目的 结合技术接受模型和信息系统成功模型,基于结构方程分析护理临床决策支持系统临床护士使用意愿及影响因素,以期为该系统的优化提供有价值的建议.方法 通过循证文献和咨询专家初步拟定影响因素,建立结构方程模型,采用自制问卷对使用该系统的临床护士调查,以验证该模型的有效性,确定影响因素,并分析路径.结果 信息质量、服务质量、系统质量、感知易用性、感知有用性、使用意愿维度均分分别为(2.64±1.04)分、(2.31±0.85)分、(2.28±1.03)分、(2.40±0.94)分、(2.24±0.83)分、(2.28±0.89)分.感知有用性和感知易用性对使用意愿有正向影响,路径系数分别为 0.267、0.392(P＜0.05);系统质量、信息质量、服务质量对感知有用性有正向影响,路径系数分别为 0.175、0.085、0.526(P＜0.05);系统质量、信息质量、服务质量对感知易用性有正向影响,路径系数为分别 0.130、0.197、0.170(P＜0.05).结论 系统质量、信息质量、服务质量是护士感知有用性和感知易用性的重要影响因素,感知有用性和感知易用性是护理临床决策支持系统使用意愿的关键影响因素.

可穿戴设备因具有便携、灵活、可穿戴等特点,已被应用于骨科康复医学中.本文通过文献复习,总结国内外可穿戴设备的发展现状,从监测康复步态、关节活动度、辅助关节支撑及脊髓神经功能康复4个方面归纳可穿戴设备在骨科康复中的应用与进展,为骨科临床康复提供一定的技术支撑.

Objective This paper constructs the quality evaluation index of “Internet plus nursing services”,and establishes quantifiable indicators in order to further promote the development of “Internet plus nursing services”. Methods Based on the three-dimensional quality structure theory, the first draft of the index system was drawn up and the questionnaire was compiled. The Delphi method was adopted to conduct two rounds of correspondence consultation with 18 experts, and weights of indicators at all levels were determined by the analytic hierarchy process. Results The effective recoveries of two rounds of expert questionnaire by correspondence were 100% and 94.44%,and the coefficients of expert authority were 0.805 and 0.818 respectively. The Kendall’s coefficients of concordance in two rounds of correspondence consultation were 0.137 and 0.180（P＜0.001）respectively. Finally, the quality evaluation index of “Internet plus nursing services” has been formed, including 3 first-level indicators, 15 second-level indicators and 51 third-level indicators. Conclusions The quality evaluation index of “Internet plus nursing services” constructed in this study provides the basis of quality evaluation for promoting “Internet plus nursing services” safely.

Objective:To explore the effect of Helicobacter pylori(HP)eradication on development of metachronous gastric cancer(MGC)after endoscopic submucosal dissection(ESD)in elderly patients with early gastric cancer.Methods:From January 2014 to December 2019, 748 early gastric cancer patients aged 60 years or older, receiving ESD in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, were included.According to the situation of HP infection and eradication efficacy within 1 year postoperatively, patients were divided into three groups.The patients with HP infection and successful HP-eradication were enrolled into successful eradication group, those without eradicating or with eradication failure were enrolled into eradication failure group, those with HP negative were enrolled into HP-negative group.And then the occurrence and risk factors of MGC after ESD among the three groups were statistically analyzed.Results:MGC were detected in 58 cases(7.7%)in elderly patients with early gastric cancer after ESD.The median follow-up time was 39 months.The multivariate regression analysis results of MGC showed that no HP-eradication or HP eradication of failure( HR=2.231, 95% CI: 1.054-4.722, P=0.036)and multiple lesions( HR=1.857, 95% CI: 1.076-3.204, P=0.026)were independent risk factors.Non-smoking was a protective factor for the occurrence of MGC( HR=0.409, 95% CI: 0.234-0.716, P=0.002). After adjusting for confounding factors, Cox proportional risk regression analysis showed that the incidence of MGC was significantly higher in group of no HP-eradicating or HP-eradicating of failure than in group of successful HP-eradicating group( χ2=37.877, P<0.001). Conclusions:HP eradication can effectively prevent MGC in elderly patients with early gastric cancer after ESD.Multiple lesions and smoking are independent risk factors for MGC.

