Objective:To construct a Harvard cancer index-based risk predictive model for perioperative venous thromboembolism (VTE) in elderly patients with femoral neck fracture and assess its predictive effectiveness.Methods:A retrospective cohort study was conducted to analyze the clinical data of 610 elderly patients with femoral neck fracture admitted to Peking Union Medical College Hospital between January 2013 and December 2022, including 193 males and 417 females, aged 60-99 years [(77.3±9.0)years]. The patients were divided into VTE group ( n=125) and non-VTE group ( n=485) according to occurrence of VTE during the perioperative period. The two groups were compared in terms of gender, age, body mass index, smoking status, alcohol consumption, time from fracture to admission, surgical waiting time, comorbidities, perioperative electrolyte disorders, past or present history of malignancy, past history of deep vein thrombosis (DVT) or pulmonary embolism (PE), and preoperative use of oral anticoagulants. Univariate analysis and multivariable stepwise Logistic regression analysis were conducted to evaluate and identify independent risk factors for perioperative VTE in elderly patients with femoral neck fracture. A perioperative VTE risk predictive model for elderly patients with femoral neck fracture was constructed using the Harvard cancer index: (1) assigning a risk score to each variable according to the corresponding conversion criteria of the Harvard cancer index and risk score, based on the magnitude of their ORs; (2) determining the exposure rate of each risk factor based on the population distribution observed in this study; (3) calculating the average population risk score; (4) computing the individual VTE risk score; (5) deriving the ratio (X) of each individual ′s VTE risk score to the population average. Based on the Harvard cancer index classification criteria for disease risk levels, individual VTE risk categories were determined. The predictive performance of the risk stratification was evaluated by comparing the incidence of VTE across different risk levels. The predictive performance of the model was evaluated based on sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC). The calibration of the model was assessed using the Hosmer-Lemeshow (H-L) test and internal validation was performed using the bootstrap resampling method with 1000 iterations. Results:Univariate analysis showed that gender, age, time from fracture to admission, surgical waiting time, previous cerebral infarction, stroke within the past month, Alzheimer′s disease, primary Parkinson′s syndrome, hysterectomy with bilateral adnexectomy, perioperative electrolyte disorders, history of DVT or PE, and preoperative use of oral anticoagulant drug were moderately associated with the occurrence of VTE in elderly patients with femoral neck fracture ( P<0.10). Multivariable stepwise logistic regression analysis demonstrated that female gender ( OR=2.26, 95% CI 1.34, 3.80, P<0.01), time from fracture to admission>1 day ( OR=3.70, 95% CI 2.24, 6.12, P<0.01), surgical waiting time>70 hours ( OR=2.06, 95% CI 1.29, 3.30, P<0.01), previous cerebral infarction ( OR=3.78, 95% CI 1.04, 13.76, P<0.05), stroke within the past month ( OR=11.57, 95% CI 1.21, 110.44, P<0.05), Alzheimer′s disease ( OR=3.26, 95% CI 1.12, 9.49, P<0.05), primary Parkinson ′s syndrome ( OR=3.47, 95% CI 1.22, 9.85, P<0.05), previous hysterectomy with bilateral adnexectomy ( OR=4.75, 95% CI 2.09, 10.80, P<0.01), perioperative electrolyte disorders ( OR=2.73, 95% CI 1.39, 5.35, P<0.01), and preoperative oral anticoagulant use ( OR=3.86, 95% CI 1.18, 12.67, P<0.05) were significantly associated with the occurrence of perioperative VTE in elderly patients with femoral neck fracture. Based on the above 10 risk factors, a perioperative VTE risk predictive model for elderly patients with femoral neck fracture was constructed with the Harvard cancer index. The formula was as follows: X=[10×(female gender)+25×(time from fracture to admission>1 day)+10×(surgical waiting time>70 hours)+25×(previous cerebral infarction)+50×(stroke within the past month)+25×(Alzheimer′s disease)+25×(primary Parkinson′s disease)+25×(previous hysterectomy with bilateral adnexectomy)+10×(perioperative electrolyte disorders)+25×(preoperative use of oral anticoagulant drug)]/33. Individualized VTE risk was classified into five levels: very low, low, moderate, high, and very high, with corresponding VTE rates of 4.8%, 11.8%, 14.9%, 32.3%, and 73.5%, respectively ( χ2=87.71, P<0.01). The VTE risk predictive model demonstrated an AUC of 0.74 (95% CI 0.69, 0.79, P<0.01), with a sensitivity of 63.2% and specificity of 74.8%. The H-L goodness-of-fit test indicated satisfactory model calibration ( P>0.05). The internal validation with the bootstrap method confirmed that the AUC remained 0.74. Conclusions:Female gender, time from fracture to admission>1 day, surgical waiting time>70 hours, previous cerebral infarction, stroke within the past month, Alzheimer′s disease, primary Parkinson′s syndrome, hysterectomy with bilateral adnexectomy, perioperative electrolyte disorders, and preoperative use of oral anticoagulant drug are independent risk factors for perioperative VTE in elderly patients with femoral neck fracture. Based on these factors, the perioperative VTE risk predictive model constructed using the Harvard cancer index demonstrates good clinical predictive value. Individualized VTE risk stratification can effectively identify high-, intermediate-, and low-risk populations, providing a valuable reference for tailoring anticoagulant prophylaxis strategies and enhancing postoperative surveillance.

