Objective To explore the effect of continued nursing intervention on quality of life of patients with chronic obstructive pulmonary disease. Methods The study took use of randomized controltest. All the 130 patients who were on admission because of acute exacerbation of chronic obstructive pulmonary disease were randomly divided into the intervention group (62 cases) and the control group (68 cases). The intervention group received telephone and home follow-up for one year, and the control group was provided conventional care. Lung function, SGRQ and dyspnea degree were collected on one-month,three-month, six-month, twelve-month after intervention. Results Lung function and activity scores of SGRQ, dyspnea degree and six minutes walk test between two groups had statistical significance after intervention. Conclusions Continued nursing intervention can postpone the rate of FEV1% declining, reduce dysnea degree, decrease the frequency of acute exacerbation, increase the quality of life of COPD patients.

The prone position ventilation, as a new type of mechanical ventilation treatment technology, has been widely used in clinical practice. Patient populations and disease types have been obviously expanded. The implementation of the technology needs medical staff's cooperation. The intervention effect, safety and quality critically depend on nursing work. In the whole process, the nursing quality has been put forward higher request. In recent years, increasing scholars have paid attention to the related researches. This paper summarizes the clinical application, nursing points, and the challenges of the prone position ventilation in patients with respiratory failure, in order to provide reference for the development and optimization of the clinical nursing.

Objective To explore the effects of heated humidified high flow nasal cannulae (HFNC) oxygen therapy among patients with pulmonary fibrosis. Methods A total of 60 patients in accord with diagnostics guide for idiopathic pulmonary fibrosis and admitted to Department of Respiratory at a Class III Grade A hospital in Tianjin for pulmonary fibrosis were selected by convenience sampling from May 2016 to March 2017. They received oxygen inhalation through nasal cannula for 24 hours and sequentially HFNC oxygen therapy for 24 hours respectively. The blood gas analysis,degree of comfort,severity of dyspnea and incidence of complications were compared two,four and twenty-four hours after adopting oxygen inhalation through nasal cannula and HFNC oxygen therapy. Results There were statistically significant differences in PaO2,SpO2,base excess (BE) and respiratory rate (RR) between oxygen inhalation through nasal cannula and HFNC oxygen therapy (P<0.05). The degree of comfort and severity of dyspnea significantly improved by HFNC oxygen therapy (P<0.05). There was a statistically significant difference in the incidence of complications (P<0.05). However,there was no statistically significant differences in PaCO2and PH between two oxygen methods (P>0.05). Conclusions The application of HFNC can increase PaO2and SpO2,and slow RR among patients with pulmonary fibrosis. Meanwhile,it can also effectively improve the severity of dyspnea,promote patients′ comfort and reduce the incidence of complications.

Objective:To translate the Understanding COPD (UCOPD) into Chinese, culturally adjust it and test its reliability and validity.Methods:According to the translation principle of Brislin questionnaire, the English version of UCOPD was translated, back-translated and culturally adjusted and pre-tested to form the Chinese version of UCOPD. From December 2020 to April 2021, a total of 101 COPD patients admitted to Tianjin Medical University General Hospital were enrolled using the convenient sampling method. The reliability and validity of the scale were tested.Results:The Chinese version of UCOPD included section A and B. Section A included 3 dimensions, such as "about COPD" "managing symptoms of COPD" "accessing help and support", with a total of 18 items. The results of exploratory factor analysis showed that the cumulative variance contribution rate of the three common factors was 59.35%. The Cronbach's α coefficient of section A was 0.893, and the Cronbach's α coefficient of each dimension was 0.756-0.864. The test-retest reliability of section A was 0.954, and the test-retest reliability of each dimension was 0.779-0.887. Section B included 6 items, which were used to measure the satisfaction of pulmonary rehabilitation courses in COPD patients. However there were big individual differences, so the reliability and validity test of section B were not evaluated.Conclusions:Section A of the Chinese version of UCOPD questionnaire has good reliability and validity. It can be used to evaluate self management ability of patients with good knowledge of COPD but less confidence in symptom control and health maintenance, so as to guide clinical medical staff to formulate accurate intervention measures to improve patients' self management.