Objective:To retrieve, evaluate and integrate relevant evidence on telerehabilitation management of motor function in stroke patients with hemiplegia.Methods:Guidelines, best practices, evidence summaries, and systematic reviews on the management of motor function telerehabilitation in stroke patients with hemiplegia were systematically retrieved from UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, National Institute for Health and Care Excellence, Canadian Medical Association, Guidelines International Network, Cochrane Library, PubMed, Web of Science, Medline, WanFang, China National Knowledge Infrastructure, VIP and China Biomedical Database. The retrieval time limit was from the establishment of the database to August 17, 2021. After evaluating the methodological quality of the article, two researchers extracted and summarized relevant evidence according to the theme.Results:According to the inclusion and exclusion criteria, a total of two guidelines and 15 systematic reviews were included. A total of 36 pieces of best evidence were obtained from 10 aspects of organization team, process arrangement, remote media, motor environment, personality assessment, motor plan, motor program, effect evaluation, motor safety and health education.Conclusions:The best evidence for the telerehabilitation management of motor function in stroke patients with hemiplegia is summarized, which provides relevant evidence-based support for clinical practice.

目的 检索、再评价脑卒中患者远程康复运动管理的系统评价,为临床医护人员临床决策及康复运动干预策略的持续改进提供借鉴.方法 计算机检索Cochrane Library、Embase、PubMed、Web of Science、CINAHL、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库以及万方数据库、中国知网、维普数据库和中国生物医学文献数据库,查找关于脑卒中患者运动功能远程康复管理相关的系统评价/Meta分析/荟萃分析,检索时限为建库至2021年9月19日.2名经过循证知识系统培训的研究人员应用系统评价方法学质量评价工具(Assessment of Mutiple Systematic Reviews,AMSTAR)对文献进行方法学质量评价后,采用推荐分级的评估、 制订与评价(Grades of Recommendations Assessment,Development and Evaluation,GRADE)系统进行证据汇总与分级.结果 初检文献124篇,纳入文献14篇,AMSTAR质量评价结果显示,中等质量文献有5篇,其余9篇为高等质量,纳入文献的整体方法学质量较高.采用GRADE系统对14篇系统评价的67条主要结局指标的证据质量评价结果显示,22条证据为中等质量,29条证据为低等质量,16条证据为极低质量.结论 该研究纳入的系统评价方法学质量较高,但其结局指标证据质量较低.远程康复运动管理有利于改善患者的运动功能、生活自理能力及生活质量,可提高患者的满意度与参与度,但远程运动管理干预方式的研究设计及结局指标的客观性仍需改进.

在相关文献分析基础上,阐述可穿戴设备定义和关键技术、基本结构以及在骨科康复护理领域中的应用情况、特征、优势,提出相关建议,为可穿戴设备在骨科临床护理中的应用提供有益借鉴.

目的 探讨早期胃癌内镜黏膜下剥离术后远程随访管理平台的应用效果.方法 建立远程随访管理平台,对66例早期胃癌内镜黏膜下剥离术后患者(观察组)进行远程随访,并与此前采用常规电话随访的221例患者(对照组)进行随访效果比较.结果 观察组术后首次内镜复查率及幽门螺杆菌根除治疗率显著高于对照组(均P＜0.05).96.97％患者对平台使用十分满意或满意.结论 早期胃癌内镜黏膜下剥离术后远程随访管理平台的应用可提升患者术后随访管理效率,提高患者术后随访依从性及满意度.

Objective:To explore the effectiveness of blended learning in the clinical teaching of wound care clinic.Methods:Blended learning based on WeChat and offline CBL teaching method was constructed by applying evidence-based nursing. Totally 125 interns from the wound care clinic of our hospital were selected as subjects, among which 62 didn't receive the blended learning (control group), and 63 received the blended learning (observation group). At the end of the two-week practice, the effectiveness of the two teaching methods was compared. The objective evaluation was carried out in the forms of theory test, practice evaluation and comprehensive quality questionnaire combined with online self-test and offline practice. All data were analyzed by SPSS 20.0 statistical software.Results:The scores of theory test, practice evaluation and comprehensive quality assessment in the observation group were all higher than those in the control group ( P<0.001). Conclusion:The blended learning with WeChat as the medium can guide student active learning, consolidate the basic knowledge, improve the efficiency of teaching, stimulate the enthusiasm of practice, and improve the comprehensive quality. It's a clinical teaching method that can be used for reference.

以信息系统成功模型为基础,采用问卷调查法分析临床护士对智能护理信息系统使用情况、影响因素,从医院管理、护理管理、护士自身层面提出建议.

