Objective To systematically evaluate the type and magnitude of effectiveness of pulmonary rehabilitation program on patients diagnosed with chronic obstructive pulmonary disease (COPD) in none-acute phases.Methods Two investigators independently searched three databases including Cochrane library,Pub Med and CNKI to collect randomized controlled trials about Pulmonary Rehabilitation Program on COPD Patients.A total of 17 trials were included.The quality of these RCTs was evaluated by two investigators and the combination of study results was conducted using RevMan 5.0.2 software.Results Pulmonary Rehabilitation Program could improve COPD patients' exercise tolerance,quality of life,lung function and blood oxygen level.It was also beneficial to patients' discomforts including dyspnea and fatigue.Conclusions The meta-analysis had identified a significant effect of pulmonary rehabilitation program on COPD patients,so nurses are suggested to integrate effective programs into clinical practice.

Objective? To explore the effects of self-managed, home-based pulmonary rehabilitation on quality of life and motor ability in patients with chronic obstructive pulmonary disease (COPD) in rural areas. Methods? Totally 92 patients from rural areas diagnosed with COPD in inpatient or outpatient department of two county-level hospitals in Hubei province from October 2016 to November 2017 were selected using convenient sampling and divided into the experimental group (n=46) and the control group (n=46) according to the random number table. Patients in the control group received conventional diagnosis, treatment and nursing care, while patients in the experimental group received self-managed, home-based pulmonary rehabilitation for 13 weeks besides the conventional intervention. St. George's Respiratory Questionnaire (SGRQ) and Six Minutes Walking Test (6MWT) were used to evaluate and compare the quality and life and motor ability of the two groups before and after intervention. Results? A total of 74 COPD patients completed the study with 38 in the treatment group and 36 in the control group. There was no statistically significant difference in general information, SGRQ scores or 6 MWT between the two groups before intervention (P＞0.05); the SGRQ score of the treatment group was lower than that of the control group after intervention with statistical significance(P＜0.05). The 6 MWT of the treatment group was higher than that of the control group after intervention(P＜0.05). Conclusions? Self-managed, home-based pulmonary rehabilitation can improve the quality of life and motor ability of COPD patients in rural areas.

Objective To investigate the efficacy and safety of home-based pulmonary rehabilitation on the improvement of quality of life in patients with COPD by Meta-analysis.Methods Randomized controlled tests (RCT) about the effectiveness of home-based pulmonary rehabilitation on quality of life in COPD patients were retrieved from electronic databases including PubMed, Science Direct, Cochrane Library, CBM, China National Knowledge Infrastructure (CNKI) and Wanfang Database from their establishment to January 31th, 2016. According to inclusion and exclusion criteria, RCT screening, data extraction and quality assessment were conducted by two reviewers independently. Meta-analysis was performed using RevMan 5.1 software.Results A total of 14 RCT involving 495 COPD patients were included. The Meta-analysis showed that: the home-based pulmonary rehabilitation intervention could significantly improve the quality of life evaluated by Saint-George's Respiratory Questionnaire [MD=-10.54, 95%CI (-15.44, -5.64)](intervention for 12 weeks) and improve the exercise capacity (six minutes walking distance) [MD=45.85, 95%CI (26.98, 64.72)]in COPD patients compared with the conventional treatment (P<0.05). Statistically significant differences in improving pulmonary function were not found between the two groups (FEV1%) [MD=0.52, 95%CI (-6. 75, 7.80)], (FEV1/FVC) [MD=-0.30, 95%CI(-6.43, 5.83)](P>0.05). There were no statistically significant differences in the mortality rate [RR=1.28, 95%CI (0.41, 4.02)] and the frequency of acute exacerbation [RR=1.34, 95%CI (0.60, 2.97)]between the two groups (P>0.05). Conclusions The home-based pulmonary rehabilitation is a safe and effective rehabilitation training form, which can effectively improve the quality of life and exercise capacity, reduce the degree of dyspnea in patients with stable COPD, but has no effects in the improvement of pulmonary function of stable COPD patients.

Objective? To explore the effect of applying Porter-Lawler comprehensive incentive model in nursing performance management in Psychiatric Department. Methods? From January 2017, we began to implement the Porter-Lawler comprehensive incentive model orientated nursing performance management, including improving job performance evaluation, integrating job incentive and high-quality nursing service incentive in the performance management. The incidence of Psychiatric Department inpatients' nursing adverse events, nurses' turnover intention, discharged patients' satisfaction on nurses and nurses' working satisfaction were compared before implementation(January to December,2016) and after implementation(January to December, 2017). Results? The incidence of adverse nursing events decreased from 1.049 thousand hospital days to 0.555 thousand hospital days after the implementation of Porter-Lawler comprehensive incentive model-oriented nursing performance management, the difference was statistically significant (χ2=8.06, P＜ 0.01). The total score of turnover intention of nurses decreased from (16.93±4.75) to (13.65±4.50). The difference was statistically significant (P＜ 0.01). The satisfaction of discharged patients increased from 95.2% to 98.5%. The difference was statistically significant (χ2=9.29,P＜ 0.01). The job satisfaction of nurses increased from (65.48±4.85) to (82.95±6.35). The difference was statistically significant (P＜ 0.01). Conclusions? Implementing incentive-based nursing performance management in Psychiatric Department can effectively enhance the working enthusiasm of nurses, reduce the turnover intention of nurses, improve the quality of nursing work, and increase patient satisfaction.

