), were measured. The data was analyzed by correlation analysis and general linear regression analysis. Results In this sample, the mean (standard deviation) of fatigue scores was 51.94 (10.79). TNF-α (r = 0.21, p < 0.001), IL-6 (r = 0.134, p = 0.027) and IL-8 (r = 0.209, p = 0.001) were positively correlated to prenatal fatigue, although IL-1β was not. TNF-α (β = 0.263, p < 0.001), along with sleep quality (β = 0.27, p < 0.001) and depression (β = 0.376, p < 0.001) independently predicted prenatal fatigue. Conclusions TNF-α was identified as an independent biomarker for prenatal fatigue in our study. Reducing pro-inflammatory cytokines may be a unique method for lowering prenatal fatigue and, consequently, enhancing mother and child health.

Background Perinatal fatigue among women is related to the clinical outcomes of mothers and infants. Perinatal fatigue changes over time, and the trajectory varies according to the predictors and outcomes of the mothers. This, however, has not been documented in any study. Objectives This study aimed to identify and characterize the trajectory patterns of perinatal fatigue among women from late pregnancy to 6 months after delivery. Methods We used growth mixture modeling to estimate the trajectory of perinatal fatigue at 28 gestational weeks (T0), 37 gestational weeks (T1), 3 days (T2), 1 week (T3), 6 weeks (T4), and 6 months (T5) after delivery with (n = 1,030). The Mann-Whitney U test and binary logistic regression were used to tie the selected trajectory classes to predictors and outcomes. Results There were two distinct patterns of perinatal fatigue in women: “persistently high” (11.1%, n = 114) and “persistently low” (88.9%, n = 916). Levels of perinatal fatigue among women in the “persistently high” group were higher than those in the “persistently low” group across the six measurements. Complications, fatigue at T0, and employment status in late pregnancy were all significant predictors of trajectories. Additionally, the “persistently high” group had a greater prevalence of difficult baby care and weight retention and a lower prevalence of exclusive breastfeeding. Conclusions Our study proved the heterogeneity and characteristics of perinatal fatigue among women. Future research should concentrate on developing intervention packages targeted at specific individuals in order to alleviate perinatal fatigue in women.

Background.Perinatal fatigue among women is related to the clinical outcomes of mothers and infants.Perinatal fatigue changes over time, and the trajectory varies according to the predictors and outcomes of the mothers.This, however, has not been documented in any study.Objectives.This study aimed to identify and characterize the trajectory patterns of perinatal fatigue among women from late pregnancy to six months after delivery.Methods.We used growth mixture modeling to estimate the trajectory of perinatal fatigue at 28 gestational weeks (T0), 37 gestational weeks (T1), three days (T2), one week (T3), six weeks (T4), and six months (T5) after delivery with (n=1030).The Mann-Whitney U test and binary logistic regression were used to tie the selected trajectory classes to predictors and outcomes.Results.There were two distinct patterns of perinatal fatigue in women: "persistently high" (11.1 %, n=114) and "persistently low" (88.9 %, n=916).Levels of perinatal fatigue among women in the "persistently high" group were higher than those in the "persistently low" group across the six measurements.Complications, fatigue at T0, and employment status in late pregnancy were all significant predictors of trajectories.Additionally, the "persistently high" group had a greater prevalence of difficult baby care and weight retention and a lower prevalence of exclusive breastfeeding. Conclusions.Our study proved the heterogeneity and characteristics of perinatal fatigue among women.Future research should concentrate on developing intervention packages targeted at specific individuals in order to alleviate perinatal fatigue in women.

Background.Fatigue is one of the most prevalent symptoms among pregnant women.In patients with various diseases, pro-inflammatory cytokines are associated with fatigue; however, such associations are unknown in pregnant women.Objectives.The objective of this study was to examine the associations between pro-inflammatory cytokines and prenatal fatigue.Methods.A cross-sectional study was conducted on 271 pregnant Chinese women in their third trimester of pregnancy.Patient-reported Outcome Measurement Information System (PROMIS) was used to evaluate women's prenatal fatigue.Using enzyme-linked immunosorbent assay (ELISA), the serum concentrations of four pro-inflammatory cytokines, including tumor necrosis factor alpha(TNF-α), interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8), were measured.The data was analyzed by correlation analysis and general linear regression analysis.Results.In this sample, the mean (standard deviation) of fatigue scores was 51.94 (10.79).TNF-α (r=0.21,p<0.001),IL-6 (r=0.134,p=0.027) and IL-8(r=0.209,p=0.001) were positively correlated to prenatal fatigue, although IL-1β was not.TNF-α (β=0.263,p<0.001), along with sleep quality(β=0.27,p<0.001) and depression (β=0.376,p<0.001) independently predicted prenatal fatigue.Conclusions.TNF-α was identified as an independent biomarker for prenatal fatigue in our study.Reducing pro-inflammatory cytokines may be a unique method for lowering prenatal fatigue and, consequently, enhancing mother and child health.