Objective:To construct the rehabilitation strategy of anterior cruciate ligament reconstruction based on the evidenced method and evaluate the effectiveness in clinic.Methods:The rehabilitation strategy was firstly built based on evidenced method. And then 80 patients from Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital from January to August, 2019 were randomly and equably sent to experiment group and control group. Patients in experiment group or control group were accepted the evidenced method or regular method as treatment strategy, respectively. The visual analogue scale (VAS), thigh circumference, motion range of knee joint and Lysholm score were recorded before and after surgery.Results:Six papers met the inclusion criterion and were been screen out from 1 535 papers, and then the evidenced rehabilitation strategy of anterior cruciate ligament reconstruction was made. The VAS scores in 12 and 24 h were 1(0-2), 1(1-3) in experiment group and 2(1-3), 3(1-3)in control group, the differences were significant between two groups( Z values were 4.955, 6.489, P<0.001). The motion ranges of knee joint in 2, 4, 6, 12 weeks after operation were (61.6±5.1)°, (85.3±6.6)°, (114.6±5.2)°, (127.6±3.4)° in experiment group and(54.9±4.6)°, (71.0±8.8)°, (105.1±5.9)°, (115.8±4.0) °in control group, the differences were significant between two groups( t values were 6.209-14.138, P<0.001). The Lysholm scores at 6,8,12 weeks after operation were 58.8±3.7, 71.1±3.1, 84.3±3.7 in experiment group and 56.0±3.4, 65.4±4.3, 75.6±3.0 in control group, the differences were significant between two groups( t values were 3.511, 6.867, 11.439, P<0.001). Conclusions:This evidenced rehabilitation strategy of anterior cruciate ligament reconstruction in this study was helpful to alleviating the pain, improving motion range of knee joint after anterior cruciate ligament reconstruction.

结合消化内镜图文系统,根据消化内镜中心工作实际,构建并应用消化内镜清洗消毒闭环管理系统.实施后,清洗消毒错误事件从2017年2973例下降至663例,工作效率从2017年30条/天提升至40条/天,差异均具有统计学意义(P<0.05).消化内镜清洗消毒闭环管理系统提高了清洗消毒质量,提高了人力资源使用效率,提升了消化内镜中心质量管理水平.

目的 调查护士职业倦怠、职业认同、结构授权得分情况并分析职业倦怠的影响因素.方法 采用一般资料问卷、职业倦怠量表、护士职业认同评定量表及结构授权量表对南京市某三甲医院的1005名护士进行调查.结果 护士处于重度职业倦怠,职业倦怠各维度得分:情感衰竭为(24.81±10.76)分,去人格化为(7.99±6.69)分,低个人成就感为(15.71±9.21)分;相关性分析显示,职业认同各维度与职业倦怠呈负相关,结构授权各维度与职业倦怠呈负相关;多元逐步回归分析显示,健康状况、每月夜班次数、职称、是否有子女、工作职务、职业认同和结构授权都对得分有影响(P<0.05).结论 职业认同、结构授权是护士职业倦怠的影响因素.健康状况欠佳、每月夜班次数多、职业认同度低和低结构授权的护士更容易产生职业倦怠,护理管理者应特别关注此类护士,并制定相应的干预措施.

目的 了解胰腺疾病医护合作型多学科门诊的运行情况,为更好地开展胰腺疾病医护合作型多学科诊疗和提高护理服务质量提供参考.方法 采用整群抽样,选取2019年9月-12月在胰腺多学科门诊就诊的患者共92例,通过调查问卷和现场调查,调查患者的满意度、患者对多学科门诊的知晓情况、再次参加意愿以及病例讨论时间.结果 患者对所有服务满意度评分平均分＞4.50分,其中对就诊流程、等待时间、心理疏导的满意度相对较低.患者在会诊开始前被告知多学科诊治的相关情况率达88.75％,93.75％的患者不清楚参与专家情况,98.75％的患者希望再次参与胰腺疾病多学科会诊.属于其他分类的胰腺疾病讨论时间较长,为(15.55 ±9.33) min;胰腺炎性疾病讨论最短,为(12.50 ±6.22) min.结论 医护合作型多学科门诊有利于提高患者满意度,门诊普及和推广力度有待加强,效率有待提高,专科护士加入多学科门诊能促进医护协作.

目的 探讨上消化道早癌内镜黏膜下剥离术后患者癌症复发恐惧状况及其影响因素,为制定针对性临床干预措施提供参考.方法 通过便利抽样,将2019年9月至2020年1月就诊于我院的348例上消化道早癌内镜黏膜下剥离术治疗患者作为研究对象,使用恐惧疾病进展量表、社会支持评定量表、简易应对方式量表调查患者恐惧疾病进展程度、社会支持及问题应对情况,采用单因素和多元线性逐步回归分析法明确上消化道早癌内镜黏膜下剥离术后患者癌症复发恐惧的影响因素.结果 上消化道早癌内镜黏膜下剥离术后患者癌症复发恐惧得分为18～58(34.99±5.92)分,61.21％患者存在癌症复发恐惧.多元线性逐步回归结果显示,性别、年龄、家庭人均月收入、家庭经济负担、病变部位、病理诊断、幽门螺旋杆菌感染情况、术后并发症、社会支持、应对方式均是癌症复发恐惧的独立危险因素(P<0.05).结论 上消化道早癌内镜黏膜下剥离术后患者癌症复发恐惧现状不容乐观,通过鼓励并帮助患者建立有利的社会支持系统,积极应对疾病,再进行针对性干预,提高患者健康认知、内镜复查依从性及幽门螺旋杆菌根除治疗依从性,从而降低癌症复发恐惧,促进身心健康.

