Background: adequate bowel preparation is related to the quality of colonoscopy.Dried lemon slices can increase gastrointestinal peristalsis, which has shown potential as an adjuvant of bowel preparation.We hypothesized that the combination of dried lemon slices and polyethylene glycol (PEG) could improve the efficacy of bowel preparation and be more acceptable to participants.Aim: to investigate the effectiveness of lemon slices combined with PEG for colonoscopy preparation.Methods: a prospective, single-center, randomized, controlled trial was performed of 521 patients randomly assigned to two groups.A total of 254 patients were given lemon slices based on conventional 4-L PEG treatment for the bowel, while 267 patients received only 4-L PEG treatment.Patients' basic information, procedurerelated parameters, adverse effects, and subjective feelings were collected by questionnaires.Intestinal tract cleanliness was scored according to the Boston Bowel Preparation Scale (BBPS) by experienced endoscopists.Data were analyzed by the twosample t-test or the Chi-squared test.Results: the BBPS scores were significantly higher in the PEG + lemon slice group (p < 0.05).The taste acceptability, satisfaction, and willingness to repeat bowel preparation were significantly higher in the PEG+ lemon slice group (p < 0.05).However, a larger proportion of patients from the PEG+ lemon slice group (30.7 %) suffered abdominal distension compared with the PEG group (20.6 %), while the incidence of other adverse effects was comparable between the two groups.Conclusion: the addition of dried lemon slices to conventional PEG showed its superiority for bowel preparation.

总结39例经颈静脉路径行经导管三尖瓣瓣环修复术患者的护理经验.护理主要内容如下:开展精准评估,优化术前准备策略;多学科团队协作,制订应急预案,预控术中风险;术后进行目标导向血流动力学监测、预防出血、严密监测术后心脏相关并发症;实施渐进式肢体康复锻炼,加速患者康复进程;建立个性化管理档案,确保延续性照护的实施.经过精心的治疗和护理,39例均康复出院,随访3～6个月,恢复良好.

Objective To explore the effect of the objective structured clinical examination（OSCE） on evaluating the transport ability of critically ill patients of nurses in cardiovascular departments. Methods The OSCE training program was designed through Delphi technique based on the evaluation of nurses’ transport ability of critically ill patients,the transport practice process as the main line,and the transport cases bank as the basis. Six examination stations were established including pretransport assessment and grading,pretransport communication and preparation,dynamic monitoring during transport,emergency disposal during transport,standardized handover after transport,feedback and evaluation. The examination was conducted in 36 nurses in department of cardiovascular surgery and department of cardiovascular medicine. Results In terms of evaluation experience,nurses had a high degree of recognition for the effect of the OSCE. In terms of OSCE program quality evaluation,the average score was（73.25±4.29）,with normal distribution. The difficulty coefficients of each station ranged from 0.60 to 0.83,with an average of 0.73. The Cronbach’s α coefficient of test scores was 0.79,indicating good internal consistency. In terms of clinical effectiveness,the transport ability of nurses was improved after OSCE assessment:the accuracy of assessment and grading before transport,the efficiency of communication before transport,the qualified rate of preparation before transport,the rate of compliance with monitoring and treatment during transport,and the standard rate of handover after transport were statistically significant compared with those before OSCE（P＜0.05）. Conclusion The OSCE evaluated the transport capacity of nurses in cardiovascular departments comprehensively and scientifically,which could provide a reference for the teaching and assessment of the transport of critically ill patients.

Background Promoting reflection about death may support better living, and how to carry out death education is an important issue to be addressed across the world. The purpose of the current study was to explore the attitude of heart transplant recipients toward death and their inner real experience to provide information for the development of death education strategies. Methods A phenomenological qualitative study was conducted using a snowball method. A total of 11 patients who had undergone heart transplantation more than 1-year ago were recruited for the current study for semi-structured interviews. Results A total of five themes were identified: “Not avoid talking about death,” “Feeling fear about the pain in the process of death”, “Wanting a good death at the end of life,” “The richness of feelings during near-death is surprising,” and “Being close to death makes people more receptive to death.” Conclusion Heart transplant recipients have a positive attitude toward death and wish for “good death” at the end of life. These patients' near-death experiences and positive attitudes toward death during the course of their illness provided evidence of the need for death education in China and supported the experiential approach to death education.

