Objective To investigate the influence of patient-related factors on hospital-home medication discrepancy in patients with chronic heart failure（CHF） during the transitional period（short for transitional period）. Methods A total of 405 patients with CHF in the transitional period were randomly selected by convenient sampling method. A telephone follow-up study was conducted using questionnaires, including the general information questionnaire, Medication Discrepancy Tool, Morisky Medication Adherence Scale（MMAS）, Self-efficacy for Appropriate Medication Use Scale（SEAMS）, and medication literacy questionnaire. The influence of patient-related factors on transitional medication discrepancy was analyzed by Logistic regression. Results Among 405 patients, 270 had transitional medication discrepancy, with an incidence of 66.67%. The univariate analysis showed that there were statistically significant differences between the group with medication discrepancy and the group without in terms of heart failure duration, MMAS score, SEAMS score, and medication literacy score（P＜0.05）. Binary Logistic regression analysis showed that high scores in MMAS, SEAMS and medication literacy were independent protective factors for transtional medication discrepancy in CHF patients（OR=0.241, 0.922, 0.541, P＜0.05）, and the MMAS score had the strongest association. Conclusion MMAS, SEAMS and medication literacy scores in patients with CHF are the influencing factors of medication discrepancy in the period of transition,suggesting the need for comprehensive assessment and targeted intervention strategies before discharge to reduce transitional medication discrepancy.

AIMS:To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF).METHODS:From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status.RESULTS:The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777).CONCLUSION:Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

目的 调查主动脉夹层术后患者社会疏离现状并分析其影响因素.方法 以便利抽样法选取我院收治的214例主动脉夹层术后患者,采用一般疏离感量表(GAS)评估患者社会疏离状况,自我护理能力量表(ESCA)评估患者自我护理能力,社会支持评定量表(SSRS)评估社会支持状况;行Pearson相关性分析主动脉夹层术后患者社会疏离感评分与各项SSRS评分、ESCA评分的相关性;多因素Logistic回归分析主动脉夹层术后患者社会疏离感的影响因素.结果 患者社会疏离感总分(52.23±5.31)分,ESCA评分总分(41.57±4.31)分,SSRS评分总分(20.32±2.05)分;不同年龄、文化程度、住院时间、ESCA评分及SSRS评分患者社会疏离感评分比较差异有统计学意义(P<0.05),不同性别、居住方式、手术方式、术后并发症及结算方式患者社会疏离感评分差异无统计学意义(P>0.05);主动脉夹层术后患者社会疏离感评分与各项SSRS评分、ESCA评分均呈负相关(P<0.05);文化程度、年龄、ESCA评分及SSRS评分为主动脉夹层术后患者社会疏离感的影响因素(P<0.05).结论 主动脉夹层术后患者普遍存在社会疏离状态,文化程度、年龄、ESCA评分及SSRS评分为其影响因素,应根据患者情况采取针对性措施以减轻患者社会疏离状态.

Abstract Purpose: To explore the influence of cumulative fluid balance (CFB) on volume status in patients with heart failure (HF).Methods: A total of 206 patients were enrolled and divided into groups of decreasing estimated plasma volume status (△ePVS(-)) (n=106) and increasing estimated plasma volume status(△ePVS(+)) (n=100), or groups of alleviated clinical congestion score(△CCS(-)) (n=86) and aggravated clinical congestion score(△CCS(+)) (n=120) according to the change of plasma volume and congestion status respectively. Data on patients’ general information and CFB at 1 to 7 days were compared between two pairs of groups respectively.Results: The incidence of positive CFB ranged from 65.53% to 74.76%, and cumulative volume (CV) were from (0.23±1.00)L to (2.36±5.46)L at 1 to 7 days. CV at 4 to 7 days in the △ePVS(+) and △CCS(+) groups were significantly higher than that in △ePVS(-) and △CCS(-) groups respectively. When CV at 4 to 7 days reached 2.308L, 3.361L, 3.625L, and 3.816L, the AUC of ePVS were 0.672, 0.722, 0.644, and 0.754, respectively (P＜0.05), while when CV reached 2.308L, 3.383L, 4.670L, and 4.622L, the AUC of CCS were 0.625, 0.696, 0.656, and 0.709, separately (P＜0.05). Conclusions: Patients with HF have a high incidence of positive CFB. CV at 4 to 7 days was an independent risk factor for △ePVS(+) and △CCS(+). It is suggested that the duration and volume of positive CFB should not exceed 3 days and 2.308L.