概念图法是一种被广泛应用的混合性研究方法,实施步骤包括:前期准备、产生声明、声明结构化、概念图分析、解读概念图和概念图应用.目前,该方法在国内护理领域中应用尚少.本文以一项居家安宁疗护的研究为例,探讨概念图法在护理科研中的应用过程,以期为今后在护理领域运用概念图法提供参考.

Background Dietary management was an important strategy for controlling low anterior resection syndrome (LARS) after sphincter-saving surgery, however, the influencing dietary factors of LARS are not completely clear. This study aims at exploring the specific association between perioperative intake of foods and nutrients and the improvement of LARS within the first 6 months after surgery. Methods This study applied a prospective cohort design. 210 consecutive patients were admitted in the colorectal surgical ward after the sphincter-saving surgery in a tertiary hospital in China from May to November in 2020. The perioperative food intake was assessed by the food frequency questionnaire, and the bowel symptoms were assessed by the Low Anterior Resection Syndrome Score Scale. The binary logistic regression was used to analyze the collected data. Results It was found out that both the intake of oil before surgery and at 6 months after surgery were significantly associated with the improvement of LARS. The average daily intake of livestock and poultry meats and oil during the first 6 months after sphincter-saving surgery were also associated with the improvement of LARS. Conclusions The relationship between the intake of Livestock and poultry meats and oil and the improvement of LARS was significant in this study. It provides evidence for medical staff to make up effective interventions of moderating diet to promote the relief of LARS during the first 6 months after sphincter-saving surgery.

Background Pre-pregnancy overweight and obesity are negatively associated with delayed onset of lactogenesis II (OL), but the mechanisms by which these conditions affect OL are still unclear. Objectives To identify biological factors related to pre-pregnancy overweight/obesity and determine whether these biological factors were associated with delayed OL in this population. Methods In this prospective observational study, we assigned 72 primipara to a pre-pregnancy overweight/obese group ( n = 36) and a normal-weight group ( n = 36). Blood samples were collected at 37 w of gestation and 48 h postpartum and assayed for levels of the following hormones: leptin, insulin, estradiol, prolactin (PRL), progesterone, and oxytocin. The primary outcome was timing of OL, estimated by maternal perception of breast fullness. We used linear-regression analysis to determine associations between hormones and delayed OL. Results Sixty-three participants (87.5%) had complete data. OL occurred later in overweight/obese than in normal-weight women ( p < .001). Compared with the normal-weight group, the overweight/obese group showed higher leptin levels at both times of observation and exhibited a slower drop in estrogen concentrations from 37 w of gestation to 48 h postpartum (all p < .05). After adjusting for confounding factors, leptin concentrations in late pregnancy and the magnitudes of decline in estrogen concentrations at 48 h postpartum were correlated with OL. Conclusion Women who were overweight/obese before pregnancy had elevated leptin levels in late pregnancy and a delayed decline in estrogen concentrations at 48 h postpartum. Both of these phenomena were related to delayed OL in this population.

本文对直肠癌保肛术后排便障碍患者饮食管理的相关研究进行综述,包括排便障碍的发生机制,排便障碍的护理,排便障碍与饮食的相关性,直肠癌保肛术后患者控制排便障碍的饮食管理需求及现状等.鉴于目前的研究现状,建议医护人员针对排便障碍的饮食相关影响因素开展广泛、深入探索,为临床护理人员采取科学合理的饮食管理方案提供可靠依据,以期更好地控制直肠癌保肛术后患者的排便障碍,提高患者生活质量.

目的探索上海市居家安宁疗护服务开展的阻碍因素,明确解决这些因素的优先顺序和可行性,为推动居家安宁疗护服务开展提供参考.方法采用概念图法作为方法学指导:通过质性访谈和文献回顾,探索影响居家安宁疗护服务开展的阻碍因素;对阻碍因素进行分类,并对解决每个因素的优先度和可行性进行评分;通过多维尺度分析和层次聚类分析形成概念图.结果共有50名来自社区卫生服务中心和卫生管理部门的人员参加.通过访谈和文献回顾获得61个阻碍因素,层次聚类分析分为5类:员工能力和实践场所(优先级= 4.93,可行性= 4.38);服务设计(优先级= 5.08,可行性= 4.30);医疗费用和工作酬劳(优先级= 5.62,可行性= 4.40);患者与家属的知识和态度(优先级=5.07,可行性= 4.27);其他因素(优先级=4.42,可行性= 3.69).结论综合考虑5个聚类解决的优先度和可行性,最应优先解决且具有较高可行性的是医疗费用和工作酬劳问题.建议出台相关政策,保障专项资金的落实,建立合理的服务收费标准,并适当提高工作人员酬劳,以鼓励医护人员积极投入居家安宁疗护服务中.