To summarize the nursing experience of two cases of middle and late pregnancy complicated with maternal cardiac myxoma. Key points of nursing:in view of the important and difficult problems of preoperative maternal and fetal monitoring and perioperative nursing,a multidisciplinary collaboration was adopted to build an emergency response team,provide preoperative rigorous obstetric monitoring,tumor monitoring and being caution with tumor incarcerated valve obstruction,embolism early warning management;Intraoperative maintenance of hemodynamic stability,observation and nursing of active uterine bleeding after heparinization;Postoperative accurate volume management;Individual psychological care. The patient was discharged 13 days and 6 days after surgery respectively.

Objective To construct and apply intra-hospital transport checklist for critically ill cardiovascular patients to improve transport safety. Methods The preliminary draft of intra-hospital transport checklist for critically ill cardiovascular patients was developed based on literature review and semi-structured interviews,and the Delphi method was used to conduct 2 rounds of consultation with 12 experts,the final intra-hospital transport checklist for critically ill cardiovascular patients was formed. After evaluating the reliability and validity of the checklist,it was carried out in a cardiovascular surgical ward and a cardiovascular ward of a tertiary class A hospital in Zhejiang Province from September to December 2021. 67 cases of transport from September to October were regarded as control group,72 cases from November to December were experimental group. The experimental group used intra-hospital transport checklist for critically ill cardiovascular patients on the basis of routine transport,while the control group used routine transport nursing. The rate of adverse events and transport time were compared between the two groups. Results The response rate of the 2 rounds of expert consultation were 100%. Expert authority coefficients was 0.811 and 0.856. And expert coordination coefficients were 0.363 and 0.387（P＜0.05）. Kappa value of each item ranged from 0.733 to 1.000, with average of 0.803（P＜0.05）. The content validity index at the level of items ranged from 0.810 to 1.000, and the index of whole checklist was 0.912. The checklist contained 6 firstlevel indicators,22 second-level indicators,and 50 third-level indicators. After application of the checklist,the incidence of some disease/technology-related adverse events, the preparation time and transit time of experimental group were lower than those of control group（P＜0.05）. Conclusion The construction of transport checklist was scientific and reliable. It can shorten the transport time,and is helpful for the effective implementation of the key link of transport,then improve transport safety.

Objective:To explore the transition from hospital discharge to home care in heart transplant recipients based on the Meleis' transition theory, so as to provide a basis for improving the quality of life of recipients.Methods:In July 2021, purposeful sampling was used to select heart transplant recipients from the First Affiliated Hospital of Zhejiang University School of Medicine as the research subject. A total of 12 recipients of one year after heart transplantation were selected for semi-structured interviews by snowballing. The interview data were analyzed using the Colaizzi 7-step method.Results:Through reading, analysis, sorting and summarizing, 4 themes and 11 sub-themes were extracted, namely, relatively stable recovery of physical condition, lack of medication and emotional management (unmet needs for medication cognition and management, good physical condition, early emotional experience of vulnerability) , the support of family and social resources affected the transition (the communication and support of patients promoted the transition, the support of the family promoted the transition, the lack of community resources hindered the transition, and the reimbursement policy affected the transition) , a positive experience in the transition (confidence to deal with future life, return to society and self-realization) , and expecting to obtain comprehensive and continuous management of body and mind (the needs of nursing care centered on mental health, the needs of professional management teams and the communication platform among doctors, nurses and patients) .Conclusions:The experience of home self-care after discharge has many physical and psychological impacts on heart transplant recipients. It is necessary to pay attention to the recipients in the transition period, and to build a whole-of-society support system to give help to heart transplant recipients.

目的 为1例高龄暴发性心肌炎合并急性心肌梗死患者制订并实施抢救性心脏移植循证护理方案.方法 在多学科协作基础上,针对护理重点和难点提出问题,计算机检索PubMed、Cochrane Library、JBI循证卫生保健数据库、英国国家临床医学研究所指南库、国际指南协作网、美国指南网、中国生物医学文献数据库、中国知网、维普数据库及万方数据库查找相关文献,对证据进行评价和整合后,将其应用于患者围手术期护理与康复.结果 最终纳入9篇文献,其中诊疗规范2篇,指南1篇,专家意见及共识4篇,系统评价2篇.结合患者实际临床问题及多学科团队建议制订针对性的护理方案,包括出血预警管理、循环目标导向性管理、排异预控管理及康复个体化管理.经过68 d的治疗及康复,患者各项功能恢复良好出院.结论 针对高龄紧急心脏移植患者,运用循证方法为患者提供针对、科学、有效的护理措施,在成功救治和顺利康复中起到了关键作用.

