This study reviewed the exercise intensity，exercise time，exercise frequency，exercise mode and assessment tools of bowel cleanliness for bowel preparation，explored the relevant mechanisms of exercise to improve the effect of bowel cleansing，and analyzed the safety and efficacy of exercise on bowel preparation，in order to provide reference for clinicians to formulate personalized bowel preparation programs.

目的 构建并验证ICU获得性衰弱风险预测模型,为早期筛查ICU获得性衰弱危险人群提供有效工具.方法 Meta分析ICU获得性衰弱的危险因素,以各危险因素的综合危险度的自然对数为模型的β系数,以某时段ICU获得性衰弱发病率与未发病率比值的自然对数为模型的α系数,建立预测模型.收集137例ICU患者资料,分析模型的预测性能.结果 ICU获得性衰弱预测模型为logit(P)=-0.781+0.039年龄+0.077APACHE+0.940休克+0.122机械通气时长十0.971脓毒血症+0.756神经肌肉阻滞剂+1.311血管活性药物+1.308皮质类固醇+0.747性别+0.626高血糖+1.973肾脏替代治疗;模型ROC曲线下面积为0.752,95％CI(0.672,0.833),概率P函数的临界值为0.998,敏感度为0.930,特异度为0.489.结论 基于Meta分析建立的ICU获得性衰弱风险预测模型可作为早期预测ICU获得性衰弱危险人群的工具.

目的 构建综合医院护理人员人文关怀培训课程,并评价其应用效果.方法 通过文献回顾、专家咨询法构建护理人员人文关怀培训课程.按照构建的培训课程对护理人员进行1年培训,比较培训前后护理人员关怀能力和住院患者满意度.结果 构建的综合医院护理人员人文关怀培训课程包括人文关怀认知与知识、人文关怀技术与实践、人文关怀教学与培训和人文关怀研究4个模块15项培训内容.培训后护理人员关怀能力及住院患者满意度显著高于培训前(均P＜0.01).结论 构建的综合医院护理人员关怀能力培训课程科学、合理,培训后可提升护理人员关怀能力及住院患者满意度.

目的 探讨基于儿科护士需求分析的人文关怀分层培训的应用效果.方法 采用访谈法了解不同层级儿科护士的人文关怀培训需求,根据培训需求对142名儿科护士实施人文关怀分层培训6个月,比较培训前及培训后各层级儿科护士关怀能力和培训满意度.结果 培训后不同层级儿科护士关怀能力及对人文关怀培训满意度显著高于培训前(P＜0.05,P＜0.01).结论 采用基于需求的人文关怀分层培训有利于提高各层级儿科护士的人文关怀能力,提高培训满意度.

目的 检索炎症性肠病患者营养支持的相关证据,并汇总最佳证据.方法 计算机检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、加拿大安大略注册护士协会循证护理指南网、 苏格兰学院间指南协作网、 英国国家卫生与临床优化研究所网站、 欧洲临床营养和代谢学会网站、Cochrane Library、PubMed、CINAHL、Springer Link、Elsevier Science Direct、OVID、医脉通、中国知网、中国生物医学文献数据库、万方数据库,获得与炎症性肠病患者营养支持相关的指南、系统评价、专家共识及各类原始研究.检索时限为建库至2020年6月18日.采用临床指南研究与评价系统Ⅱ、系统评价质量评估量表、乔安娜布里格斯研究所循证卫生保健中心的文献评价标准和证据分级系统,对纳入文献进行质量评价及证据级别评定.结果 共纳入17篇文献,结合专业人员的判断,汇总了21条与炎症性肠病患者营养支持相关的证据,包括饮食与炎症性肠病的关系、营养风险筛查与营养评估、能量及蛋白质摄入、微量营养素监测、营养支持治疗、人员支持6个方面.结论 该研究总结了炎症性肠病患者营养支持的最佳证据,可为医护人员开展营养支持提供循证依据.医护人员应结合临床情景、患者偏好有针对性的选择并应用最佳证据.