Chronic diseases bring significant changes to both the child and their parents. Compared to the child, the child's parents are more likely to perceive the child's vulnerability. Even though there is medical evidence to suggest that children with chronic diseases are in a stable state, parents still believe that their children are very vulnerable to disease, injury, or death, that is, parental perceptions of child vulnerability (PPCV). PPCV is commonly present in children with chronic diseases and can have a significant negative impact on both the child and their parents. This paper reviews the concept and evaluation tools of PPCV in children with chronic diseases, and focuses on the negative impact and intervention strategies of PPCV on children and their parents, so as to provide reference for the evaluation, prevention, and intervention of PPCV in children with chronic diseases.

Objective:To analyze the research hotspots on domestic and international chronic illness trajectory models (CITM) .Methods:Literature on CITM was retrieved from the Web of Science Core Collection and China National Knowledge Infrastructure. CiteSpace 6.2.R4 was used to analyze research institutions, authors, and keywords visually.Results:A total of 1 316 articles were obtained. The majority of the literature originated from foreign countries. Research hotspots on CITM included chronic diseases, anxiety, and quality of life. International studies focused on risk research, while domestic studies emphasized self-care, self-efficacy, and complications.Conclusions:Research on CITM in China is still in its infancy. Both domestic and international efforts need to enhance collaboration among institutions, authors, and disciplines to conduct in-depth research on CITM. Chronic illness, anxiety or depression, and quality of life are likely to become research hotspots in the field of CITM both domestically and internationally.

AIM:This study aims to investigate the effects and mechanisms of silent information regulator 6(SIRT6)on carbon tetrachloride(CCl4)-induced liver fibrosis in mice,as well as the expression changes in the down-stream pathways of hepatic stellate cells after SIRT6 silencing.METHODS:Thirty male C57BL/6J mice were randomly divided into a normal control group(n=6)and a model group(modeling at 2,4,8,12 weeks,n=24).A liver fibrosis model in mice was prepared by intraperitoneal injection of CCl4 twice a week for 12 weeks.Serum alanine aminotransfer-ase(ALT)and aspartate aminotransferase(AST)levels were measured to assess liver injury.Hematoxylin-eosin(HE)and Masson staining were used to observe the pathological changes in mouse liver tissues.Immunohistochemical staining was conducted to detect the expression of α-smooth muscle actin(α-SMA)in the liver,Western blot analysis was used to measure the expression of liver α-SMA,SIRT6,acetyl histone H3 at Lys9(H3K9ac),acetyl histone H3 at Lys56(H3K56ac),interleukin-1β(IL-1β),and IL-18 proteins.Hepatic stellate cells-T6(HSC-T6)underwent SIRT6 gene si-lencing,divided into NC siRNA group and SIRT6 siRNA group,with Western blot performed to detect the expression of SIRT6,H3K9ac,and H3K56ac proteins.RESULTS:Compared with the normal control group,the serum ALT and AST levels in the model group were significantly increased(P<0.05);HE and Masson staining results showed that the patho-logical changes in the liver of the model group worsened over time,with an increase in collagen fiber deposition.Both im-munohistochemistry and Western blot showed that the expression of liver α-SMA significantly increased at 8 and 12 weeks in the model group(P<0.05).Western blot results showed that the expression of SIRT6 protein in the liver of all model group mice was lower than that in the normal control group(P<0.05),and decreased gradually with the progression of liv-er fibrosis;also,the expression levels of H3K9ac,H3K56ac,IL-1β,and IL-18 in the liver of the model group mice were significantly elevated at 8 and 12 weeks(P<0.05);after SIRT6 silencing,compared with the NC siRNA group,the levels of H3K9ac and H3K56ac in the SIRT6 siRNA group significantly increased(P<0.05).CONCLUSION:The deficiency of SIRT6,by abnormally increasing H3K9ac and H3K56ac,raises the expression of IL-1β and IL-18,intensifying the in-flammatory response and promoting the progression of liver fibrosis,indicating that the aberrant expression of SIRT6 is in-volved in the development of liver fibrosis.

Objective To understand the implementation of the nursing group standards for oxygen inhalation therapy in clinical practice,and to provide a reference for improving the nursing practice of oxygen therapy.Methods A convenience sampling method was used to investigate nurses from 902 hospitals in 24 provinces and municipalities directly under the central government using a self-designed questionnaire from December 15th,2022,to January 14th,2023.The content of questionnaire included whether they had implemented the recommendations of the oxygen therapy standards,the knowledge of safety related to oxygen therapy,and the components of oxygen therapy prescriptions,the indications used for patients receiving oxygen therapy and practice status of oxygen therapy.Results A total of 10481 questionnaires were returned,of which 10447 were valid,with a valid questionnaire recovery rate of 99.68%.63.14%of the nurses indicated that the hospital had organized training on oxygen therapy standards.Only 47.82%of nurses know the correct use of the Venturi mask.41.90%of nurses could indicate the correct indicator of flow adjustment.31.88%of the nurses stated that they will adjust the oxygen flow rate based on the oxygenation status of carbon dioxide storage patients.Only 19.56%of nurses indicated that humidification is applied in oxygen therapy based on the oxygen flow and duration.Conclusion Even though nurses had received training related to oxygen therapy standards,the level of knowledge of oxygen therapy standards was still low;therefore continuous systematic training was needed,and the implementation of the content of oxygen therapy standards needed to be further standardized.Healthcare institutions would focus on organizing systematic training and maintaining the training effect,enhancing infrastructure and providing support for implementation.Recommendation to the nursing administration is to explore how to comprehensively and continuously implementing the oxygen therapy nursing standards with the ultimate goal of providing patients safer and more accurate oxygen therapy.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.