Objective:To carry out evidence-based nursing practice of nutritional management of patients in the perioperative period of hepatobiliary surgery, formulate review indicators based on the best evidence, analyze obstacles, and provide reference for the application of evidence in clinical practice.Methods:According to the "6S" evidence model, the search was conducted on Cochrane Library, Joanna Briggs Institute evidence-based Health Care Center Database, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, the British Journal of Medicine, PubMed, SinoMed, CNKI and Wanfang Database from the date of database construction to September 30, 2021. Through systematic search, evaluation and summary of evidence, the evidence-based nursing review plan for perioperative patients in hepatobiliary surgery was determined and the status review was conducted. Influencing factors were analyzed, and action strategies were formulated.Results:A total of 14 pieces of best evidence were included in this study, and 16 review indicators were formulated, of which the implementation rate of one indicator was 85%, and the implementation rate of the other indicators was 0-55%. The main obstacles include the following: the lack of relevant knowledge at the medical and nursing level; the resistance of medical staff caused by the increasing clinical work, the lack of systems, procedures, quantitative tools, and instruments and equipment; insufficient leadership, etc.Conclusions:There is a big gap between evidence-based nursing evidence and clinical practice. It should be combined with the judgment of clinical professionals and the results of the baseline review to analyze the obstacles and formulate action strategies to promote the effective transformation of evidence.

BACKGROUND: Low-density computed tomography (LDCT) improved early lung cancer diagnosis but introduces an excess of false-positive pulmonary nodules data. Hence, accurate diagnosis of early-stage lung cancer remains challenging. The purpose of the study was to assess the feasibility of using circulating tumour cells (CTCs) to differentiate malignant from benign pulmonary nodules. METHODS: 122 patients with suspected malignant pulmonary nodules detected on chest CT in preparation for surgery were prospectively recruited. Peripheral blood samples were collected before surgery, and CTCs were identified upon isolation by size of epithelial tumour cells and morphological analysis. Laser capture microdissection, MALBAC amplification, and whole-exome sequencing were performed on 8 samples. The diagnostic efficacy of CTCs counting, and the genomic variation profile of benign and malignant CTCs samples were analysed. RESULTS: Using 2.5 cells/5 mL as the cut-off value, the area under the receiver operating characteristic curve was of 0.651 (95% confidence interval: 0.538-0.764), with a sensitivity and specificity of 0.526 and 0.800, respectively, and positive and negative predictive values of 91.1% and 30.3%, respectively. Distinct sequence variations differences in DNA damage repair-related and driver genes were observed in benign and malignant samples. TP53 mutations were identified in CTCs of four malignant cases; in particular, g.7578115T>C, g.7578645C>T, and g.7579472G>C were exclusively detected in all four malignant samples. CONCLUSIONS CTCs play an ancillary role in the diagnosis of pulmonary nodules. TP53 mutations in CTCs might be used to identify benign and malignant pulmonary nodules.
Humans ; Lung Neoplasms ; Exome Sequencing ; Multiple Pulmonary Nodules ; Carcinoma ; DNA Repair