Background: The elderly patients admitted to cardiac intensive care unit (CICU) are at relatively high risk for developing delirium. A simple and reliable predictive model can benefit them from early recognition of delirium followed by timely and appropriate preventive strategies.Objective: To explore the role of frailty in delirium prediction and develop and validate a delirium predictive model including frailty for elderly patients in CICU.Design: A prospective, observational cohort study.Settings: CICU at China-Japan Friendship Hospital from March 1, 2022 to August 25, 2022 (derivation cohort); CICU at Beijing Anzhen Hospital affiliated to Capital Medical University from March 14, 2023 to May 8, 2023 (external validation cohort).Participants: A total of 236 and 90 participants were enrolled in the derivation and external validation cohorts, respectively. Participants in the derivation cohort were assigned into either the delirium (n = 70) or non delirium group (n = 166) based on the occurrence of delirium.Methods: The simplified Chinese version of the Confusion Assessment Method for the Diagnosis of Delirium in the Intensive Care Unit was used to assess delirium twice a day at 8:00-10:00 and 18:00-20:00 until the onset of delirium or discharge from the CICU. Frailty was assessed using the FRAIL scale during the first 24 h in the CICU. Other possible risk factors were collected prospectively through patient interviews and medical records review. After processing missing data via multiple imputations, univariate analysis and bootstrapped forward stepwise logistic regression were performed to select optimal predictors and develop the models. The models were internally validated using bootstrapping and evaluated comprehensively via discrimination, calibration, and clinical utility in both the derivation and external validation cohorts.Results: The study developed D-FRAIL predictive model using FRAIL score, hearing impairment, Acute Physiology and Chronic Health Evaluation-II score, and fibrinogen. The area under the receiver operating characteristic curve (AUC) was 0.937 (95% confidence interval [CI]: 0.907-0.967) and 0.889 (95%CI: 0.840-0.938) even after bootstrapping in the derivation cohort. Inclusion of frailty was demonstrated to improve the model performance greatly with the AUC increased from 0.851 to 0.937 (p < 0.001). In the external validation cohort, the AUC of D-FRAIL model was 0.866 (95%CI: 0.782-0.907). Calibration plots and decision curve analysis suggested good calibration and clinical utility of the D-FRAIL model in both the derivation and external validation cohorts.Conclusions: For elderly patients in the CICU, FRAIL score is an independent delirium predictor and the D-FRAIL model demonstrates superior performance in predicting delirium.

冠状动脉粥样硬化性心脏病是目前全球疾病负担最大的单病种疾病,全球患病率为1.53％,占全部心血管疾病的26％[1].我国冠心病的患病率和死亡率自1990年以来呈持续上升趋势.据《中国心血管健康与疾病报告2021》[2]报告,我国心血管病现患数为3.3亿,其中冠心病1139万,占 87.6％.

Objective:To translate Career Success in Nursing Scale (CSNS) into Chinese and evaluate the reliability and validity of it.Methods:According to the translation principle of Brislin questionnaire, the English version of CSNS was translated, back-translated and culturally adjusted to determine the simplified Chinese version of CSNS items and form the Chinese version of CSNS. A total of 1 489 nurses from China-Japan Friendship Hospital were selected as the research objects from May to June 2021. The general information questionnaire and simplified Chinese version of CSNS were used to investigate them. Internal consistency and split-half reliability coefficient were used to evaluate the reliability of the scale. Pearson correlation analysis was used to analyze the correlation between each dimension and the relationship between each dimension and the total scale. A total of 1 489 questionnaires were collected and 1 434 valid questionnaires were collected, with an effective recovery rate of 96.3%.Results:The Chinese version of CSNS included 4 dimensions, such as "desired career development" "providing quality care" "effective self-regulation" and "fit between human and organization" , with a total of 39 items. The expert content validity was 0.984. The results of exploratory factor analysis showed that the cumulative variance contribution rate of the four common factors was 74.71%. The Cronbach's α coefficient of the total scale was 0.985 and the Cronbach's α coefficient of each dimension was 0.955-0.979. The split-half reliability of the total scale was 0.986 and the split-half reliability of each dimension was 0.957-0.979. The test-retest reliability of the scale was 0.966.Conclusions:The Chinese version of CSNS scale has good reliability and validity, which can be used to evaluate the psychological characteristics of nurses' career success.