目的:分析近十年心力衰竭护理研究热点和难点问题,为开展心力衰竭护理研究提供参考.方法:检索2009年至2019年发表于国内10种护理科技核心期刊上心力衰竭护理临床研究相关文献,采用文献计量学方法 对文献年代、期刊及作者分布等方面进行分析,运用CiteSpace V软件对关键词进行可视化分析,阅读代表性文献进行内容分析.结果:纳入335篇文献,合著率高达 87.16%;文献主要来源于江苏、北京、上海、广东等经济发达地区;医学院校及其附属医院是发文主力军;基金论文所占比例为37.31%;研究内容主要集中在慢性心力衰竭、生活质量及影响因素.结论:我国心力衰竭护理相关研究内容和范围不断扩大,但重视程度不够,研究设计的类型有待进一步丰富,循证护理实践能力有待进一步提高.

目的 探讨对剖宫产术实施快速康复护理的临床价值.方法 选取2019年1～12月我院行计划性剖宫产术的孕产妇460例,随机分为对照组和观察组,每组各230例,对照组实施剖宫产围手术期常规护理,观察组在快速康复外科理念指导下开展针对性护理干预,具体操作为术前护理(健康教育、心理指导、缩短术前禁食禁饮时限)、术中护理(给予适量的麻醉剂量、采取保温措施、缩短剖宫产手术时间)、术后护理(饮食指导、体位管理、主动运动指导、心理护理、母乳喂养指导、疼痛管理).比较两组临床效果及护理满意度.结果 观察组护理满意度为99.13％,高于对照组的93.04％(P<0.05);观察组手术前低血糖反应发生率为0.86％、术中低体温发生率为6.52％、不良反应发生率为2.61％、剖宫产手术时间为(55.47±5.33)min、母乳分泌时间为(19.23±4.37)h、排气时间为(20.58±3.37)h、下床活动时间为(38.82±6.54)h、产后48 h子宫底高度为(5.66±1.26)cm、住院时间为(4.65±1.48)d,全部低于对照组的3.91％、13.91％、11.30％、(61.78±6.04)min、(26.45±4.80)h、(29.35±4.28)h、(49.40±5.56)h、(7.25±1.40)cm、(5.70±1.50)d(P<0.05).结论 针对行剖宫产术的孕产妇实施快速康复护理,有助于产妇术后尽快下床活动,并促进产妇快速康复,该护理方案值得应用并推广.

目的 探索早期胃癌患者内镜黏膜下剥离术后内镜复查依从性的影响因素.方法 回顾性分析2016年1月至2019年9月南京大学医学院附属鼓楼医院消化内科内镜黏膜下剥离术治疗的592例早期胃癌患者的临床资料.分析内镜黏膜下剥离术后患者复查依从性现状,收集所有患者临床资料(手术住院期间、术后复查),采用多因素Logistic回归分析患者术后复查依从性的独立影响因素.结果 592例患者纳入分析,中位随访时间为26个月,63.51％患者术后内镜复查依从性低.单因素分析结果显示,年龄、文化程度、职业、医保、居住地、复查路程、手术期间H pylori、术后并发症、肿瘤或消化道肿瘤家族史、消化道合并症数目、既往手术次数显著影响术后内镜复查依从性(P＜0.05).多因素Logistic回归分析结果显示,医保(OR=1.485,95％CI:1.007～2.188)、手术期间H.pylori(OR=5.472,95％CI:2.880 ～ 10.396)、术后并发症(OR=1.861,95％CI:1.039～3.332)及消化道肿瘤家族史(OR=2.297,95％ CI: 1.219～4.328)均是术后内镜复查依从性的独立影响因素(P＜0.05).结论 患者医保、手术期间Hpylori、术后并发症及消化道肿瘤家族史与其术后内镜复查依从性密切相关,临床应予以关注,提高患者术后内镜复查依从性,降低术后复发及病情加重风险.

目的 研究康复自我效能对全膝关节置换术后患者居家康复锻炼依从性的影响.方法 2019年10月～12月,选取膝关节置换术后患者128例,采用一般资料调查表、膝关节置换术患者居家康复锻炼依从性量表和中文版康复自我效能量表进行问卷调查.结果 膝关节置换术患者居家康复锻炼依从性得分(30.09±3.86)分,康复自我效能得分(66.29±11.40)分,均处于中等水平.多重线性回归结果显示,康复自我效能是居家康复锻炼依从性的影响因素(P<0.05).结论 全膝关节置换术后患者居家康复锻炼依从性有待提高,医护人员可以通过提高其康复自我效能来提高居家康复锻炼依从性.