目的:构建基于器官系统内外整合模式下心血管护理学科建设指标体系，旨在为以患者为中心、以循环系统为核心的心血管护理学科建设提供参考。方法:以健康学科群系统理论为基础，体现内外整合护理理念和心血管学科特色，通过文献回顾、专家访谈及专家咨询法，确定心血管护理学科建设指标体系的内容及各指标的权重。通过SPSS 23.0对两轮函询所得数据进行统计分析。结果:专家的积极系数为92.308%，权威系数为0.812，一、二、三级指标协调系数分别为0.412、0.421、0.347。最终形成的指标体系包括4个一级指标、17个二级指标、66个三级指标。结论:构建的心血管护理学科建设指标体系具有较高的科学性和可靠性，对基于器官系统内外整合医学模式下心血管护理学科建设和人才培养有一定的借鉴意义。

目的 应用基于循证制订的护理方案,以提高口服华法林住院患者国际标准化比值的达标率.方法 基于循证制定护理方案并应用于口服华法林的住院患者,比较循证护理方案实施前后患者国际标准化比值处于目标范围内的时间百分比及达标率.结果 循证护理方案实施后,患者国际标准化比值目标范围内的时间百分比提高至(66.64±29.41)％,较基线调查时的(50.10±30.93)％ 提高,达标率由49.79％ 提升至65.12％,差异具有统计学意义(P<0.05);出血或栓塞的发生率差异无统计学意义(P>0.05).结论 循证护理方案的实施在不增加出血风险的前提下,可提高口服华法林住院患者国际标准化比值达标率.

心脏移植是治疗终末期心脏疾病的有效方法。目前,无论是外科手术技术,还是移植术后监护,均趋于成熟 [1] 。然而,心脏移植围术期管理面临诸多挑战,如术前心肺功能衰竭,手术准备环节复杂,术后并发症监护、感染防控、排异反应观察等,均关乎患者安全。医护人员一些不经意的疏忽或错误可能对患者造成伤害,延长住院时间,甚至危及患者生命。查检单可以在短时间内对重要环节进行质量检查,以保证安全,其最早应用于航空业,近年来被医院管理者引进,应用于患者的质量改进 [2] 。

目的:总结1例暴发性心肌炎合并急性心肌梗死老年患者紧急心脏移植的护理要点。方法:对浙江大学医学院附属第一医院2020年7月收治的1例暴发性心肌炎合并急性心肌梗死老年患者给予出血预警护理、循环目标导向性护理，排异分阶段护理，感染防控护理、呼吸机撤机精准护理及康复个体化护理，观察其效果。结果:患者术后移植心脏功能恢复良好，未发生排异反应；出院前患者神清语利，积极乐观，自主进食，6 min步行试验距离300 m，生命体征平稳。出院1个月随访生活自理，情绪平稳。结论:对暴发性心肌炎合并急性心肌梗死老年患者紧急心脏移植术后做好出血、循环护理，排异护理，感染防控护理，呼吸机撤机精准护理及康复个体化护理，是确保手术成功和术后患者康复的有效手段。

目的:探讨开展护士主导的多学科循证干预在口服华法林住院患者抗凝管理中的效果。方法:本研究采用类实验研究设计方法，于2019年8月1日至12月31日选取浙江大学医学院附属第一医院心脏大血管外科及心血管内科478例患者作为基线审查组，2020年2月1日至5月31日494例患者作为后效评价组。成立多学科团队，以基于证据的持续质量改进模式图为理论框架，结合证据综合及临床实践制订循证方案，比较抗凝干预前后国际标准化比值（INR）、处于目标范围内的时间百分比（TTR）及抗凝相关并发症的发生率。结果:采用多学科循证干预前后，患者TTR平均值分别为（51.67±31.04）、（64.34±26.37）%，差异有统计学意义（ t值为6.958， P<0.01）；出血及栓塞的发生率比较差异无统计学意义（ χ2值分别为0.294、0.268， P>0.05）。 结论:护士主导的多学科循证干预可提高口服华法林住院患者抗凝治疗的强度和稳定性。

模式介绍 1 在"四大战场"上展现浙一护理创新力量 随着疫情进展,浙大一院成为浙江省抗击新型冠状病毒肺炎(简称"新冠肺炎")的主战场,湖北武汉、意大利米兰,也成为浙大一院护理人逆行的目的地,在院内、省内、国内及国际这四大战场中,浙一护理人获得一个又一个阶段性胜利,临床紧密结合科研,在实践中摸索经验,在学习中发现问题,在改进中提升能力,运用科技能力解决一个又一个临床实际问题,获得一个又一个区域成果,在攻坚克难中追求卓越,勇于创造,引领省内、国内乃至国际的抗击新冠疫情的护理技术成果.

