目的 总结乳腺癌患者心理痛苦风险及筛查的最佳证据,为临床实践提供循证依据.方法 系统检索国内外相关网站及数据库发表的有关乳腺癌患者心理痛苦风险及筛查的中文或英文文献,检索时限为建库至2022年7月.对符合质量标准的文献进行最佳证据的提取与整合.结果 纳入11篇文献,形成危险因素、筛查时机、筛查内容和筛查工具4个方面的23条最佳证据.结论 提取的23条证据可作为乳腺癌患者心理痛苦筛查的参照.

Abstract Background Proper nutritional management was demonstrated to reduce complications and related to better clinical outcomes. However, inaccurate nutritional screening and assessment, inappropriate nutrition support, and contrary to the suggested guidelines were observed in clinical. Methods A self-designed questionnaire was used to conduct a cross-sectional survey in a tertiary-level general hospital. Nutritional Risk Screening 2002 was used for nutrition screening. A total of 620 patients with neurological diseases were enrolled in this study. Results All patients were conducted with nutritional screening, and among them, 24.4% had nutritional risk on admission and 22.7% in the final assessment. However, there were no statistically significant differences in nutritional status between the first and final assessments, except for the serum albumin concentration. 118 patients (19.0%) received pharmaceutical nutrition therapy and complications occurred in 35(45.5%) patients treated with EN and 29 (30.5%) patients treated with PN. In our study, not all nursing measures for tube feeding apart from confirming catheter position and raising the head of the bed were carried out in every patient receiving tube feeding in our research. Conclusions The incidence of nutritional risk of inpatients with neurological diseases enrolled in this research was relatively lower. However, nutritional treatment in this study was not standardized enough and the medical staff was suggested to accept relevant professional training to perform better in nutrition support.

目的 遴选并获取成人恶性肿瘤患者膳食管理的相关证据,并对最佳证据进行总结.方法 系统检索英国卫生与临床优化研究所(National Institute for Health and Care Excellence,NICE)、加拿大安大略注册护士协会(Registered Nurses Association of Ontario,RNAO)网站、国际指南网(Guidelines International Network,GIN)、苏格兰学院间指南网络(Scottish Intercollegiate Guidelines Network,SIGN)、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、Up to Date、BMJ Best practice、Cochrane Library、PubMed、中国生物医学文献数据库关于成人恶性肿瘤患者膳食管理的所有证据,包括临床决策、证据总结、指南、推荐实践、系统评价、专家共识,检索时限为建库至2021年9月30日.由2名具有循证护理培训背景的研究者独立完成质量评价,并对纳入文献进行证据提取.结果 共纳入14篇文献,包括临床决策2篇,证据总结3篇,指南6篇,系统评价1篇,专家共识2篇.总结了30条最佳证据,包括多学科团队、膳食评估、膳食目标量、膳食营养素来源、膳食建议、膳食模式、膳食补充剂、体质量和身体活动9个方面.结论 本研究成汇总人恶性肿瘤患者膳食管理的相关证据,为医务人员临床实践提供相关循证依据,以期建立恶性肿瘤患者膳食管理规范化流程,改善癌症患者预后,提高临床护理质量.

目的 检索及筛选成人结直肠癌患者围术期口服营养补充的最佳证据,结合ORTCC模型进行总结,为优化临床口服营养补充实施流程提供参考.方法 依据"6S"模型检索国内外数据库及专业网站中关于成人结直肠癌患者围术期口服营养补充相关的证据,包括临床决策信息册、指南、专家共识、证据总结、系统评价,进行文献质量评价,参考ORTCC模型提取并汇总相关证据.结果 共纳入18篇文献,其中包括7篇指南、6篇专家共识、2篇证据总结、3篇系统评价,总结5个维度26条证据.结论 基于ORTCC的成人结直肠癌患者围术期口服营养补充最佳证据总结为临床实践提供循证依据,需结合临床实际加以应用,提高营养治疗效果,使患者受益.

The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occlusions, infections, and mechanical complications was 5.0%, 2.0%, and 3.0%, respectively. Then, we compared the frequency of port-related complications between standard and longer flushing intervals. There were no differences between the group's changes in the frequency of total late complications, occlusions, infections, and mechanical complications. This systematic review and meta-analysis demonstrates that longer flushing intervals for ports are safe. However, more prospective, power appropriated randomized trials are needed to explore the specific flushing time for ports.

目的 构建肠内营养相关便秘预警分级标准及干预方案.方法 基于循证,结合临床实践,通过专家会议法初步设定咨询内容,运用德尔菲法进行2轮专家函询,确立了最终方案.结果 2轮函询中专家的积极系数均为100％,权威系数分别为0.866、0.902,肯德尔和谐系数为0.139、0.301.最终确立了肠内营养相关便秘预警分级标准及干预方案,包括5级便秘预警分级及17项干预措施.结论 构建的肠内营养相关便秘预警分级标准及干预方案具有一定的科学性和可靠性,为护理肠内营养患者提供了参考依据.