Objective C-reactive protein (CRP) is a powerful predictor of and risk factor for cardiovascular disease. However, the relationship between CRP and sudden death (SD) is controversial. Therefore, we performed a meta-analysis to evaluate the association between CRP and SD. Methods We conducted a comprehensive search of the databases of PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc, and Weipu. Two researchers independently screened the literature, extracted data, and evaluated the data quality. The overall effect size was meta-analyzed using Stata software version 12.0 (StataCorp, College Station, TX, USA). Results Twelve prospective studies involving 36,646 patients were included in the present meta-analysis. The data revealed that patients with higher CRP concentrations had a greater risk of SD (hazard ratio, 1.19; 95% confidence interval, 1.09–1.29). When the hazard ratio of SD was calculated by multivariate analysis of nine studies, CRP was confirmed to be an independent predictive factor for SD (hazard ratio, 1.05; 95% confidence interval, 1.03–1.07). Conclusions This meta-analysis confirmed that CRP is an independent predictor of SD. These results support the recommendation of recording the CRP concentration for risk assessment of SD in clinical practice.

Objective:To evaluate the value of Roy adaptation model in the perioperative period of patients with Stanford B aortic dissection.Methods:A total of 100 patients with Stanford type B aortic dissection who were admitted to the Department of Cardiovascular Surgery of Jiangsu Province Hospital from February 2019 to February 2021 were selected and randomly divided into a control group (n=50) and an observation group (n=50). The control group received routine nursing care, and the observation group followed the Roy adaptation model on this basis. The two groups were compared for anxiety self-rating scale (SAS), depression self-rating scale (SDS), and self-efficacy (GSES) scores, as well as the quality of life (SF-36), ability of daily living (ADL), and health behavior ability score (SRAHP) before and after nursing. The satisfaction with nursing was also recorded in the two groups.Results:SAS and SDS scores after nursing were lower than those before nursing in both groups (P＜0.05), while GSES scores were higher than before nursing (P＜0.05); SAS and SDS scores of the observation group were lower than those of the control group after nursing (P＜0.05), but the GSES score was higher than that of the control group (P＜0.05). The SF-36 and ADL scores after nursing were higher than those before nursing (P＜0.05); the SF-36 and ADL scores of the observation group were higher than those of the control group after nursing (P＜0.05). The total score of SRAHP and the scores of nutrition management, health responsibility, exercise management, and psychological well-being after nursing were higher than those before nursing in both groups (P＜0.05); the total score of SRAHP and the scores of health responsibility and psychological well-being of the observation group after nursing were higher than those of the control group (P＜0.05), though there was no significant difference in the scores of nutrition management and exercise management between the two groups (P＞0.05). The nursing satisfaction of the observation group was 96.00%, which was higher than that (84.00%) of the control group (P＜0.05).Conclusion:The Roy adaptation model has a significant effect in the care of patients with Stanford B aortic dissection. It can reduce depression, anxiety, and other negative emotions, improve self-management ability and daily life ability, and improve the quality of life by improving the patient's self-healthy behavior ability. The Roy adaptation model also improve patients' satisfaction with nursing care satisfaction.

目的 探讨心脏瓣膜置换术后自我效能感量表(GSES)评分的影响因素及心理干预应用价值.方法 选取2020年1月至2021年10月在我院就诊的心脏瓣膜置换术患者160例,分为观察组(n=84)和对照组(n=76),观察组给予心理干预,对照组给予常规干预,采用GSES量表评估患者自我效能感,比较两组干预前后GSES评分差异,并分析GSES评分的影响因素,结果160例患者平均GSES评分为(25.40±8.89)分,其中GSES评分<23分45例,≥23分115例.不同水平GSES评分患者的年龄、学历和心功能状态比较,差异有统计学意义(P<0.05);Logistic回归分析结果显示:性别、学历、心功能状态是GSES评分的影响因素(P<0.05).观察组干预后GSES评分明显高于对照组(P<0.05).结论 心脏瓣膜置换术后GSES评分受患者性别、学历及心功能状态的影响,给予心理干预后,患者GSES评分明显改善.

目的 构建慢性心力衰竭(chronic heart failure,CHF)患者个体化液体摄入管理方案,并分析其应用效果.方法 基于前期研究结果,结合入组时体内水分过多(overhydration,OH)值,制订CHF患者个体化液体摄入管理方案.2020年5月—10月通过便利抽样法,选择江苏省某三级甲等医院住院CHF患者278例,随机分为试验组和对照组各139例.试验组采用个体化液体摄入管理方案,对照组采用指南推荐的液体摄入量,分析两组应用效果.结果 试验组OH值、估计血浆容量、临床淤血评分、口渴痛苦感、明尼苏达心力衰竭生活质量、出院后3个月和6个月再入院率均低于对照组,差异具有统计学意义(P<0.05);试验组出院后3个月和6个月心源性死亡率较对照组低,但差异无统计学意义(P>0.05).结论 个体化液体摄入管理方案能改善CHF患者的容量状态、缓解口渴痛苦感、提升生活质量、降低再入院率,可为CHF患者的液体摄入管理提供依据.