This article summarizes a series of emergency management strategies such as early warning activation,continuous advancement,and scientific prevention and control in the centralized treatment of coronavirus disease 2019（COVID-19） from the perspective of nursing service department The strategies include fully functioning the longitudinal command and horizontal coordination of the nursing service department,reasonable allocating treatment and nursing human resources,and efficiently promoting in-hospital fever clinics,isolation wards,ICU and other centralized treatment and referral and treatment of provincial critical illness patients 5 prevention and control groups were established for training and examination,management and supervision,psychological assistance,logistical support,and reporting and publicity,so as to ensure the sustainability of prevention and control With the support of National Clinical Medical Research Center of Infectious Diseases,we optimize the work process,improve the nursing specifications,solve clinical problems,and lead the provincial nursing work The implementation of these strategies ensures the timely,orderly,safe and efficient centralized treatment The goal of zero death for severe cases and zero infections for medical staff has been achieved

OBJECTIVES:This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019 (COVID-19).METHODS:The strategies of the Nursing Department included an early warning for prevention and control, taking functions of vertically commanding and horizontally coordinating, and reasonably allocating nursing workforce, to facilitate centralized treatment work in the in-hospital fever clinic, isolation wards and ICU, and referral and admission of critical patients. Five special groups were established in charge of training and examination, management and supervision, psychological support, logistical support, and reporting and publicity, respectively.RESULTS:It was achieved that no deaths from critical patients and no medical staff, no other patients were infected.CONCLUSION:Through the implementation of these strategies, safe and efficient centralized treatment was ensured timely, orderly and sustainably.

总结1例肺出血型钩端螺旋体病患者应用体外膜肺氧合技术治疗的监护体会.监护关键在于及时调整呼吸机模式并行机械通气监护,有条件时尽早应用体外膜肺氧合技术,一旦应用体外膜肺氧合技术,做好体外膜肺氧合治疗的监护、镇静镇痛护理、血流动力学监护及感染的预防和护理.本例患者在重症监护室住院治疗13 d,氧合改善,成功撤机,病情稳定后转入传染科病房治疗,10 d后痊愈出院.

加速康复外科(enhanced recovery after surgery,ERAS)是一项基于多学科、多模式的围术期干预理念,旨在减少手术应激反应和术后并发症,促进患者早期康复、提高患者术后生活质量.在2019年5月,美国JAMA Surgery发布了心外科领域的第一部加速康复外科指南,旨在建立一套心脏外科ERAS的标准和规范.然而我国心脏外科领域对ERAS仍然缺乏深入、有效的理解,本综述从国内外ERAS研究和指南入手,分析目前心脏外科ERAS的应用及现状,归纳、总结并提出一套安全、有效、适用的心脏外科ERAS体系,为心脏外科临床医师提供标准化、规范化参考意见.

This paper reviewed the present nursing manager succession planning at home and abroad, covering the succession standard of nursing managers, the content and form of pre-job training, and the evaluation tool of management ability. These efforts aim to provide references for the construction of nursing management talents teams in China.

坏死性筋膜炎(necrotizing fasciitis,NF)是一种由于感染沿筋膜迅速蔓延而造成软组织大范围、快速坏死的严重病症[1],临床上少见但病死率非常高,如不能及时诊断和妥善处理,病人往往死于败血症、毒血症和感染中毒性休克,病死率高达41％左右[2].糖尿病是坏死性筋膜炎最常见的危险因素,坏死性筋膜炎伴发糖尿病病人可达18％～60％,坏死性筋膜炎好发于四肢,发生于会阴部少见[3].2017年2月我科收治1例糖尿病合并阴囊及肛周坏死性筋膜炎的病人,经多次反复清创引流、精心治疗和护理,病人痊愈出院.现将护理总结如下.