Objective To explore the feasibility and safety of early ambulation in patients with acute deep ve-nous thrombosis. Methods The literatures about early ambulation for acute venous thrombosis were collected and the quality of the literature was evaluated by two investigators independently. Results Thirteen published studies were recruited for systematic review,including 10 RCTs and 3 CCTs. The meta-analysis showed that compared with bed rest,early ambulation did not increase the incidence of secondary pulmonary embolism in patients with acute DVT[early activity:22/1408;bed rest:34/1417;RR=0.62,95%CI(0.37,1.03),and the incidence of DVT progression [early activity:48/1523;bed rest:45/1525;RR=0.85,95%CI(0.58,1.24)]. There were no statistically significant differ-ences in mortality,swelling,and pain relief in acute DVT patients. Conclusion Early ambulation did not increase the incidence of thrombus progression and secondary pulmonary embolism in patients with acute DVT compared with bed rest. Besides,early ambulation cannot relieve symptoms of swelling and pain in DVT patients. However,it can relieve the acute pain of DVT patients with moderate to severe pain.

Objective: To summarize the experience of respiratory tract management in a case of spinal muscular atrophy with neuromuscular scoliosis. Methods: Respiratory tract nursing included prevention of pulmonary infection, inspiratory muscle training, rebuilding respiratory form before surgery, and assessment of sputum expectoration capacity, pain management, airway management after surgery. Results: The patient was discharged without pulmonary complications. Conclusions For patient with breathing problem, respiratory tract management can prevent pulmonary complications during perioperative period.

Objective To evaluate the application effect of Wechat platform in clinical teaching of production& practice nursing students in Department of Orthopaedics .Methods By convenience sampling , 102 practice nursing students in Ward of Department of Orthopaedics in Peking Union Medical College Hospital were selected , among whom , 50 were set as the control group , who did the practice from July 2013 to June 2014 , and another 52 were set as the experimental group , who did the practice from July 2014 to June 2015 . The nursing students in the control group were taught by traditional clinical teaching method , while the nursing students in the experimental group were taught with the assistance of Wechat platform , on the basis of traditional teaching.Final examination scores of the nursing students at the completion of the internship and their evaluation on the clinical teaching were compared between the two groups .Results Total scores of final examination of the students in the experimental group were (96.014 ±1.040), and total scores of the students′evaluation on clinical teaching were (92.615 ±2.774), both higher than the scores in the control group (t=8.612, 4.909;P<0.01).Conclusions Wechat platform, as a new assistance teaching method, can improve quality of clinical teaching and has won popularity among nursing students , which make it worth promoting in clinical teaching.

0bjective To summarize the nursing experience of 1 case underwent total hip arthroplasty of left side after 4 years of heart transplantation. Method Effective preoperative assessment and adequate preparation for patients. Prevent the postoperative complications such as cardiac allograft vasculopathy, infection,renal impairment. To conduct effective psychological care. Implementing individualized functional training. Ensuring patient safety. Promoting functional recovery of hip joint in patients. Results After careful nursing care, the patient recovered well and discharged from hospital after 5 days. Conclusions In view of this patient. Adequate preoperative assessment, prevention of complications after surgical and individual functional exercise. All of these could ensure perioperative safety of patients. They have effective means to promote functional recovery of hip joint.