目的 检索并筛选围手术期患者口服营养补充的相关证据,并对最佳证据进行总结.方法 通过计算机检索UpToDate、BMJ Best Practice、国际实践指南注册平台、英国卫生与临床优化研究所网站、国际指南网、加拿大安大略注册护士协会网站、苏格兰学院间指南网、欧洲肠外肠内营养学会网、美国肠外肠内营养学会网、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、Cochrane Library、PubMed和中国生物医学文献数据库中有关成人围手术期患者口服营养补充的相关证据,包括指南、临床决策、证据总结、系统评价及专家共识.检索时限为2017年1月—2019年12月.由2名研究者对文献质量进行独立评价,同时提取和汇总相关证据.结果 共纳入14篇文献,包括2篇指南、2篇临床决策、6篇专家共识、4篇系统评价,共总结了16条证据,内容包括适应证、推荐剂量、健康宣教、术前营养、术后营养、减重手术及出院后营养7个方面.结论 该研究总结的围手术期患者口服营养补充的最佳证据具有科学性和全面性,为营养不良或存在营养不良风险的围手术期患者的营养干预提供循证依据.

Objective To understand the practice of decision-making among neonatal PICC specialty nurses,and to provide reference for setting up nursing intervention to enhance neonatal PICC specialty nurses' decision-making level.Methods Semi-structured interviews were conducted among 12 neonatal PICC specialty nurses,and data were analyzed using thematic analysis method.Results Two themes were extracted on nurses' perception of clinical nursing decision-making:perceived the importance of decision-making and unclear of the exact definition and process of decision-making.Five themes were extracted regarding their experience of clinical decision-making:multiple role conflicts had negative effects on decision-making,individual differences in decision-making,desire for convenient specialized support and cooperation,ambivalence of challenging difficult decision-making and fear of consequences,post-decision-making experience summary and self-reflection.Conclusion Neonatal PICC specialty nurses' perception on clinical decision making is insufficient,and positive and negative experience coexisted.Nursing educators and administrators should do something to improve specialty nurses' perception and emphasis on clinical nursing decision-making,so as to reduce their decision-making stress,and raise decision-making efficiency via establishing regional interactive platform.

目的 根据应用反馈,最终形成基于SBAR模式的专科化《监护室护士床旁交班方案》.方法 采用前后对照的研究方法,纳入15名监护室护士,在某监护室应用4个月,评估基于SBAR模式专科化《监护室护士床旁交班方案》修订版的应用,采用主观评价指标(中文版护士交接班评估量表,自制满意度测试问卷)评价交班效果及对交班模式的满意度;客观过程评价指标(接班时错误信息发生数量、接班时信息遗漏发生数量、床旁交班时间、准备交班内容时间及交班方案使用频率)测量交班的效率性.结果 干预期间,中文版护士交接班评估量表得分干预后第一月最低,干预后第二月显著高于基线.满意度结果得分干预后第一月最低,干预后第二月显著高于基线.信息的遗漏一直呈现下降趋势;床旁交班时间、准备交班时间,干预后均要长于干预前,随着使用时间增长,时间缩短.交班使用频率也是随着干预时间增长,而呈现减少趋势(P＜0.05).结论 《监护室护士床旁交班方案》修订版,对监护室护士的挑战较大,但是通过有效的培训,足够时间的磨合,当监护室护士适应后,能提高监护室交班的有效性及监护室交班的满意度.

目的 了解成人患者治疗结束后PICC闲置现况,并分析影响因素.方法 采用自制PICC情况调查表对上海市5所三级甲等综合医院358例PICC拔管患者进行调查.结果 255例(71.2％)患者PICC闲置.Logistic回归分析显示,人际交往程度、自觉PICC影响程度、医疗付费方式、化疗次数、置入手臂、拔管建议者是患者PICC闲置的影响因素(P＜0.05,P＜0.01).结论 PICC闲置问题较普遍,应针对影响因素进行管理和改进,及时拔除不再需要的PICC导管,促进PICC使用安全.

Background: Increasing studies concern about idle vascular access devices, but still scant data on idle peripherally inserted central catheters. We aimed to assess the prevalence and risks of idle peripherally inserted central catheters in adult patients. Methods: A multicenter cross-sectional observational study was performed between April 2018 and July 2018. Patient demographics and peripherally inserted central catheters-related information were abstracted using a site questionnaire by directly inquiring and medical records reviewing right after their peripherally inserted central catheters were removed. Results: Three hundred and fifty-eight patients with peripherally inserted central catheter episodes who met the inclusion criteria were studied. Of the 58,000 total catheter-days recorded, 5311 (9.2%) were considered as idle based on our study criteria. Two hundred and fifty-five (71.2%) patients had at least 1 idle catheter-day with a mean duration of 14.84 (19.31) idle days. The incidence of catheter-related complications in patients with idle peripherally inserted central catheters was lower than that in patients without idle peripherally inserted central catheters, though the difference did not reach statistical significance (odds ratio = 0.635, 95% confidence interval = 0.367-1.099, p = 0.103). Conclusion: In conclusion, idle peripherally inserted central catheters were common in adult patients, but the low risks of catheter-related complications may justify maintaining a peripherally inserted central catheter for further observation when necessary.