目的 探讨归因训练在老年心脏瓣膜置换术(HVR)患者中的应用效果.方法 选择2018年5月至2020年5月我院收治的老年HVR患者113例,采用分层随机法分为观察组57例与对照组56例.对照组给予常规护理干预及健康教育,观察组联合应用归因训练.出院6个月,比较两组患者归因方式与自我管理能力.结果 观察组老年HRV患者正性事件、人际事件、成就事件、内外维度评分高于对照组,负性事件、宿命维度评分低于对照组(P＜0.05);症状管理、治疗依从性管理、日常生活管理、情绪管理、自我效能管理、自我管理能力总分高于对照组(P＜0.05).结论 归因训练有助于引导老年HRV患者形成积极的归因倾向,促进自我管理能力的养成.

目的 检索、评价和整合脑卒中后认知障碍患者管理的相关证据,为临床实践提供参考.方法 应用循证护理的方法,系统检索关于脑卒中认知障碍管理的所有证据,包括临床实践指南、专家共识、最佳临床实践信息册、系统评价、证据总结,检索时间为2014年1月-2019年12月.采用JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行质量评价及证据级别的评定.结果 共纳入21篇文献,其中指南7篇,专家共识2篇,系统评价12篇.从筛查、评估、治疗、预防、健康教育5个方面,以及认知障碍受损不同领域的管理共总结出69条最佳证据.结论 卒中认知障碍管理的证据总结过程科学,实用性强,临床护理人员可根据认知障碍受损的不同功能,结合临床环境、患者及家属的需求,针对性的应用最佳证据,建立更加科学完善的管理制度.

Objective:To systematically review the effects of limited fluid intake on the prognosis of patients with heart failure.Methods:RCTs about the effects of limited fluid intake on the prognosis of patients with heart failure published up to March 31, 2021 were retrieved from PubMed, The Cochrane Library, CINAHL, Embase, Web of Science, CNKI, Wanfang, VIP, and SinoMed. Two independent researchers were employed to extract data and evaluate the quality of included literature. Rev Man 5.3 was used for Meta-analysis, sequential analysis to evaluate the reliability and authenticity of the research results, and the Egger's test for publication bias.Results:A total of 7 articles were included, with a sample size of 867 cases. Meta-analysis showed that the body weight [ MD=-3.04, 95% CI (-4.70, -1.38) , P<0.001], B-type natriuretic peptide [ MD=-249.32, 95% CI (-305.00, -193.63) , P<0.001], blood creatinine [ MD=-22.03, 95% CI (-24.98, -19.09) , P<0.001], readmission rate [ OR=0.30, 95% CI (0.20, 0.45) , P<0.001] of the limited fluid intake group in the chronic phase of heart failure were lower than those in the control group; the body weight [ MD=1.41, 95% CI (-3.73, 6.55) , P=0.59], B-type natriuretic peptide [ MD=64.52, 95% CI (-50.01, 179.06) , P=0.27], serum creatinine [ MD=3.83, 95% CI (-9.69, 17.36) , P=0.58], readmission rate [ OR=1.21, 95% CI (0.65, 2.27) , P=0.55] of the acute fluid intake group were not statistically different from those in the control group. Conclusions:Limiting fluid intake in the chronic phase of heart failure can effectively improve the patients' heart and kidney function and the prognosis of the disease. In the acute phase of heart failure, it may be necessary to combine multiple treatments to keep the patients at the best volume state.