Objective:To construct a Harvard cancer index-based risk predictive model for perioperative venous thromboembolism (VTE) in elderly patients with femoral neck fracture and assess its predictive effectiveness.Methods:A retrospective cohort study was conducted to analyze the clinical data of 610 elderly patients with femoral neck fracture admitted to Peking Union Medical College Hospital between January 2013 and December 2022, including 193 males and 417 females, aged 60-99 years [(77.3±9.0)years]. The patients were divided into VTE group ( n=125) and non-VTE group ( n=485) according to occurrence of VTE during the perioperative period. The two groups were compared in terms of gender, age, body mass index, smoking status, alcohol consumption, time from fracture to admission, surgical waiting time, comorbidities, perioperative electrolyte disorders, past or present history of malignancy, past history of deep vein thrombosis (DVT) or pulmonary embolism (PE), and preoperative use of oral anticoagulants. Univariate analysis and multivariable stepwise Logistic regression analysis were conducted to evaluate and identify independent risk factors for perioperative VTE in elderly patients with femoral neck fracture. A perioperative VTE risk predictive model for elderly patients with femoral neck fracture was constructed using the Harvard cancer index: (1) assigning a risk score to each variable according to the corresponding conversion criteria of the Harvard cancer index and risk score, based on the magnitude of their ORs; (2) determining the exposure rate of each risk factor based on the population distribution observed in this study; (3) calculating the average population risk score; (4) computing the individual VTE risk score; (5) deriving the ratio (X) of each individual ′s VTE risk score to the population average. Based on the Harvard cancer index classification criteria for disease risk levels, individual VTE risk categories were determined. The predictive performance of the risk stratification was evaluated by comparing the incidence of VTE across different risk levels. The predictive performance of the model was evaluated based on sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC). The calibration of the model was assessed using the Hosmer-Lemeshow (H-L) test and internal validation was performed using the bootstrap resampling method with 1000 iterations. Results:Univariate analysis showed that gender, age, time from fracture to admission, surgical waiting time, previous cerebral infarction, stroke within the past month, Alzheimer′s disease, primary Parkinson′s syndrome, hysterectomy with bilateral adnexectomy, perioperative electrolyte disorders, history of DVT or PE, and preoperative use of oral anticoagulant drug were moderately associated with the occurrence of VTE in elderly patients with femoral neck fracture ( P<0.10). Multivariable stepwise logistic regression analysis demonstrated that female gender ( OR=2.26, 95% CI 1.34, 3.80, P<0.01), time from fracture to admission>1 day ( OR=3.70, 95% CI 2.24, 6.12, P<0.01), surgical waiting time>70 hours ( OR=2.06, 95% CI 1.29, 3.30, P<0.01), previous cerebral infarction ( OR=3.78, 95% CI 1.04, 13.76, P<0.05), stroke within the past month ( OR=11.57, 95% CI 1.21, 110.44, P<0.05), Alzheimer′s disease ( OR=3.26, 95% CI 1.12, 9.49, P<0.05), primary Parkinson ′s syndrome ( OR=3.47, 95% CI 1.22, 9.85, P<0.05), previous hysterectomy with bilateral adnexectomy ( OR=4.75, 95% CI 2.09, 10.80, P<0.01), perioperative electrolyte disorders ( OR=2.73, 95% CI 1.39, 5.35, P<0.01), and preoperative oral anticoagulant use ( OR=3.86, 95% CI 1.18, 12.67, P<0.05) were significantly associated with the occurrence of perioperative VTE in elderly patients with femoral neck fracture. Based on the above 10 risk factors, a perioperative VTE risk predictive model for elderly patients with femoral neck fracture was constructed with the Harvard cancer index. The formula was as follows: X=[10×(female gender)+25×(time from fracture to admission>1 day)+10×(surgical waiting time>70 hours)+25×(previous cerebral infarction)+50×(stroke within the past month)+25×(Alzheimer′s disease)+25×(primary Parkinson′s disease)+25×(previous hysterectomy with bilateral adnexectomy)+10×(perioperative electrolyte disorders)+25×(preoperative use of oral anticoagulant drug)]/33. Individualized VTE risk was classified into five levels: very low, low, moderate, high, and very high, with corresponding VTE rates of 4.8%, 11.8%, 14.9%, 32.3%, and 73.5%, respectively ( χ2=87.71, P<0.01). The VTE risk predictive model demonstrated an AUC of 0.74 (95% CI 0.69, 0.79, P<0.01), with a sensitivity of 63.2% and specificity of 74.8%. The H-L goodness-of-fit test indicated satisfactory model calibration ( P>0.05). The internal validation with the bootstrap method confirmed that the AUC remained 0.74. Conclusions:Female