Objective:To explore effects of different flow rates and temperature settings of high-flow nasal cannula oxygen therapy (HFNC) on patients with mild to moderate community-acquired pneumonia (CAP) accompanied by type I respiratory failure.Methods:Using the convenient sampling method, a total of 92 patients with mild to moderate CAP accompanied by type I respiratory failure who were admitted and received HFNC in the Department of Respiratory and Critical Care Medicine in a Class Ⅲ Grade A hospital in Tianjin were selected as the research objects from December 2019 to December 2020. They were randomly divided into 4 groups, including low temperature and low flow rate group (31 ℃, 30 L/min) , low temperature and high flow rate group (31℃, 50 L/min) , high temperature and low flow rate group (34℃, 30 L/min) , high temperature and high flow rate group (34 ℃, 50 L/min) , with 23 cases in every group. Two-factor factorial analysis of variance was used to compare effects of different flow rates and temperature settings of HFNC on the comfort, oxygenation index, respiratory rate and heart rate of patients with mild to moderate CAP.Results:The comfort level of patients in the low flow rate group (30 L/min) was higher than that of the high flow rate group (50 L/min) , and the comfort level of patients in the low temperature group (31 ℃) was higher than that of the high temperature group (34 ℃) . The differences were statistically significant ( P<0.01) . The oxygenation index of patients in the high flow rate group (50 L/min) was higher than that of the low flow rate group (30 L/min) , and the difference was statistically significant ( P<0.01) . Different flow rates and temperatures of HFNC have no interaction effect on the comfort, oxygenation index and heart rate of patients ( P>0.05) , but they have an interaction effects on respiratory rate ( P<0.01) . Individual effect analysis showed that the respiratory rate of patients in the low temperature and high flow rate group (31 ℃, 50 L/min) was lower than that of the high temperature and high flow rate group (34 ℃, 50 L/min) and the low temperature and low flow rate group (31 ℃, 30 L/min) , and the differences were statistically significant ( P<0.01) . Conclusions:For patients with mild to moderate CAP accompanied by type I respiratory failure, the application of HFNC should start with low temperature and low flow rate parameter settings. Under the condition of ensuring the patient's comfort, the overall effect of flow rate and temperature is integrated and the inhalation flow rate of HFNC is appropriately increased, which can increase the clinical effect of high-flow nasal cannula oxygen therapy.

Objective:To summarize the best evidence for exercise intervention in elderly patients with sarcopenia in intensive care unit (ICU) through literature search, and provide a reference for clinical implementation of early exercise intervention in this population through evidence-based practice.Methods:① Summary of best evidence: relevant literature on exercise intervention for elderly patients with sarcopenia in ICU, including guideline, evidence summary, expert consensus, systematic review, and original study [quasi-experiment and randomized controlled trial (RCT)] from UpToDate Clinical Advisor, Ovid database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, SinoMed, CNKI, Wanfang Database, VIP, and Yimai Tong Guideline Network were systematically searched. The search period covered from the establishment of these databases up to August 24, 2023. The quality of the literature was evaluated by two researchers with methodological expertise in evidence-based medicine, and the evidences were extracted and summarized. ② Evidence-based practice: the elderly patients with high risk of sarcopenia who had been hospitalized in the ICU for more than 7 days from January to April 2024 were enrolled as the research subjects, and they were divided into a control group and an intervention group using convenience sampling method. The control group received routine intensive care nursing. The intervention group implemented exercise intervention based on the actual situation of the patients, the baseline review was conducted before evidence application, and the effectiveness of evidence application at 7 days and 14 days was evaluated.Results:① A total of 19 pieces of literature were included, including 4 guidelines, 1 summary of evidence, 4 expert consensuses, 4 systematic reviews, and 6 original studies (1 quasi-experiment, 5 RCT). After literature quality evaluation, all 19 articles were enrolled. Finally, 31 pieces of best evidence were extracted from eight aspects, including assessment and diagnosis, multidisciplinary cooperation, indication, preparation before intervention, intervention program, safety monitoring, post-intervention evaluation, and special task. ② Finally, a total of 30 patients were enrolled in the intervention group, of which 17 completed 14 days of rehabilitation exercise, and 13 completed 7 days of rehabilitation exercise. Twenty-seven patients were enrolled in the control group, of which 17 completed 14 days of monitoring, and 10 completed 7 days of monitoring. Clinical evidence application results showed that the patients in the intervention group did not experience adverse events such as increased heart rate, extubation, or physical discomfort. The skeletal muscle mass index (SMI) in both groups was gradually decreased with the prolongation of intervention duration, but the 7-day SMI in the intervention group was significantly higher than that in the control group (kg/m 2: 8.61±2.66 vs. 6.65±1.50, P < 0.01). Conclusion:By summarizing the best evidence and evidence-based practice of exercise intervention for elderly patients with sarcopenia in ICU, this study confirmed the feasibility due to safe and effective of implementing early exercise intervention for elderly sarcopenia patients in ICU.