目的:探讨应用 ICF检查表调查老年慢性心力衰竭患者健康状态的信效度及优势.方法:对 140 例患者采用 ICF检查表与生活质量调查量表 36(SF-36)和坎斯坦城心肌病生活质量量表(KCCQ)进行评估,应用信效度比较以上量表的临床效果,应用 ROC曲线探索 ICF检查表在不同年龄层患者的界值点,使用频数表现不同年龄段患者 ICF类目特点.结果:ICF 检查表 Cronbach’s α系数为 0.933～0.962,75 岁以上人群 Cronbach’s α系数为0.962,SF-36 量表Cronbach’s α系数为0.904～0.906.ICF检查表内部效度 spearman相关系数为 0.411～0.944 (P<0.01),总分与 SF-36 量表外部效度 r系数为-0.483～-0.678(P=0.000).ICF检查表与 SF-36 量表 ROC曲线下面积分别为0.700～0.790,0.340～0.493,前者界值点兼具良好的灵敏度与特异度.不同年龄段人群总体或各维度高频 ICF类目不尽相同,相比而言 60～74 岁人群 b 134.睡眠功能、d 920.娱乐与休闲功能损伤问题更突出;75 岁以上人群 b 440.呼吸功能、d 430.举起与搬运物体、s 430.呼吸系统的结构和 s 110.脑的结构功能损伤问题更突出.结论:相比于 SF-36 与KCCQ量表,ICF检查表在老年CHF患者中应用具有更好的信效度与病情严重度的诊断价值,不同年龄段患者损伤的功能种类存在差异,今后临床工作应有针对性的进行评估与治疗.

Objective:To deeply explore the comprehensive function impairment of chronic heart failure (CHF) patients and analyze its influencing factors.Methods:From November 2018 to January 2019, this study selected medical workers (doctors and nurses) , CHF patients or their family members in Department of Cardiovascular at a Class Ⅲ Grade A hospital in Jiangsu Province as subjects by purposive sampling. Semi-structured interview was carried out for the subjects with the phenomenological method. Colaizzi analysis was used to extract concepts. Two researchers matched the concept with the international classification of functioning, disability and health (ICF) based on Cieza link rules. This study took ICF category no more than 5% of the former after two interviews as the sample size saturated standard.Results:Finally, a total of 28 interviewees were included. A total of 80 ICF categories were linked, 31 (38.8%) of them in body function, 5 (6.2%) in body structure, 28 (35.0%) in activity participation and 16 (20.0%) in environmental factors. Other 482 concepts could not be linked with ICF categories with health status (30.7%) for the most followed by personal factors (27.4%) .Conclusions:ICF could be used to describe the comprehensive function impairment of CHF patients and its influencing factors. Being linked with multitudinous ICF categories indicates the complex function impairment and the numerous influencing factors. This study will be beneficial to carry out the individualized, detailed and dynamic treatment and nursing based on comprehensive evaluation for CHF patients.

Objective:To construct the different functional graded care programs for elderly patients with chronic heart failure (CHF) .Methods:In March 2019, convenience sampling was used to select 24 nursing experts from 14 ClassⅢ Grade A hospitals in Northeast, North China, East China, South China, Central China and Northwest China as the subjects of correspondence. Based on the "International Classification of Functioning, Disability and Health" (ICF) , we took the function as the starting point to construct the different functional graded care programs for elderly CHF patients through systematic reviews, expert meeting and expert consultations.Results:In three rounds of questionnaires, the recovery rates were 100.00%, 100.00% and 95.83%; the authority coefficients of experts were 0.912, 0.914 and 0.913; the coordination coefficients were 0.348, 0.451 and 0.752, respectively; the differences were all statistical ( P<0.001) . The finally constructed different functional graded care programs for elderly CHF patients included heart function, respiratory function, water and electrolyte function, energy and drive function, emotional function, skin protection function, sleep function, and activity and participation function, totaling 8 ICF functions, 14 nursing measures and 161 nursing activity. Conclusions:The different functional graded care programs for CHF patients is comprehensive and systematic, which can not only improve nurses' nursing decision-making, standardize nursing behaviors, but also can be dynamically adjusted. It is scientific and feasible, and can satisfy the individualized and differentiated care demands of CHF patients with impaired function in different disease stages. At the same time, it also provides a theoretical framework for the future development of nursing information systems.