目的:评价不同导尿方式对脊髓损伤病人尿路感染和膀胱功能的影响.方法:通过计算机检索EMBASE、Medline、Cochrane Library、Pubmed、CNKI、万方、维普等数据库,时间为自建库起至2017年4月发表的文献.纳入比较两种不同导尿方式对脊髓损伤病人尿路感染和尿道功能影响的随机对照试验(RCT),研究对象为病情稳定、无严重临床并发症、符合美国脊柱损伤学会2006年制定的脊髓损伤标准的脊髓损伤病人.对照组采用留置尿管进行导尿,试验组采用间歇导尿方式.培训2名评价员,对文献进行独立筛选和评价,同时对数据进行提取.结果:最终纳入6篇文献,共489例病人.Meta分析显示,间歇导尿可以降低脊髓损伤病人尿路感染率[OR=0.16,95％CI(0.10,0.25),P<0.00001],可明显缩短病人自主排尿时间[WMD=-10.28,95％CI(-11.38,-9.18),P<0.00001],降低病人膀胱残余尿量[WMD=-35.90,95％CI(-40.53,-31.27),P<0.00001],提高病人临床总有效率[OR=0.19,95％CI(0.07,0.53),P=0.001],可明显增加膀胱容量[WMD=93.68,95％CI(76.68,110.91),P<0.00001].敏感性分析显示该研究稳定性较好,漏斗图提示各研究没有发表偏倚.结论:间歇导尿可以降低脊髓损伤病人尿路感染发生率,有利于病人膀胱功能重建.但由于纳入文献数量偏少,且有些文献质量偏低,仍需要加大样本量继续对此进行研究论证.

目的:评价跨专科护理健康教育平台应用于患者健康教育的效果.方法:在医院场景下,针对微信公众平台与Web网页进行二次开发,通过建立跨专科健康教育资料库、功能端与管理端,实现跨专科之间健康教育知识共享.比较平台使用前后试点科室患者满意度与护士健康教育能力.结果:跨专科移动护理健康教育平台使用后,患者满意度由(86.59±10.03)分提高为(90.66±8.00)分,护士健康教育能力由(139.29±20.48)分提升为(150.30±18.19)分,差异均具有统计学意义(P<0.05).结论:跨专科护理健康教育平台的建立与应用能够促进跨专业健康教育知识的交流与融合,提高护士健康教育能力和改善患者满意度,提升医院整体健康教育能力与质量,值得推广.

压力性损伤(pressure injury,PI)的发病率为9.2％～15.5％[1],这不仅需要花费高额的医疗费用,还会影响患者原发疾病的恢复、降低患者生存质量、延长住院时间、提高病死率和出院30d内再住院率,甚至引起医疗纠纷[2].2017年中国医院协会发布的《患者安全目标》中明确提出对评估为PI的高风险的患者,应采取有效的预防措施[3].目前对于护士 PI预防能力的培训大多采用单纯"理论式"培训,缺乏互动及实践能力培训,存在与临床实际情景存在差异的问题,导致护士在实际工作中难以准确的识别并处理患者PI的风险[4].案例培训模式(case training model,CTM)以案例为核心,理论与实践相结合,是一种能够提高被培训者临床逻辑思维和推理判断能力的教学方法[5].同时,多元化培训模式,即采用理论授课、临床学习、比赛等形式相结合的培训教育,激发被培训者的学习兴趣,提高学习效果[6].在此背景下,我院探索性采取CTM与多元化培训相结合的模式,即以案例为切入点,多元化分析、分享的方式,对临床护士开展预防PI评估和处理的培训,引导临床护士及时、准确地掌握PI预防的相关内容,已有效地应用于临床工作.

Pressure injury is a common problem faced by global health care institutions, which seriously threatens the lives and health of patients. The treatment and care of pressure injuries need people in multiple professional fields to work together. This article interprets the assessment and planning part of the clinical practice guideline for the third edition of " Assessment and Management of Pressure Injuries for the Interprofessional Team" developed by the Registered Nurses' Association of Ontario, Canada. This article aims at helping the interprofessional team conduct accurate, comprehensive, and full-process assessments of patients with pressure injuries, formulate a reasonable diagnosis and treatment plan, and providing a basis for the implementation of correct treatment measures, so as to promote the improvement and healing of pressure injuries.

This article comparatively analyzed the Prevention and Treatment of Pressure Ulcers/Injuries：Clinical Practice Guideline issued by the National Pressure Injury Advisory Panel（NPIAP），European Pressure Ulcer Advisory Panel（EPUAP），and Pan Pacific Pressure Injury Alliance（PPPIA） in 2019 and the Assessment and Management of Pressure Injuries for the Interprofessional Team（Third Edition）issued by Registered Nurses' Association of Ontario（RNAO）in 2016，in order to provide the references for the standardized management of pressure injuries in China.