Objective To analyze the correlation between cumulative fluid balance volume and increasing plasma volume and aggravated clinical congestion symptoms in patients with heart failure on admission for 1～7 d,and to explore the application value of cumulative fluid balance volume in predicting volume overload.Methods Using the convenience sampling method,235 heart failure patients hospitalized from October 2022 to February 2023 in a total of 3 tertiary hospitals in Nanjing,Lianyungang,Jiangsu Province,and Zhumadian,Henan Province,were selected and classified into an increasing/decreasing plasma volume group and an aggravated/alleviated clinical congestion symptoms group.General information,clinical characteristics,and 1～7 d cumulative fluid balance volume of the study subjects were collected to compare the differences in cumulative fluid balance volume between the 2 groups.Logistic regression was used to analyze the effect of cumulative fluid balance volume on plasma volume and clinical congestion symptoms.Receiver operating characteristic curves were used to analyze the optimal cutoff value of cumulative fluid balance volume for predicting increasing plasma volume and aggravated clinical congestion symptoms.Results Excluding 15 pat ients who were discharged early and 3 patients with inaccurate records of fluid intake and excretion,a total of 217 patients were included.The incidence of positive fluid balance was lowest on day 1,at 65.90%,with the smallest cumulative volume of(0.235±0.983)L;the highest incidence of positive balance occurred on day 6,at 75.58%,with the largest cumulative volume of(2.444±5.445)L.The cumulative fluid balance at 4～7 d in the increasing plasma volume group was higher than that in the decreasing plasma volume group,and the difference was statistically significant(P<0.05);the cumulative fluid balance at 4～7 d was an independent risk factor for plasma volume elevation,and a cumulative fluid balance of 2.308,3.361,3.518,and 3.702 L at 4～7 d was predictive of a plasma volume elevation,and areas under receiver operating characteristic curve were 0.686,0.721,0.647,and 0.766,respectively.The cumulative fluid balance for 4～7 d in the aggravated clinical congestion symptoms group was higher than that in the alleviated clinical congestion symptoms group,and the difference was statistically significant(P<0.05);the cumulative fluid balance for 4～7 d was an independent risk factor for the aggravated clinical congestion symptoms,and a cumulative fluid balance for 4～7 d of 2.574,3.383,4.995,and 4.235 L predicted aggravated clinical congestion symptoms,and area under receiver operating characteristic curve was 0.640,0.693,0.654,and 0.720,respectively.Conclusion The incidence of cumulative positive fluid balance in heart failure patients is high,and the amount of cumulative fluid balance can better predict the occurrence of volume overload,and the increase of plasma volume precedes the appearance of clinical congestion symptoms.It is suggested that heart failure patients with more than 3 d of cumulative positive balance should be closely monitored,and when the cumulative positive balance exceeds 2.308 L,measures should be taken in time to drain excessive fluid,so as to avoid the incidence of volume overload.

Objective:To deeply understand the real experience of young and middle-aged lymphoma patients returning to society.Methods:From August to September 2021, 17 young and middle-aged lymphoma patients admitted to the Department of Hematology of the First Affiliated Hospital with Nanjing Medical University were selected as the research object by objective sampling. Phenomenological research method was using to conduct face-to-face in-depth interviews. Colaizzi 7-step analysis method was used to summarize, analyze and refine the theme.Results:A total of 3 first-level themes and 10 second-level themes were extracted. Among them, the willingness to return to society included firm willingness of social return and negative attitude of social return. The scope of social return included returning to work, interpersonal communication, family responsibilities, leisure and entertainment and lifestyle. The influencing mechanism of social return was composed of disease and treatment factors, mental factors, external support and economic capacity.Conclusions:The experience of young and middle-aged lymphoma patients returning to society is a dynamic change process in many aspects. In the future, it is necessary to further explore the status quo of social return of such groups and explore the influencing factors and change tracks of heterogeneity.

Objective:To explore the practice-orientated connotation from the perspective of nursing managers, and provide a reference for the construction of practice-oriented nurse professional title promotion evaluation system.Methods:From January to April 2022, a total of 12 nursing managers from 4 Grade A hospitals in Jiangsu Province were selected by purpose sampling method. The semi-structured interview method was used to interview nursing managers. The data was sorted and analyzed by content analysis method.Results:A total 4 themes were extracted: technical ability (nursing workload, nursing technical difficulty) , quality and safety (patient health outcomes, satisfaction management) , resource utilization (nursing service cost) , contribution.Conclusions:Nursing managers' evaluation of practice-oriented connotation covers several topics, however some indexes are still dominated by subjective evaluation. A scientifically quantifiable practice-oriented nurse professional title promotion evaluation system should be constructed with the help of information technology.