Objective To explore the effect of the rehabilitation self-efficacy of patient with total knee arthroplasty on the first time of ambulation after operation.Methods Totally 110 patients undergoing total knee arthroplasty were recruited,they were investigated with self-designed general information and disease situation questionnaire and recorded the first time of ambulation.The self-efficacy was measured by the Self-Efficacy for Rehabilitation outcome scale(SER).Results The earliest time of ambulation was 7.5 hours after surgery.The latest time of ambulation was 54.0 hours after surgery.The median time of the first ambulation was 46.0 h.The mean score of self-efficacy for rehabilitation therapy exercises was (28.58 ± 9.18) points,and the mean score of self-efficacy in overcoming barriers was (43.07 ± 11.04) points,and the mean score of SER was (71.65 ± 18.47) points.The total score of self-efficacy for rehabilitation therapy exercises,self-efficacy in overcoming barriers,and the score of SER were negatively correlated with the first time of ambulation (r=-0.442,-0.299,-0.399,P＜ 0.01).The self-efficacy of rehabilitation was one of the influencing factors of patient's first time of ambulation(P ＜ 0.05),which explained 9.7％ of total variance of early ambulation of patients with total knee arthroplasty.Conclusions The self-efficacy of rehabilitation after total knee arthroplasty was significantly correlated with the first time of ambulation,and the higher self-efficacy of rehabilitation,the earlier the first time of ambulation.The self-efficacy of rehabilitation was one of the important factors that affect the first time of the patient's ambulation after total knee arthroplasty.

Objective To explore the effects of the systematic "three preventions and three positions" nursing on preventing arthritic prosthesis dislocation after total hip arthroplasty (THA) for different diseases. Methods Based on historical control,459 patients who received THA in the orthopedics department of a hospital between January 2012 and December 2013 were selected as a control group. Patients in the control group received conventional nursing as well as health education and perioperative care as per routines. Totally 768 patients who received THA in the same hospital between January 2014 and December 2016 were selected as a treatment group. On the basis of conventional nursing,patients in the treatment group received targeted holistic nursing derived from the systematic "three preventions and three positions" nursing. The incidence of arthritic prosthesis dislocation between the two groups 3 months after THA was then compared.Results The incidence of arthritic prosthesis dislocation of the treatment group was 0.65%,including 1.56% for revision of THA,0.90% for femoral neck fractures,0.64% for osteonecrosis of the femoral head (ONFH),and 0.70% for congenital hip disorder (CHD) patients,while the incidence of arthritic prosthesis dislocation of the control group was 2.18%, which included 33.33% for revision of THA,1.25% for femoral neck fractures,0.70% for ONFH,and 0.70% for CHD patients. The treatment group′s incidence of arthritic prosthesis dislocation was lower than that of the control group (χ2=5.552;P<0.05):The incidence of arthritic prosthesis dislocation of THA revision patients in the treatment group was significantly lower than that of the patients in the control group (χ2=5.485;P<0.05);and the incidence of arthritic prosthesis dislocation among femoral neck fractures,ONFH and CHD patients in the treatment group was lower than the patients in the control group (χ2=0.309,0.743,2.771;P>0.05). Conclusions The systematic "three preventions and three positions" nursing helps to reduce the incidence of arthritic prosthesis dislocation after THA and THA revision,which is worthy of application and expansion.

Objective:To explore and construct the nursing quality standards of spine surgery, provide a scientific basis for improving the nursing quality of spine surgery.Methods:Taking the "structure-process-outcome" three-dimensional quality model as the theoretical framework, through evidenced-based literature search and semi-structured interview, the items pool was formed, and finally the nursing quality standards were determined by two rounds of Delphi method of expert inquiry from May to July 2023.Results:The positive coefficients of the two rounds of inquiries to experts were 0.90 and 1.00, respectively. The authority coefficients were 0.946 and 0.951, respectively. The Kendall coefficients of the first, second and third level standards in the first round were 0.161, 0.095 and 0.108, respectively, and the Kendall coefficients of the first, second and third level standards in the second round were 0.162, 0.088 and 0.100, respectively, the differences were statistically significant (all P<0.05). The final nursing quality standards were finally constructed, including 3 first-level standards (structural quality, process quality and outcome quality), 20 second-level standards and 60 third-level standards.Conclusions:The nursing quality standards of spine surgery based on the three-dimensional quality model of "structure-process-outcome" have high reliability and science, which can provide target incentives for clinical nurses, provide a basis for the quality of specialized spine nursing, and promote the development of nursing specialization and the construction of nursing discipline.

