Background: Despite numerous studies on physical activity and sleep disorders, few have focused on physical activity and sleep disorders in middle-aged people who are particularly stressed. A restricted cubic web (RCS) technique was applied to determine whether there is a dose-response relationship between physical activity and the self-rated prevalence of sleep disorders in middle-aged adults. Methods: This study analyzed 8880 middle-aged adults aged 40-65 years who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) between physical activity and the risk of sleep disorders in middle-aged adults. Thereafter, the dose-response connection was examined using RCS. Results: After adjusting for potential confounders, subjects with MET values in the first quartile (Q1) compared to subjects with MET values in the second, third, and fourth quartiles had odds ratios (OR) for sleep disturbance that were0.851(95% CI=0.745–0.973), 0.800 (95% CI = 0.698–0.917) and 0.780 (95% CI = 0.680–0.895) , respectively. RCS regression showed a non-linear association between physical activity and sleep disorders in middle-aged adults (non-linearity P=0.0382). Furthermore, the prevalence of sleep disorders in middle-aged adults decreased with increasing physical activity, reaching a minimum when weekly physical activity was around 166.27MET*h(OR=0.885, 95% CI=0.799–0.981). Limitations：Self-reporting of sleep disorder and physical activity may be biased. Conclusion: Our research demonstrates that physical activity was associated with a reduced risk of sleep disorders.

Abstract Background Among the numerous studies on physical activity and sleep disorders, few have focused on physical activity and sleep disorders in middle-aged people who are particularly stressed. A restricted cubic web (RCS) technique was applied to determine whether physical activity and the self-rated prevalence of sleep disorders exhibit a dose-response relationship in middle-aged adults. Methods This study analyzed 8880 middle-aged adults aged 40–65 years who participated in the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) between physical activity and sleep disorders in middle-aged adults. Thereafter, the dose-response connection was examined using RCS. Results After adjusting for potential confounders, subjects with MET values in the first quartile (Q1) had odds ratios (OR) for sleep disturbance of 0.851 (95% CI = 0.745–0.973), 0.800 (95% CI = 0.698–0.917), and 0.780 (95% CI = 0.680–0.895) compared to subjects with MET values in the second, third, and fourth quartiles respectively. RCS regression showed a non-linear association between physical activity and sleep disorders in middle-aged adults (non-linearity P = 0.0382). Furthermore, the prevalence of sleep disorders in middle-aged adults decreased with increasing physical activity, reaching a minimum when weekly physical activity was around 166.27MET*h (OR = 0.885, 95% CI = 0.799–0.981). Conclusion Our research demonstrates that physical activity was negatively associated with sleep disorders.

Background: Transition education is a robust strategy to improve the core competency of newly graduated nurses and the quality of clinical nursing and ensure people's safety. Limited information about the learning objectives and educational content for newly graduated nurses in China was available.Objective: Construct the learning objectives and educational content for newly graduated nurses based on defined core competencies. Design: We used a literature review and the e-Delphi method to conduct this study.Settings: Ten tertiary teaching hospitals and six nursing schools in Zhejiang Province, China, were selected.Participants: Experts (n = 21) were invited to the e-Delphi study. Methods: Based on seven competencies from the literature review and the research group discussions, we formed an initial set of objectives and specific educational content for newly graduated nurses. Subsequently, experts provided supportive and modification advice on the competencies, objectives, and specific content in the two Delphi rounds. The consensus percentage and the weight of each first-level, second-level, and third-level item were calculated.Results: Consensus was achieved on seven core competencies, 44 learning objectives, and 60 components of educational content. The positive coefficient of the two Delphi rounds was 100 %, the authority coefficient was 0.83 and 0.87, the proportion of experts who made suggestions was 71.40 %, the coefficient of variation (CV) was <0.25 (P < 0.05) except for two items and the Kendall coefficient (W) was 0.15-0.48 (P < 0.01).Conclusion: The developed objectives and content framework provide a reference for implementing systematic and standardized education for newly graduated nurses.

总结全病种睡眠医学中心的建立及管理体会.合理的空间布局、舒适的环境设施、经验丰富的医护技团队、完善的工作制度和流程是全病种睡眠医学中心设立和管理的重点.全病种睡眠医学中心自2021年5月建立至2022年11月共收治患者2 615例,2021年第三季度患者满意度97.4分,护理质量检查各项目均在95分以上,2022年第三季度患者满意度99.1分,护理质量检查各项目均在97分以上.

The study investigated the association between Serum Uric Acid (SUA) levels and all-cause as well as cardiovascular mortality in patients with Obstructive Sleep Apnea (OSA). This prospective cohort study enrolled participants with OSA from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008, and 2015-2018. A weighted Cox proportional hazards model was used to assess adjusted hazard ratios (aHRs) and their corresponding 95% confidence intervals (CI) for all-cause and cardiovascular mortality. Additionally, multivariable logistic regression and restricted cubic splines (RCS) models were employed to examine nonlinear relationships between SUA and all-cause and cardiovascular mortality. Among the 5,584 OSA participants included in the study, covering the four NHANES cycles and with a median follow-up of 4.333 years, a total of 537 deaths were observed, including 108 deaths attributed to cardiovascular disease. Comparing the fourth quartile (Q4) of uric acid levels, both the fifth quartile (Q5) (aHRs = 1.51, 95% CI [1.08, 2.12]) and the second quartile (Q2) (aHRs = 1.53, 95% CI [1.04, 2.25]) of uric acid levels were independently associated with an increased risk of all-cause mortality. Furthermore, comparing the fourth quartile (Q4) of uric acid levels, the second quartile (Q2) (aHRs = 2.40, 95% CI [1.08, 5.35]) of uric acid levels were independently associated with an increased risk of cardiovascular mortality. The RCS model demonstrated a U-shaped pattern in the association between SUA and all-cause mortality in OSA, with an inflection point observed at 5.83 mg/dl. The findings of this study suggest a U-shaped association between serum SUA levels and all-cause mortality and nonlinearity association between serum SUA levels and all-cause mortality. Further studies are warranted to determine the causal relationship between SUA levels and all-cause and cardiovascular mortality.