Objective:To summarize the best evidence for nutrition management of type 2 diabetes mellitus (T2DM) , so as to provide a reference for formulating nutrition management plans.Methods:According to the "6S" evidence model, evidence-based guidelines, expert consensus, and systematic reviews on nutrition management for T2DM were systematically searched and screened in professional group websites, clinical practice guideline websites and databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱwas used to assess the methodological quality of the guideline. Quality evaluation of systematic reviews and expert consensus was conducted according to the appraisal system of the Australian Joanna Briggs Institute (JBI) Evidence-based Health Care Center. The recommended items with the same or similar content were synthesized according to the principle of evidence synthesis, and group discussion was carried out on evidence of conflicting conclusions. The recommendations for nutrition management of T2DM suitable for our national conditions were selected.Results:A total of 5 399 domestic and foreign articles were searched, and 19 articles were finally included, including 8 guidelines, 1 expert consensus, and 10 systematic reviews. The quality evaluation results of 1 guideline were grade A, and 7 guidelines were grade B, and the results of systematic review and expert consensus evaluation were both recommended. According to the principle of evidence synthesis, the recommendations were synthesized, including 5 aspects, namely nutrition management methods, nutrition screening and assessment, energy requirements, macronutrient intake, and micronutrient intake, with a total of 29 pieces of best evidence.Conclusions:Evidence on nutrition management of adults with T2DM is extensive but limited. Macronutrients have similar recommendations. However, there is still a lack of high-quality evidence for micronutrients, especially in terms of whether routine micronutrient supplementation is necessary and the specific intake. Extensive practical exploration and scientific research are needed to enrich the relevant evidence in the field of T2DM.

Objective:To investigate the psychological resilience level of Chinese children and adolescents with type 1 diabetes mellitus (T1DM) and to explore its influence on glucose sugar control.Methods:Using the convenient sampling method, a total of 200 children and adolescents with T1DM in the First Affiliated Hospital of Nanjing Medical University and Nanjing Children's Hospital were selected as research obejcts from January 2019 to January 2021. The general information questionnaire, Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen) and Diabetes Behavior Rating Scale (DBRS) were used to investigate the level of psychological resilience and self-management behavior. And the glycated hemoglobin (HbA1c) value was collected, and analyzed the effect of mental toughness level on it.Results:A total of 200 questionnaires were distributed in this survey, and 196 valid questionnaires were recovered. The total score of DSTAR-Teen for 196 children and adolescents with T1DM was (43.60±8.55) and the total score of DBRS was (0.64±0.16) , the HbA1c value was 7.2% (6.5%, 8.3%) . The results of multiple linear regression analysis showed that the level of mental toughness was an influencing factor of HbA1c level in children and adolescents with T1DM ( P<0.05) . Conclusions:In this study, children and adolescents with T1DM have a higher level of psychological resilience, which may affect their blood glucose control. In the future, interventions that increase the level of mental resilience are suggested to be implemented to promote the improvement of health outcomes of patients.

Objective:Based on the real-world clinical data of hospital electronic medical records, to analyze the length of stay and healthcare costs associated with in-hospital falls and fall injuries in hospitals.Methods:Based on the electronic medical record system of the First Affiliated Hospital of Nanjing Medical University, a retrospective cohort study was conducted on patients admitted to these departments reported falls in nursing management information system from January 2017 to December 2019. A total of 38 481 patients from 74 units were enrolled in this study. The patients′ characteristics, falls, falls injury, and explore the length of hospital stay and bottom-up direct cost were analyzed.Results:A total of 243 cases (0.6%) fell and 154 cases (63.4%) were injured by falls from January 2017 to December 2019. Compared with non-fallers, the median length of stay of patients with falls was 19 days, which was significantly increased compared with 7 days of patients without falls ( Z=-15.18, P<0.05). The median hospitalization cost of patients with falls was 39 000 yuan, which was significantly higher than 16 300 yuan of patients without falls ( Z=-11.47, P<0.01). There was no statistical difference between non-injuried fallers and injuried fallers for length of stay and healthcare costs ( Z=-0.92, -0.64, P>0.05). Linear regression model analysis showed that gender, age, comorbidity, inpatient department unit, reason of hospitalization were significantly correlated with inpatient cost and length of stay ( F=280.05, 217.31, all P<0.05). Conclusions:Patients who have an in-hospital fall have significantly longer hospital stays and higher direct costs, mainly can be attributed to the fall itself, not the injury. Our findings have important financial implications for real world in light of optimal intervention strategies, resource allocation and economic evaluation of fall prevention.