目的 分析上海市社区医护人员在提供安宁疗护服务中遇到的困难,为促进服务开展提出建议.方法 采用目的抽样法,选取14家社区卫生服务中心的26名参与安宁疗护服务的医护人员进行半结构式访谈,以社会生态模式为框架,采用质性内容分析法提炼主题.结果 影响安宁疗护服务开展的个人层面因素包括患者和家属的认知与观念、医护人员的工作能力和积极性;人际层面的影响因素包括医患互动不理想;组织层面的因素包括服务形式和频次、人力资源、医疗药品和设备、绩效评估体系和服务收费标准.结论 建议完善社区人力、药物资源配置;构建完善绩效评估体系和服务收费标准;提供安宁疗护专科培训,提升医护人员专业能力;加强安宁疗护宣传,提高民众接受度.

Aim: To explore the experience of dealing with defecation dysfunction by changing the eating behaviours of people with rectal cancer following sphincter-saving surgery. Design: The descriptive qualitative design was applied. Methods: Individual semi-structured interviews were conducted with 36 purposively selected rectal cancer survivors who had experienced sphincter-saving surgery. All interviews were recorded and transcribed verbatim. The thematic analysis was used to structure the data analysis. Results: Three major themes, namely "have motivations to change diet"; "need strategies to change diet" and "face barriers to change diet" were generated along with 12 subthemes. Overall, needing to change one's dietary behaviour is the most important theme in addressing defecation dysfunction in patients following sphincter-saving surgery. Future studies need to focus more on the specific relationship between different food types and the degree of defecation dysfunction. Systematic, scientific and continuous instructions on eating behaviour are in great need for patients after sphincter-saving surgery.

ObjectiveTo review the studies on the home-based end⁃of⁃life care both at home and aboard，in order to shine a light on the future development of the home⁃based end⁃of⁃life care in China.MethodsLiteratures on home⁃based end⁃of⁃life care were searched in PubMed，Web of science，CINAHL，Scopus，OVID，PubMed，Sino⁃Med，CNKI，Wanfang data and VIP databases from January 2009 to July 2019 using summary evaluation.The literatures on home⁃based end⁃of⁃life care were included，and the structure，process，and outcome of services were described and summarized using the Donabedian evaluation framework.ResultsA total of 92 articles including 58 end⁃of⁃life care programs in foreign countries and 25 end⁃of⁃life care programs in China were reviewed.Patients in most Chinese end⁃of⁃life care programs were cancer patients，while service objects in foreign countries were more diversified.Doctors and nurses were the main care providers.The multidisciplinary team of the end⁃of⁃life care in China still need to develop.Home visits and telephone follow⁃ups were the most common service form.The frequency of the service in foreign countries was higher than that in China.The frequency of nurse visits were higher than that of doctor visits.The knowledge education of end⁃of⁃life care and death education were the characteristics of domestic service.Domestic literatures mostly focused on outcomes of patients，while foreign literatures focused on the outcomes related to medical resources.ConclusionThe domestic home⁃based end⁃of⁃life care could appropriately expand the scope of admission，build the multidisciplinary service team，give full play to the important role of nurses，increase the service frequency，and add the indicators related to the medical service system in the service evaluation.

Dietary self-management is an important strategy for controlling bowel symptoms after sphincter-saving surgery; however, the dietary factors influencing bowel symptoms are not completely clear. This study aimed to explore the relationship between the specific consumption of food components and bowel symptoms. This study applied a cross-sectional study design. Using convenience sampling, a total of 169 patients with rectal cancer after sphincter-saving surgery were selected from a tertiary hospital. Data were collected through three questionnaires, including general and treatment-related questionnaires, the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function scale—Chinese version, and the Food Frequency Questionnaire. Multiple linear regression analysis was used to analyze the collected data. It was found that the consumption of fruit, cholesterol, and protein and the interaction of cereals and milk products were the main dietary factors affecting bowel symptoms in patients after sphincter-saving surgery. The consumption of protein and fruit was negatively correlated with the symptoms of frequent and urgent defecation, and the consumption of fruit and protein was negatively correlated with general bowel function. The consumption of fruit was negatively correlated with the abnormal feeling of defecation, and the interaction between cereals and milk products was positively correlated with the abnormal feeling of defecation. The results of this study provide evidence for medical staff to further develop scientific dietary education programs to relieve bowel symptoms and promote the quality of life of patients in the future. More research is also needed to explore the mechanisms of the effects of different food components on bowel symptoms in patients after sphincter-saving surgery in the future.