目的 观察"智慧服药"提醒系统联合微信群督导模式在颅内外动脉支架置入术后患者服药中的应用效果.方法 对符合研究条件的81例患者按住院时间的先后顺序进行分组,对照组(40例)采取传统出院健康宣教及院外电话随访延续护理形式,观察组(41例)出院后实行"智慧服药"提醒系统联合微信群督导模式护理,在出院时、出院后3个月和6个月3个时间点评价患者的服药依从性和血脂水平.结果 重复测量方差分析结果显示,两组患者服药依从性在时间、组间、时间和组间交互效应上比较差异均有统计学意义;两组患者总胆固醇和高密度脂蛋白胆固醇在时间、组间上比较差异有统计学意义;两组患者甘油三酯和低密度脂蛋白胆固醇在时间、组间、时间和组间交互效应上比较差异有统计学意义.结论 "智慧服药"提醒系统联合微信群督导模式能提高颅内外动脉支架置入术后患者的服药依从性,降低患者的血脂水平.

总结1例佩里综合征患者的护理经验.护理重点为:做好有创呼吸机及无创呼吸机的序贯治疗管理;给予针对性心理护理;做好低体质量营养管理以及出院指导与随访.患者住院23 d后,携带无创呼吸机顺利出院;随访3个月,未发生严重的呼吸衰竭事件,恢复较好.

目的 观察循证改进后的难愈性伤口护理会诊流程的实施效果.方法 采用目的抽样法选取61名临床护士为研究对象,按照工号从小到大排列并按顺序编号,编号奇数31名护士为对照组,偶数30名护士为观察组.对照组采用常规电子护理会诊系统和模式,观察组基于循证,通过检索国内外相关文献,并采用Johns Hopkins证据等级与质量评定方法评价文献,同时综合专家和临床医护人员意见,考虑患者需求,了解难愈性伤口护理工作模式、存在的问题、临床需求以及电子会诊系统的现状,开发难愈性伤口护理会诊可视化信息平台,并实践.比较两组护士的换药操作得分.结果 观察组护士换药操作得分高于对照组,比较差异具有统计学意义(P＜0.05).结论 难愈性伤口护理会诊循证改进后可视化信息平台能有效传递专科护士的会诊意见、诊治方法,提高临床护士操作能力,为患者提供同质化的护理服务.

目的:分析磁性医院认证标准下的护士分层培训项目的效果.方法:分析磁性医院认证标准要求,结合医院及护理部的规划、临床护理质量监控指标及评估各层级和各岗护士的学习需求,设立护士分层培训项目,使护理部与护理单元紧密结合,每年根据不同需求进行各类项目的精细化设计、实施和评价.结果:我院在全方位评估的基础上设立各类在职培训项目,护士对各类培训项目的满意度达95％以上,护士对在职培训总体满意度超过磁性医院相关数据库的均值;同时护士在职培训项目改善了患者满意度,其中患者对“护士的技能”及“能用听得懂的方式向我解释”的满意度逐年提升且超过磁性医院相关数据库均值;护士心电图知识水平提升,全院有损伤的跌倒率下降.结论:围绕临床结局开展的在职培训项目能有效提高护士的学习效果、满意度,并提高患者满意度.

总结4例颈动脉支架成形术后发生脑高灌注综合征患者的护理经验.护理要点包括:密切监测神经系统相关症状,严格控制血压,做好早期癫痫发作的护理,以及相关的基础护理和加强偏瘫肢体的康复锻炼.4例患者经治疗和护理恢复良好,顺利出院.

脑卒中已成为我国第一位死亡原因 ,存活下来的脑卒中患者中有50% ~70% 遗留偏瘫、失语等严重残疾[1 ] .随着医学科技的发展 ,目前脑卒中的病死率虽然有下降趋势 ,但复发率有所增加,脑卒中5年内复发率在15% ~42% [2 -3 ] .服药依从性是影响脑卒中复发的重要因素.首次脑卒中后的12个月内 ,遵医嘱规律服药可显著降低脑卒中复发的风险[4 -5 ] .因此 ,为有效降低脑卒中复发率 ,提高脑卒中患者服药依从性显得极为迫切和重要.本文从脑卒中服药依从性的影响因素及应对措施两方面进行综述 ,为更好地提高脑卒中患者服药依从性 ,降低复发率提供依据.

奥瑞姆(Dorothea.E.Orem)是美国著名的护理理论学家之一,她在1971年提出自我护理的概念和自我护理理论,即自理模式(0rem'S self-careModel).此模式在实践中经过不断的发展和完善,已引起越来越多的关注.Orem自理模式分3部分;自理理论,自理缺陷理论和护理系统理论[1].