Objective:To introduce the construction process and results of the knowledge base in Nursing Decision Support System (NDSS) of the First Affiliated Hospital with Nanjing Medical University, in order to provide references for the development of nursing knowledge base.Methods:From July 2018 to March 2020, based on the "Knowledge Development Process" model, a knowledge base of NDSS covering the entire nursing process was constructed through literature review, expert meetings, and expert consultation methods.Results:The authority coefficients of two rounds of expert consultation were 0.875 and 0.925, and Kendall coordination coefficients were 0.464 and 0.534. The final built knowledge base includes nursing assessment module, nursing problem module, nursing goal module, nursing measure module, nursing activity module and matching rule module. Up to now, the knowledge sorted out 2 213 nursing assessments, 46 nursing questions, 67 nursing goals, 233 nursing goal measurement indexes, 183 nursing measures, 4 783 nursing activities and 3 332 matching rules.Conclusions:The construction process of the NDSS knowledge base has rules to follow and the content can cover the whole process of the nursing procedure. It focuses on the quantitative classification of nursing evaluation and nursing goals, as well as the individualization and pertinence of nursing measures, which can provide references for the development of clinical nursing knowledge base.

Objective:To retrieve and analyze related evidence for management of anxiety and depression in patients with inflammatory bowel disease and summarize the best evidence.Methods:BMJ Best Practice, Joanna Briggs Institute Evidence-based Healthcare Center Database, UptoDate, National Guideline Clearinghouse (NGC) , National Institute for Health and Care Excellence (NICE) , Scottish Intercollegiate Guidelines Network (SIGN) , World Gastroenterology Organization, PubMed, Cochrane Library, Embase, CINAHL, PsycInfo, China Biology Medicine disc, CNKI and Wanfang Database were searched by computer for guidelines, evidence summaries, expert consensus, best information practice booklet, recommended practices and systematic reviews on management of anxiety and depression in patients with inflammatory bowel disease.The retrieval time was from establishment of the database to April 20, 2020. Quality evaluation and evidence summary of the included literature were conducted.Results:A total of 12 articles were included, including 3 guidelines, 3 expert consensus and 6 systematic reviews. Finally, it was extracted and integrated into 3 levels of screening, evaluation and management, with 20 pieces of evidence. Among them, the management dimension could be refined into 5 aspects including information support, emotional support, psychological intervention, quitting smoking and drinking and exercise.Conclusions:The application of evidence should be adjusted individually according to the institutional environment, existing conditions, wishes of decision makers, wishes of patients and impediments to the application of evidence, so as to manage psychological problems of patients with inflammatory bowel disease in a scientific way and ensure the quality of nursing.

Objective:To explore the influence of mutuality between patients with chronic heart failure (CHF) and family caregivers on their positive emotions and positive coping styles based on the actor-partner interdependence model (APIM) .Methods:This study was a cross-sectional study. From January to July 2020, convenience sampling was used to select 101 pairs of CHF patients and their family caregivers in the Department of Cardiovascular of the First Affiliated Hospital with Nanjing Medical University. The self-designed General Information Questionnaire, the Mutuality Scale (MS) , the Chinese version of Positive and Negative Affect Scale (PANAS) and the Chinese version of Simple Coping Style Questionnaire (SCSQ) were used to conduct a cross-sectional survey of patients with heart failure and their family caregivers, and we established the APIM for the mutuality to positive emotions and positive coping styles.Results:In terms of the actor effect, the mutuality of CHF patients and their family caregivers could affect their own positive emotions (regression coefficients were 3.922, 3.427; P<0.01) and positive coping styles (regression coefficients were 2.936, 2.828; P<0.01) . In terms of the partner effect, the mutuality of family caregivers could affect the positive emotions (regression coefficient was 2.744, P<0.01) and positive coping styles (regression coefficient was 2.198, P<0.05) of CHF patients. Conclusions:CHF patients' emotions and coping behaviors are positively affected by the perceived mutuality between themselves and family caregivers, suggesting that clinicians should pay attention to the evaluation of the mutuality in CHF family care and actively explore intervention programs focusing on the mutuality.

Objective:To explore research trends in the field of heart failure nursing.Methods:Web of Science database was searched and there trieval year was set to January 2000 to October 2020. CiteSpace software was used to visualize and quantitatively analyze the retrieval results.Results:A total of 2 352 articles were included. The number of articles published on heart failure nursing showed a continuous rise, and the highest number of articles issued was in 2018.The Journal with the highest number of publications was Journal of Clinical Nursing, the author with the highest number of publications was Tiny Jaarsm, the country with the highest number of publications was the United States, and the influential institution was University of Pennsylvania.Research hotspots mainly focused on management, outcome, mortality, quality of life, readmission, risk, hospitalization, survival, depression and palliative care. Conclusions:Visualization analysis shows the research trend in the field of heart failure nursing research, transitional nursing and community nursing are still the focus of future research.The visual analysis shows the research trend in the field of heart failure nursing, and transitional nursing and community nursing are still the research hotspots in the future.