目的 提高泌尿外科临床实习护生人文关怀能力.方法 将本科护生106人按进入泌尿外科实习时间分为对照组52人和观察组54人.对照组按实习计划进行常规专科护理与人文关怀临床带教,观察组对人文关怀教学内容进行专项设计,包括激发兴趣、角色扮演、角色体验、深入交流、反馈讨论、调整优化6种形式,并融入4周专科临床教学中.结果 实习结束时观察组护生专科理论及操作考核成绩、人文关怀能力得分显著高于对照组,对教学模式认可度显著高于对照组(P＜0.05,P＜0.01).结论 将人文关怀内容融入专科临床教学中,可有效提高护生实习成绩和人文关怀能力,教学模式获得护生认可.

目的 对髋部手术患者术后康复相关指南进行质量评价,为患者术后康复护理的实施提供依据.方法 检索国内外指南网、相关学会网站及各大数据库,检索时限为建库至2020年7月17日.按照纳入排除标准严格筛选指南后,由4名经过系统培训的研究者采用指南评价工具AGREEⅡ对纳入的指南进行独立评价,采用JBI循证卫生保健中心评价工具(2016)对专家共识的真实性进行评价;汇总指南和专家共识的推荐意见.结果 共纳入4篇指南,7篇专家共识.指南在AGREEⅡ6个领域的平均标准化得分分别为88.89％,86.11％,79.43％,87.50％,77.61％,83.86％.3篇指南为A级推荐,1篇为B级推荐,专家共识的真实性高.推荐意见涉及疼痛管理、营养管理、功能锻炼、并发症管理、健康宣教5个方面.结论 纳入指南和专家共识的整体质量较高,但指南应用性领域需进一步完善;髋部手术术后康复的部分内容不甚具体,部分内容存在歧义;国内以专家共识为主,应组建多学科小组加快开发符合国内临床情境的髋部手术术后康复指南.

Intensive Care Unit (ICU) acquired weakness is a common complication in ICU critically ill survivors. Early intervention is an important measure to prevent and treat ICU acquired weakness. The scientific and standardized intervention has a positive effect on the prognosis of patients. In recent years, integrated care, as a management method for some specific patients, can effectively improve the quality of care, reduce the cost of care, and is gradually applied to the prevention and treatment of ICU acquired weakness. This paper describes the research status of integrated care clinical intervention on ICU acquired weakness, in order to provide the basis for the construction of practical plan of integrated care for ICU acquired weakness.

Abstract This review summaried the value of ultrasound in the assessment of ICU acquired weakness.Ultrasound may be a useful tool for early assessment of ICU acquired weakness.It is suggested that ultrasound assessment of ICU acquired weakness should be further strengthened to supplement the deficiency of objective assessment methods.

目的 探讨新型冠状病毒肺炎定点医院医务人员的防控管理方法及效果.方法 成立医院感染三级防控委员会,开展多元化培训,全程严格防控与督导,落实各项制度和后勤保障.结果 共收治新型冠状病毒肺炎患者2 454例,治愈出院525例;未发生医务人员新型冠状病毒感染.结论 医院感染三级防控机制的建立与实施,可有效保障医务人员安全,提高患者救治效率.

报告了3例妊娠合并糖尿病酮症酸中毒致围产儿死亡的护理过程.产前在降糖纠酸的同时要注意监测胎儿安危,若发现胎儿宫内窘迫可能,要立即行剖宫产;产时若是阴道试产,除监测孕妇生命体征及血糖外,要注意宫缩疼痛刺激而使妊娠合并DKA的症状加重;产后除观察子宫复旧情况,也应到内分泌科复查排除孕前糖尿病,下次怀孕前要做好孕前保健.