Objective:To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).Methods:A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m 2 for males and less than 5.7 kg/m 2 for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients were evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn. Results:Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio ( OR) = 0.79, 95% confidence interval (95% CI) was 0.67-0.93, P = 0.004], calf circumference ( OR = 0.64, 95% CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation ( OR = 1.06, 95% CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95% CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m 2, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test: χ 2 = 5.619, P = 0.018). Conclusion:Lower BMI, smaller calf circumference, and longer duration of mechanical ventilation are associated with an increased risk of sarcopenia in critically ill elderly patients.

Objective:To understand the sleep quality and mental health status of nurses in public health emergencies, and analyze the correlation between them.Methods:A total of 128 first-line nursing staff participating in public health emergencies on February 22-23, 2020 in Tianjin Beichen Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital were investigated by the general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Symptom Checklist 90 (SCL-90).Results:70.3%(90/128) of nursing staff had poor sleep quality, and the total score of PSQI was (9.71±4.01) points, which was statistically significant compared with the domestic norm ( t value was 16.479, P<0.01). The total score of SCL-90 was 1.59±0.52, which was statistically significant compared with the domestic norm ratio ( t value was 4.505, P<0.01). One-way ANOVA showed that the nursing staff's age had a significant impact on sleep quality, and the difference was statistically significant ( F value was 4.092, P<0.05). Pearson correlation analysis showed that the Pittsburgh sleep quality scale index scores and symptom self-assessment scale and somatization, force, sensitive interpersonal relationship, depression, anxiety, hostile, terrorist, paranoia, and psychosis were positively correlated( r values were 0.292-0.444, P< 0.01). Conclusions:The sleep quality and mental health status of nurses in public health emergencies are poor, and the sleep quality is correlated with mental health status.

Objective:To explore the relationships between medical coping modes of patients with COVID-19 and general information and social supports.Methods:From January 28 to February 20, 2020, a total of 128 patients in a designated hospital in Wuhan with novel coronavirus pneumonia were investigated using the General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) by convenient sampling. Pearson univariate analysis and multiple linear regression were used to analyze the relationship between the basic situation of patients with novel coronavirus pneumonia and coping modes.Results:The scores of the face dimension and avoidance dimension of patients with COVID-19 were lower than the norm model, while the yield dimension was higher than the norm model, and the differences were statistically significant ( P<0.05) . Support utilization and complexity were influencing factors of the face dimension ( P<0.05) . Support utilization and age were influencing factors of the yielding dimension ( P<0.01) . Subjective support, the complexity dimension of disease uncertainty and the number of confirmed patients in the family were influencing factors of the avoidance dimension ( P<0.01) . Conclusions:Patients with COVID-19 have poor medical coping modes, and they are prone to face the disease with a negative attitude. Patients are unwilling to face the disease and the tendency to yield to the disease is greater. And the older the patients, the less likely they are to succumb to the disease. The more patients diagnosed in the family, the less likely they are to avoid the disease. Patients with higher social supports and utilization have a more reasonable medical coping mode. This reminds medical staff to pay more attention to the psychological problems of patients in coping with COVID-19 and improve their coping modes and methods.