Objective:To explore the clinical efficacy of health management programs for elderly patients with comorbid diabetes and coronary heart disease, to provide suggestions for health management of elderly patients with comorbid diabetes and coronary heart disease.Methods:A randomized controlled trial was conducted. A total of 72 elderly patients with comorbid diabetes and coronary heart disease from different communities who visited the Fenglin Street Community Health Service Center, Xuhui District, Shanghai, from January to June 2023 were selected by convenient sampling method. They were divided into control group and experimental group by random number method, with 36 cases in each group. The control group used the routine health management program, the experimental group used the health management program for elderly patients with comorbid diabetes and coronary heart disease. The clinical indicators (glycated hemoglobin, body mass index, etc), self-management abilities (including those of elderly patients with diabetes and those with coronary heart disease), and quality of life were compared between the two groups.Results:There were 14 males and 22 females in the control group, with an age of (73.67 ± 5.97) years; there were 21 males and 15 females in the experimental group, with an age of (73.33 ± 5.63) years. After intervention, the glycated hemoglobin of patients in the experimental group was (7.03 ± 0.64)%, while that of the control group was (7.42 ± 0.72)%. The difference between the two groups was statistically significant ( t=-2.49, P<0.05).The scores of self-management ability of elderly patients with diabetes and elderly patients with coronary heart disease in the experimental group were (22.66 ± 4.69) and (98.28 ± 13.54) points, which were significantly higher than (20.56 ± 4.05) and (93.00 ± 8.01) points in the control group, the differences were statistically significant ( t=2.03, 2.01, both P<0.05). The score of energy in the experimental group was (35.56 ± 8.68) points, which was higher than that of the control group (28.75 ± 15.18) points, the difference was statistically significant ( t=2.34, P<0.05). Conclusions:Health management programs for elderly patients with comorbid diabetes and coronary heart disease can significantly improve patients′ blood glucose control and enhance their self-management abilities for diabetes and coronary heart disease. However, further validation is needed to improve patients′ blood lipid control level and quality of life.

Objective To explore the home rehabilitation experience of individuals with fully magnetically levitated left ventricular assist device,and to provide a basis for developing scientific nursing intervention plans and follow-up strategies for clinical practice.Methods Using phenomenological research methods,a semi-structured interview was conducted on 13 patients with fully maglev left ventricular assist device implantation in a tertiary A comprehensive hospital in Wuhan from September to October 2022.Colaizzi's 7-step analysis method was used to analyze the data and extract themes.Results A total of 3 themes and 9 subthemes were extracted,including complex emotions in home rehabilitation(challenges for new characters,anxieties and concerns,regaining new life and full of confidence),difficulties in home self-management(lack of professional knowledge,insufficient exercise,difficulty in managing pump cable bag wounds,weak ability to recognize and respond to external controller alarms),and needs for home rehabilitation(need for continuity of care,desire for more social support).Conclusion Complex emotional experiences and many difficulties and needs exist in the home rehabilitation process of patients after implantation of full magnetic levitation left ventricular assist device.Healthcare professionals should actively pay attention to the postoperative psychological changes of patients,strengthen pre-discharge training to improve patients'self-management ability,and actively build a multi-party Internet home rehabilitation management platform to improve the rehabilitation quality of patients.

Objective:To explore the clinical efficacy of health management programs for elderly patients with comorbid diabetes and coronary heart disease, to provide suggestions for health management of elderly patients with comorbid diabetes and coronary heart disease.Methods:A randomized controlled trial was conducted. A total of 72 elderly patients with comorbid diabetes and coronary heart disease from different communities who visited the Fenglin Street Community Health Service Center, Xuhui District, Shanghai, from January to June 2023 were selected by convenient sampling method. They were divided into control group and experimental group by random number method, with 36 cases in each group. The control group used the routine health management program, the experimental group used the health management program for elderly patients with comorbid diabetes and coronary heart disease. The clinical indicators (glycated hemoglobin, body mass index, etc), self-management abilities (including those of elderly patients with diabetes and those with coronary heart disease), and quality of life were compared between the two groups.Results:There were 14 males and 22 females in the control group, with an age of (73.67 ± 5.97) years; there were 21 males and 15 females in the experimental group, with an age of (73.33 ± 5.63) years. After intervention, the glycated hemoglobin of patients in the experimental group was (7.03 ± 0.64)%, while that of the control group was (7.42 ± 0.72)%. The difference between the two groups was statistically significant ( t=-2.49, P<0.05).The scores of self-management ability of elderly patients with diabetes and elderly patients with coronary heart disease in the experimental group were (22.66 ± 4.69) and (98.28 ± 13.54) points, which were significantly higher than (20.56 ± 4.05) and (93.00 ± 8.01) points in the control group, the differences were statistically significant ( t=2.03, 2.01, both P<0.05). The score of energy in the experimental group was (35.56 ± 8.68) points, which was higher than that of the control group (28.75 ± 15.18) points, the difference was statistically significant ( t=2.34, P<0.05). Conclusions:Health management programs for elderly patients with comorbid diabetes and coronary heart disease can significantly improve patients′ blood glucose control and enhance their self-management abilities for diabetes and coronary heart disease. However, further validation is needed to improve patients′ blood lipid control level and quality of life.