AIM:To explore the work experience of clinical first-line nurses treating patients with coronavirus disease 2019 (COVID-19).BACKGROUND:COVID-19 has been listed as an international public health emergency. Clinical first-line nurses are at a high risk of infection, and they face a lack of experience and inadequate preparation for COVID-19, leading to physical and psychological disorders.METHODS:A qualitative study was conducted from January to February 2020 at a COVID-19-designated hospital in Wuhan, China. Thirty nurses were selected for the study using a purposive sampling method. Data were collected by semi-structured interviews and analysed using content analysis.RESULTS:Two main categories were defined in the study from the perspective of nurses: negative experiences during clinical first-line work and positive impacts of clinical first-line work. Under the first category, two subcategories were included: psychological experiences of clinical first-line work and difficulties faced during clinical first-line work. The analysis further yielded two subcategories for the second category: the needs of clinical first-line work and the impact of clinical first-line work on professional attitudes.CONCLUSIONS:The results demonstrate that success depends upon strengthening emergency training and knowledge of infectious diseases for nurses, providing adequate protective equipment and improving the emergency response plans of hospitals for public health emergencies.IMPLICATIONS FOR NURSING MANAGEMENT:It is believed that our findings will guide hospital managers to make improvements in personal, administrative and institutional areas and that they will provide a reference and inspiration for nurses with regard to public health emergencies in the future.

目的 探索快速、高效地整建制接管新型冠状病毒肺炎(以下简称“新冠肺炎”)重症隔离病区的方法,为应对重大突发公共卫生事件提供借鉴.方法 应用清单查检与甘特图相结合的方法,对我院在驰援武汉市整建制接管重症隔离病区过程中需要的人员、设备、物资、制度流程和环境5项管理进行内容控制和时间控制,确保隔离病区各项应急工作顺利开展.结果 医疗队在2h内完成人员集结,到达武汉市24 h内整建制接管重症隔离病区,48 h内收满100张床位的重症患者,各项生命支持设备、物资到位,应急预案完成.救治2个月,重症、危重症患者占比超过90％,患者出院、转出超过91％,医疗队队员零感染、零意外.结论 双控法在整建制接管新冠肺炎重症隔离病区的护理管理和持续改进中发挥了重要的作用,是应对新冠肺炎等重大突发疫情行之有效的护理方法.

目的 对重症新型冠状病毒肺炎患者进行疏导,缓解其心理压力.方法 对经心理筛查焦虑抑郁并存的5例重症新型冠状病毒肺炎患者进行一对一心理干预,包括倾听、呼吸放松训练、疾病意义的认知、改变经验元素法等.干预前后采用数字评分尺对其担心、焦虑、恐惧及其他心理状态进行评估.结果 干预前数字评分尺评分担心、焦虑、恐惧、其他心理状况≥4分者分别为5例、5例、4例、3例,干预后分别为2例、1例、1例、2例.结论 重症新型冠状病毒肺炎患者负性情绪较重,及时的心理干预能显著改善其心理危机.

ObjectiveTo systematically evaluate the effect of neuromuscular electrical stimulation on preventing acquired weakness in ICU.MethodThe randomized controlled trials related to the effects of neuromuscular electrical stimulation on ICU acquired weakness were searched in the Cochrane Library,PubMed,EMbase,MedLine,Web of Science,OVID,CNKI,Wanfang,VIP,CBM.Literatures were screened according to inclusion and exclusion criteria.And after data extraction and quality evaluation,Meta analysis was conducted using RevMan 5.3 software.ResultsTotally 11 randomized controlled trials,involving 576 patients,were enrolled.Meta analysis results showed that neuromuscular electrical stimulation could improve muscle strength of ICU patients[MD=1.78,95%CI(0.44,3.12),P=0.009],shorten mechanical ventilation time [SMD=-0.65,95%CI (-1.03,-0.27),P=0.000 7],shorten ICU length of stay [MD=-3.41,95%CI (-4.58,-2.24),P<0.000 01] and total length of stay[MD=-3.97,95%CI (-6.89,-1.06),P=0.008]，improve the patients' daily living ability [SMD=0.90,95%CI (0.45,1.35),P=0.000 01],and increase the walking distance of discharged patients [MD=239.03,95%CI (179.22,298.85),P<0.000 01].However,it had no significant effect on improving patients' functional status, consciousness level and mortality(P>0.05).ConclusionsCurrent evidences showed that early implementation of neuromuscular electrical stimulation intervention on ICU patients could prevent ICU acquired weakness and improve patient quality of life by enhancing muscle strength, shortening mechanical ventilation,ICU hospitalization,and total length of stay.However,there was no significant effect on improving the functional status of patients in ICU,promoting patient to awaken early,and reducing mortality,and these conclusions should to be verified.