Objective? To explore the status quo of thirst distress in patients with heart failure and its influencing factors and to provide a basis for developing intervention measures. Methods? Totally 445 patients with heart failure were selected from 3 ClassⅢ Grade A hospitals in Jiangsu and He′nan Provinces by convenient sampling, and investigated with the general information questionnaire, Thirst Distress Scale-Heart Failure (TDS-HF), Minnesota Heart Failure Quality of Life Scale (MLHFQ) and 24-hour Input and Output Record between August and December 2018. The influencing factors to thirst distress in patients with heart failure were also analyzed. Results? A total of 445 questionnaires were sent out, and 401 questionnaires were effectively recovered. The TDS-HF and MLHFQ scores of the patients with chronic heart disease were (21.98±9.70) and (57.77±28.34), and there was a positive correlation between the two (P=0.003). Univariate analysis revealed that there was a statistically significant difference in TED-HF scores between the patients with different body surface area, BMI,drinking alcohol or not,7 d fluid intake, 7 d fluid output, 7 d input-output difference, proportion of morning input, proportion of afternoon input, proportion of night input, cardiac function, left ventricular ejection fraction (LVEF), NT-proBNP, estimated plasma volume status (ePVS), with or without edema and estimated glomerular filtration rate (eGFR) (P＜0.05). Multiple linear regression analysis was conducted taking TDS-HF scores as dependent variables and the statistically significant variables found in univariate analysis as independent variables. The results showed that patients′ BMI, body surface area, 7 d fluid intake, 7 d input-output difference, proportion of morning input, proportion of afternoon input, cardiac function, ePVS, edema grading and eGFR were the main influencing factors to thirst distress in patients with heart failure (P＜ 0.05). Conclusions? The thirst distress is severe in patients with heart failure, which is affected by limited water, individual variation between patients and disease conditions. It is necessary for medical and nursing workers develop targeted intervention measures, reduce thirst distress while achieving the best outcomes, and improve the patients′ quality of life.

目的:初步确定慢性心力衰竭(CHF)患者功能评估的《国际功能、残疾和健康分类(ICF)》类目.方法:检索Cochrane Library、PubMed、Embase、CNKI、WanFang、CBM数据库近5年有关CHF的临床研究,由两名研究员按照标准链接规则独立进行指标的概念提取、ICF类目链接.结果:最终纳入116篇文献,去重后得177个功能评价指标,链接到116条ICF二级类目,其中66条出现在5％以上的文献中(25个身体功能,2个身体结构,31个活动与参与,8个环境因素).频数最高的6个ICF类目分别为b410心脏功能(n=90)、s410心血管系统结构(n=49)、b415血管功能(n=43)、b440呼吸功能(n=41)、b455运动耐受功能(n=40)、d450步行(n=40).结论:链接到较多的ICF类目反应CHF患者功能损伤的异质性,同时确定了ICF可以作为对该类患者全面功能评估的框架,进一步的临床调查与Delphi专家咨询可以为构建CHF-ICF核心组合提供科学依据,有利于后续开展基于综合评估的CHF患者个体化、详尽化、动态化的治疗与护理措施.

总结《国际功能、残疾和健康分类》(ICF)评估工具的开发现状、评估内容、应用情况及作用,以期为我国今后ICF在护理程序中的融合应用有所增益.

Abstract Objective Venous leg ulceration (VLU) is one of the complications of lower extremity venous reflux and reflux disorder of severe diseases, with many adverse effects on patient’s work and life. Nowadays, more and more patients with VLU accept wound care in community setting. Clinical nurses generally take care of the patients based on their own experiences. Healing in VLU is an incredibly complex process, which puzzles even experts. The majority of general nurses do not have this level of expertise, especially those nurses serving in community. Function is the basis of nursing activities. Patients always show different clinical manifestations and self-care abilities due to various function states, which cannot be reflected completely by the existing nursing practice. How to describe nursing practice standardized in order to demonstrate the effectiveness of interventions and facilitate interdisciplinary communication is another urgent problem. Therefore, the aim of this project is to develop an accurate nursing program based on function in chronic venous leg ulcers, which can both satisfy the needs of patients and promote nursing revolution. Methods This study will use International Classification of Functioning Disability and Health as a framework to choose suitable functions and to filter function classification standards of chronic venous leg ulcers through evidence-based systematic research. Nursing interventions related to VLU are selected based on Nursing Interventions Classification, adding other nursing activities by methods of evidence-based systematic review and clinical observation. Then, nursing interventions and function status are matched through steering committee. Finally, the Delphi survey method is adopted to make nursing program native and scientific. Conclusions This study is expected to be very significant and meaningful in using standardized nursing terminology. The nursing program established could better meet the needs of both patients with chronic venous leg ulcers and clinical nurses, promoting the development of wound specialist and standardized nursing language.

目的:探讨开展礼仪和人际沟通课程对我校护理专业学生日常行为及人文关怀能力的影响.方法:采用自设的日常礼仪与人际沟通知识调查问卷和医护学生人文关怀能力调查问卷对某医科大学护理专业学生进行调查.结果:通过分析比较,系统学过礼仪和人际沟通课程的同学在日常行为和实习中表现出较强的沟通能力、良好的内在修养和人文关怀能力.结论:开展护理礼仪与人际沟通课程有助于提高护理学专业学生的自身素质,加强临床适应能力.