Objective To explore the effects of referral and rehabilitation status of patients with total knee arthroplasty (TKA) under the mode of medical alliance.Methods One hundred and ninety cases with total knee arthroplasty in the secondary rehabilitation hospitals after referral from a tertiary hospital from January 2016 to January 2017 were analyzed, including general demographic data, disease and surgical data, rehabilitation data after referral, hospital day and change of medical expenses of the tertiary hospital and rehabilitation hospitals before and after the promotion of the medical alliance mode.Results After receiving the rehabilitation treatment in secondary rehabilitation hospitals, the range of motion, muscle strength and some other indices of the patients' surgical legs were significantly improved (P<0.05). And the hospital day of the surgical hospital was shorten from (15.05±6.59) d to (12.97±5.24) d, and medical expenses were decreased by 2.18% in total, 4.76% per knee and 14.01% in rehabilitation costs.Conclusions Under the mode of medical alliance, transferring patients with TKA from a tertiary hospital to secondary rehabilitation hospitals in their early postoperative phase can facilitate recovery of the patients, and it can also help to reduce hospital day and medical expenses, thus to optimize the allocation of medical resources.

Objective? To explore the cognition of nurses in high-risk surgical departments for prevention of venous thromboembolism (VTE). Methods? Totally 464 nurses in surgical departments at high risk of VTE (departments of orthopedics, general surgery, neurosurgery, thoracic surgery, and critical care medicine) from 11 provinces (municipalities and autonomous regions) nationwide who attended the seminar on nursing by the Chinese Nursing Association in September 2017 were investigated with VTE Prevention Knowledge Questionnaire for Clinical Nurses to understand their knowledge about basic, physical and drug prevention for VTE. Results? The cognition of VTE prevention of nurses in high-risk surgical departments scored (13.51±3.42), standing at a medium level. In particular, the knowledge about physical prevention was unsatisfactory, which scored (5.71±2.18). The cognition score of VTE prevention varied in nurses of different departments, and the cognition of VTE prevention of nurses from departments of general surgery, orthopedics and critical care medicine was relatively better. Multivariate analysis revealed that educational background was an independent risk factor for the cognition of VTE prevention of nurses in high-risk surgical departments (OR=1.630,95%CI:1.035-2.567). Conclusions? The cognition of VTE prevention of nurses in high-risk surgical departments is unsatisfactory and cannot meet the needs of clinical work. Targeted training should be provided according to the weak links in the cognition of VTE prevention of nurses in high-risk surgical departments to improve the quality of VTE prevention and nursing, thus reducing the incidence rate of perioperative VTE in these patients.

Objective? To explore the application of action research method in optimizing informationized disease management system on venous thromboembolism(VTE) and to improve the VTE disease management. Methods? By convenience sampling, 50 nurses and 235 patient profiles in Peking Union Medical College Hospital from January 2015 to March 2017. According to the framework of action research method, firstly, the problems of VTE disease management system were clarified, and the system improvement plan was designed and implemented by means of literature review and expert meeting, etc. Through the two cycle processes of plan-action-observation-reflection (the first round and the second round), the informationized VTE disease system was continuously improved. The observation indicators were the completeness rate of patient profiles content, the accuracy rate of Caprini risk assessment, the accuracy rate of arm/leg circumference measurement, the filling time of reporting part and the filling time of daily tracking part. The data collection time was before intervention, after the first and second rounds of intervention. Results? Through the first round of action research, we improved the VTE information disease management system, and raised the content integrity rate of the reporting system from 72.00% to 100.00%; the correct rate of risk assessment from 68.00% to 91.11%, and the correct rate of arm/leg circumference measurement from 62.00% to 97.04%, the differences were statistically significant (P＜0.05). Through the second round of action research, the intelligence of the system increased, the filling time of the reporting part shortened from (107.32±8.07) s to (80.50±7.25) s, and the filling time of the daily tracking part shortened from (53.38 ± 6.37)s to (29.08 ±4.65)s, with statistically significant differences (P＜0.05). Conclusions? Action research method is an effective way to solve practical and multi-disciplinary cooperation problems. Based on action research method, improving and optimizing VTE disease management system can be applied to clinical practice and improve the quality of disease management.