目的 总结综合医院在应对突发重大传染病疫情时的应急护理管理实践经验,为护理管理者科学应对疫情提供参考.方法 新型冠状病毒肺炎疫情期间,该院护理部在医院疫情防控指挥小组的统一部署下,迅速成立防疫护理组织应急管理小组并启动应急管理预案,配合实施应急管理工作,持续管理护理质量与患者安全,多措并举有力保障疫情防控工作.结果 在护理部应急管理小组的统一指导下,该院一线2 800余名支援护士顺利协助并完成发热门急诊、隔离病区、方舱医院及其他一线病区患者的重症抢救、检验检查、诊疗转运等救援工作.结论 该院护理部通过制订护理组织应急管理方案和构建精准化管理策略,为指导各级护理人员进行科学防控疫情和精细化管理提供了保障.

目的:探讨新入职护士规范化培训的方法和内容,以提高培训效果、护理技能、满足临床护理工作需求.方法:采用目的抽样法,选取武汉协和医院224名新入职护士为研究对象.将2016年111名新入职护士设为对照组,采用传统新护士培训方案;2017年113名新入职护士设为观察组,根据《大纲》要求,重新制定新入职护士培训方案,培训后采用临床实境考核进行综合测评.结果:根据《大纲》重新制定的培训方案,观察组临床实境考核效果优于对照组(P＜0.05).结论:重新制定的规范化培训方案提高了新护士的业务能力和水平,提高新护士岗位胜任力.

目的 对非药物干预预防ICU获得性谵妄的相关系统评价/Meta分析进行再评价,为预防ICU获得性谵妄循证护理实践方案的制定提供证据支持.方法 计算机检索Cochrane Library、PubMed、CINAHL、OVID、EMbase、中国知网、万方和维普数据库中关于非药物干预预防ICU获得性谵妄的系统评价/Meta分析,筛选文献后,采用AMSTAR量表和GRADE系统对纳入文献进行方法学质量和证据质量等级评价.结果 共纳入16个系统评价/Meta分析,AMSTAR评分4～9分;32条结局指标的证据质量分级为高1条,中7条,低15条,极低9条.结论 非药物干预预防ICU获得性谵妄的相关系统评价/Meta分析的方法学质量不高,证据质量等级较低.目前最有效的预防措施为多组分联合干预,环境、睡眠、早期康复或物理治疗等干预措施的预防效果还有待进一步研究.

Objective:To systematically evaluate the predictive model of intensive care unit (ICU) -acquired weakness so as to provide objective basis for clinical workers to choose appropriate predictive model and provide reference for future model update and new model development.Methods:Sixth databases including PubMed, Embase, web of science, The Cochrane Library, CNKI and Wanfang were searched by the computer. The retrieval time was the construction of the database to October 15, 2019, and the language was limited to Chinese and English. A total of two researchers conducted independent screening of literature, data extraction and evaluated the quality of the included literature in turn, and then used prediction model risk of bias assessment tool (PROBAST) to evaluate the quality of the models included in the literature.Results:A total of 8 articles with high quality were included. The area under the ROC curve of the five models were all greater or equal to 0.7. The model risk of bias assessment showed that only Witteveen's model was rated as low bias, and the remaining 7 models all had a higher risk of bias, but all models had good applicability.Conclusions:The predictive performance of ICU acquired weakness model is good, but there are some biases in development and report. In the future, the whole process of model development and verification should be reported in a standardized way to reduce methodological bias and provide high-quality evidence for clinical practice. Future studies should focus on external validation and updating of models to continuously improve model prediction performance and provide practical models for clinical practice.