Objective To explore the home rehabilitation experience of individuals with fully magnetically levitated left ventricular assist device,and to provide a basis for developing scientific nursing intervention plans and follow-up strategies for clinical practice.Methods Using phenomenological research methods,a semi-structured interview was conducted on 13 patients with fully maglev left ventricular assist device implantation in a tertiary A comprehensive hospital in Wuhan from September to October 2022.Colaizzi's 7-step analysis method was used to analyze the data and extract themes.Results A total of 3 themes and 9 subthemes were extracted,including complex emotions in home rehabilitation(challenges for new characters,anxieties and concerns,regaining new life and full of confidence),difficulties in home self-management(lack of professional knowledge,insufficient exercise,difficulty in managing pump cable bag wounds,weak ability to recognize and respond to external controller alarms),and needs for home rehabilitation(need for continuity of care,desire for more social support).Conclusion Complex emotional experiences and many difficulties and needs exist in the home rehabilitation process of patients after implantation of full magnetic levitation left ventricular assist device.Healthcare professionals should actively pay attention to the postoperative psychological changes of patients,strengthen pre-discharge training to improve patients'self-management ability,and actively build a multi-party Internet home rehabilitation management platform to improve the rehabilitation quality of patients.

Objective To explore the effectiveness and practical pathways of integrating narrative education into higher vocational nursing courses for cultivating students' humanistic care ability.Methods A total of 156 nursing students from a higher vocational college were randomly divided into an observation group(narrative education intervention)and a control group(traditional teaching).Quantitative evaluations were conducted using the Caring Ability Inventory(CAI)and a self-developed Humanistic Care Quality Scale,supplemented by semi-structured interviews for qualitative thematic analysis.Results The ob-servation group demonstrated significantly higher total caring ability scores(180.1±10.9 vs 145.2±14.3),humanistic care quality(97.5±3.8 vs 77.7±5.9),and course satisfaction(9.5±0.6 vs 7.0±1.3)compared to the control group(P＜0.01).Qualitative findings revealed that narrative education enhanced professional beliefs and practical skills through empathy training,reflective writing,and team collaboration.Conclusion Narrative education systematically improves the humanistic care ability and professional of higher vocational nursing students,providing empirical support for nursing education reform.

Objective To explore the effectiveness and practical pathways of integrating narrative education into higher vocational nursing courses for cultivating students' humanistic care ability.Methods A total of 156 nursing students from a higher vocational college were randomly divided into an observation group(narrative education intervention)and a control group(traditional teaching).Quantitative evaluations were conducted using the Caring Ability Inventory(CAI)and a self-developed Humanistic Care Quality Scale,supplemented by semi-structured interviews for qualitative thematic analysis.Results The ob-servation group demonstrated significantly higher total caring ability scores(180.1±10.9 vs 145.2±14.3),humanistic care quality(97.5±3.8 vs 77.7±5.9),and course satisfaction(9.5±0.6 vs 7.0±1.3)compared to the control group(P＜0.01).Qualitative findings revealed that narrative education enhanced professional beliefs and practical skills through empathy training,reflective writing,and team collaboration.Conclusion Narrative education systematically improves the humanistic care ability and professional of higher vocational nursing students,providing empirical support for nursing education reform.

Objective:To analyse the clinical significance of selective single embryo transfer by time-lapse mo-nitoring(TLM)or conventional morphology assessment(CMA)in vitro fertilization/intracytoplasmic sperm in-jection and embryo transfer(IVF/ICSI-ET),and to initially explore the predictive value of Raman spectral analy-sis of embryo culture medium for clinical pregnancy rate.Methods:The study is a prospective randomized con-trolled clinical trial.We assigned 139 patients treated with IVF/ICSI-ET in Reproductive and Genetics Center of Suzhou Municipal Hospital from April 2019 to July 2020,which were randomly assigned to either the CMA or the TLM group.We performed selective single-embryo transfer(fresh cycle and FET)after selecting the optimal em-bryos with TLM or CMA respectively.If the patient's first embryo transfer was unsuccessful,a second one would be performed to compare the differences in the cumulative live birth rate of embryo transfer and other pregnancy outcomes between the two groups.Meanwhile,we collected 15 μl of embryo culture medium at day 3 after IVF/ISCI fertilization for Raman spectroscopy analysis.Results:There were no differences in cumulative live birth,cu-mulative clinical pregnancy,cumulative premature birth,cumulative early spontaneous abortion,cumulative ectopic pregnancy and LGA or SGA between TLM and CMA groups(P＞0.05).The Neonatal sex ratio in the TLM group was lower than that in the CMA group,but the difference was not significant(P＞0.05).Raman spectros-copy analysis of embryo culture medium predicted the clinical pregnancy rate with 67.21％accuracy.Conclu-sions:In young women with a good ovarian reserve,the advantage of using TLM to evaluate embryos is not obvi-ous,so we should remain vigilant that embryo selection based on morphokinetic parameters may affect the sex ratio.Raman spectroscopic analysis of embryo culture medium is not yet able to effectively predict the planting ability of embryos.