静脉输液的发展历经了几百年的历史,现今已成为临床最常用和最直接有效的治疗手段之一[1].研究[2]显示,90% 以上的住院患者需接受静脉输液治疗.伴随着静脉输液技术的迅猛发展,静脉输液工具即各种静脉输液导管也在不断更新和发展.尽管静脉导管是临床用药的重要途径,它在给患者带来便利的同时也会产生各种局部和系统并发症,常见的如液体外渗和堵管[3-4]、穿刺点局部感染和静脉炎也经常发生[5],同时还会引起致命的并发症包括中心静脉导管相关性血流感染(central line-associ-ated blood stream infection ,CLABSI)和深静脉血栓(deep venous thrombosis ,DVT )[6-7].越来越多的证据[8-10]表明,静脉导管相关并发症会使患者病死率增高、住院天数延长、住院费用增加.为了预防静脉导管相关并发症,必须合理使用静脉输液工具,只有在病情需要时才置入,并根据相关指南推荐,及时拔除.尽管国内外多个权威组织[11-12]均推荐及时拔除不需要的静脉导管;但研究[13]发现,许多不再需要的静脉导管仍留置在患者体内.临床指征消失后仍留置在患者体内的静脉导管即为闲置静脉导管[14].越来越多的研究者[15]开始关注闲置静脉导管,发现闲置会增加相关并发症的概率,给患者带来风险.本文就闲置静脉导管的定义、发生率、原因和风险、预防和处理的研究现状进行综述,为临床医护人员提供思路,以便其更好地管理静脉输液工具,降低静脉治疗的风险,提高患者的输液质量.

Objective To systematically e-valuate the effect of early removal of urethral catheter in patients after abdominal surgery.Methods We searched the Cochrane Database of Systematic Reviews,CINAHL,PubMed,the Excerpta Medical Databse (Embase),Web of Knowledge,Chinese biomedical literature database(CBM),Chinese national knowledge infrastructure(CNKI)and Wanfang database to collect randomized control trials(RCTs),controlled clini-cal trials(CCTs),cohort studies and case control studies.Meta-analysis was conducted for the eligible stud-ies using RevMan 5.3.Results Six RCTs and three cohort studies involving a total of 889 patients were in-cluded.Meta -analysis results indicated that early removal of urethral catheter decreased the incidence of catheter - associated urinary tract infection(CAUTI)(RR = 0.38,95% CI(0.24,0.60),P< 0.0001), shorten the length of stay(P<0.05).However,it increased the incidence of postoperative urinary retention (RR=2.30,95% CI(1.60,3.31),P<0.00001).There was no significant difference in the incidence of pul-monary complications and wound infection from among 3 studies(all P>0.05).Conclusion Early removal of urethral catheter can reduce the incidence of CAUTI,shorten length of stay,however,with result in higher incidence of POUR.There is not enough evidence to support early removal of urethral catheter to re-duce the incidence of pulmonary complications and wound infection.

Objective: To identify, describe, and evaluate interventions to reduce unnecessary central venous catheter (CVC) use to prevent central-line-associated bloodstream infections (CLABSIs) in adults. Design: Systematic review. Methods: The review has been registered in PROSPERO, an international prospective register of systematic reviews. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health (CINAHL) from inception until August 28, 2018, to collect experimental and observational studies. We included all studies that implemented interventions to reduce unnecessary CVC use, defined as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices. Results: In total, 1,892 unique citations were identified. Among them, 1 study (7.1%) was a randomized controlled trial, 9 studies (64.3%) were quasi-experimental studies, and 4 studies (28.6%) were cohort studies. Furthermore, 13 studies (92.9%) demonstrated a decrease in CVC use after intervention despite different reporting methods, and the reduction rate varied from 6.8% to 85%. Also, 7 studies (50.0%) that reported the incidence of CLABSI described a reduction in CLABSIs ranging from 24.4% to 100.0%. Data on secondary outcomes were limited, and results of the descriptive analysis showed 70%-84% compliance with these interventions, less catheter occlusion, shorter duration of hospitalization, and cost savings. Conclusions: Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSI. Healthcare providers should strongly consider implementing these interventions for prevention of CLABSI in adults.

Objective:To investigate the risk and psychological health status of obstructive sleep apnea (OSA) in patients with type 2 diabetes mellitus and to explore the relationship between them.Methods:The general situation questionnaire,the Berlin questionnaire (BQ) and the Kessler10 psychological scale (K10) were used to investigate 211 patients with type 2 diabetes mellitus.Results:78.7％ of patients with type 2 diabetes mellitus had a high risk of OSA,and the K10 scale score was (17.45±6.73).Correlation analysis showed that psychological health status was positively related to OSA risk (r=0.167,P =0.015).Multivariate logistic regression analysis showed that the risk of OSA in patients with type 2 diabetes was affected by age (OR=1.033,P=0.032),body mass index (OR=1.153,P=0.002) and psychological health status (OR =1.066,P =0.011).Conclusions:The nursing staff should pay enough attention to the sleep and psychological health of the patients with type 2 diabetes mellitus,and through psychological intervention,weight loss guidance and other ways to help patients reduce the risk of OSA.