Objective:To explore the effects of human chorionic gonadotropin (hCG), progesterone as well as the change of estradiol 12 h after hCG trigger on the outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective study was conducted at the Center for Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University. A total of 2 506 patients received IVF/ICSI-ET treatment with gonadotropin-releasing hormone agonist (GnRH-a) protocol from March 2015 to June 2020 were selected. With Spearman rank correlation analysis and path analysis, we explore the relationship among the changes of these hormones and the baseline characteristic of patients, as well as the relationship among the changes of these hormones and the outcomes of IVF treatment.Results:The increase of hCG was accompanied by the rise of progesterone and the decline of estradiol change rate ( r=0.094, P<0.001; r=-0.093, P<0.001). Meanwhile the rise of progesterone was accompanied by the decline of estradiol change rate ( r=-0.089, P<0.001). The dosage of hCG trigger was directly positively correlated to hCG level after hCG trigger, path coefficients (PC) was 0.307 ( P<0.001). Body mass index (BMI) was directly negatively correlated to hCG level and progesterone level after hCG trigger (PC=-0.434, P<0.001; PC=-0.154, P<0.001), whereas positively correlated to estradiol change rate (PC=0.097, P<0.001). Meanwhile the duration and dosage of gonadotropin (Gn) used were positively correlated to progesterone level after hCG trigger (PC=0.102, P<0.001; PC=0.080, P=0.030). hCG level and progesterone level after hCG trigger had positive correlation to oocyte retrieved rate (PC=0.098, P<0.001; PC=0.080, P<0.001). While estradiol change rate was not correlated to oocyte retrieved rate ( P>0.05). Progesterone level on hCG trigger day negatively related to normal fertilization rate (PC=-0.050, P=0.039). hCG level, progesterone level and estradiol change rate after hCG trigger had no correlation with high-quality embryo rate, clinical pregnancy rate and live birth rate (all P>0.05). Conclusion:Oocyte retrieved rate was positively affected by hCG level and progesterone level 12 h after hCG trigger. While normal fertilization rate, high-quality embryo rate, clinical pregnancy rate and live birth rate were not affected by the change of hormones level 12 h after hCG trigger. Therefore we should pay attention to hCG level and progesterone level 12 h after hCG trigger.

Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95％CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9％and specificity of 72.3％The results of the validation of independent data model showed a sensitivity of 75.0％,specificity of 74.4％,and accuracy of 74.5％.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.

Objective:To explore the effects of human chorionic gonadotropin (hCG), progesterone as well as the change of estradiol 12 h after hCG trigger on the outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective study was conducted at the Center for Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University. A total of 2 506 patients received IVF/ICSI-ET treatment with gonadotropin-releasing hormone agonist (GnRH-a) protocol from March 2015 to June 2020 were selected. With Spearman rank correlation analysis and path analysis, we explore the relationship among the changes of these hormones and the baseline characteristic of patients, as well as the relationship among the changes of these hormones and the outcomes of IVF treatment.Results:The increase of hCG was accompanied by the rise of progesterone and the decline of estradiol change rate ( r=0.094, P<0.001; r=-0.093, P<0.001). Meanwhile the rise of progesterone was accompanied by the decline of estradiol change rate ( r=-0.089, P<0.001). The dosage of hCG trigger was directly positively correlated to hCG level after hCG trigger, path coefficients (PC) was 0.307 ( P<0.001). Body mass index (BMI) was directly negatively correlated to hCG level and progesterone level after hCG trigger (PC=-0.434, P<0.001; PC=-0.154, P<0.001), whereas positively correlated to estradiol change rate (PC=0.097, P<0.001). Meanwhile the duration and dosage of gonadotropin (Gn) used were positively correlated to progesterone level after hCG trigger (PC=0.102, P<0.001; PC=0.080, P=0.030). hCG level and progesterone level after hCG trigger had positive correlation to oocyte retrieved rate (PC=0.098, P<0.001; PC=0.080, P<0.001). While estradiol change rate was not correlated to oocyte retrieved rate ( P>0.05). Progesterone level on hCG trigger day negatively related to normal fertilization rate (PC=-0.050, P=0.039). hCG level, progesterone level and estradiol change rate after hCG trigger had no correlation with high-quality embryo rate, clinical pregnancy rate and live birth rate (all P>0.05). Conclusion:Oocyte retrieved rate was positively affected by hCG level and progesterone level 12 h after hCG trigger. While normal fertilization rate, high-quality embryo rate, clinical pregnancy rate and live birth rate were not affected by the change of hormones level 12 h after hCG trigger. Therefore we should pay attention to hCG level and progesterone level 12 h after hCG trigger.