gender, time from fracture to admission>1 day, surgical waiting time>70 hours, previous cerebral infarction, stroke within the past month, Alzheimer′s disease, primary Parkinson′s syndrome, hysterectomy with bilateral adnexectomy, perioperative electrolyte disorders, and preoperative use of oral anticoagulant drug are independent risk factors for perioperative VTE in elderly patients with femoral neck fracture. Based on these factors, the perioperative VTE risk predictive model constructed using the Harvard cancer index demonstrates good clinical predictive value. Individualized VTE risk stratification can effectively identify high-, intermediate-, and low-risk populations, providing a valuable reference for tailoring anticoagulant prophylaxis strategies and enhancing postoperative surveillance.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Objective:To explore and construct the nursing quality standards of spine surgery, provide a scientific basis for improving the nursing quality of spine surgery.Methods:Taking the "structure-process-outcome" three-dimensional quality model as the theoretical framework, through evidenced-based literature search and semi-structured interview, the items pool was formed, and finally the nursing quality standards were determined by two rounds of Delphi method of expert inquiry from May to July 2023.Results:The positive coefficients of the two rounds of inquiries to experts were 0.90 and 1.00, respectively. The authority coefficients were 0.946 and 0.951, respectively. The Kendall coefficients of the first, second and third level standards in the first round were 0.161, 0.095 and 0.108, respectively, and the Kendall coefficients of the first, second and third level standards in the second round were 0.162, 0.088 and 0.100, respectively, the differences were statistically significant (all P<0.05). The final nursing quality standards were finally constructed, including 3 first-level standards (structural quality, process quality and outcome quality), 20 second-level standards and 60 third-level standards.Conclusions:The nursing quality standards of spine surgery based on the three-dimensional quality model of "structure-process-outcome" have high reliability and science, which can provide target incentives for clinical nurses, provide a basis for the quality of specialized spine nursing, and promote the development of nursing specialization and the construction of nursing discipline.

Early-onset scoliosis(EOS) refers to scoliosis diagnosed under 10 years old, and early intervention should be carried out for progressive EOS. Surgery is one of the main treatments. Due to the physiological and psychological characteristics of children such as organ structure and function are still in the stage of growth and development, young age and poor compliance, perioperative nursing strategies are different from adults, this article focuses on 13 aspects, including admission and preoperative assessment, safety management, vital signs observation, neurological function monitoring, fluid and electrolyte balance, general anesthesia awakening delirium, pain management, nutrition management, tubing management, position and early mobilization, surgical site infection prevention, identification and treatment of hemopneumothorax, and discharge-related nursing.

Objective:To explore the occurrence and influencing factors of paralytic ileus (PI) in patients with adolescent idiopathic scoliosis (AIS), so as to provide references and basis for the formulation of clinical nursing intervention measures.Methods:Using the convenient sampling method, a total of 93 AIS patients who were hospitalized in Spine Center of Peking Union Medical College Hospital from January 2019 to June 2020 were selected as the research objects. The general information, disease and operation related information of patients were collected, and the incidence of PI was recorded. Binomial Logistic regression was used to analyze the influencing factors of PI occurrence in AIS patients after surgery.Results:PI occurred in 41.9% (39/93) patients, and the incidence of anorexia, abdominal distention, nausea, vomiting and abdominal pain were 66.7% (26/39), 61.5% (24/39), 59.0% (23/39), 30.8% (12/39) and 20.5% (8/39), respectively. Binomial Logistic regression analysis showed that straight leg elevation exercise ( OR=3.582, P=0.023), postoperative first feeding time ( OR=1.209, P=0.027), proton pump inhibitors ( OR=6.820, P=0.002) and osteotomy ( OR=5.516, P=0.007) were the influencing factors of PI occurrence after AIS. Conclusions:The incidence of PI is higher in AIS patients after surgery and the accompanying symptoms are mainly anorexia, abdominal distension and nausea. Straight leg elevation exercise, time of first postoperative feeding, proton pump inhibitors and osteotomy are the influencing factors of postoperative PI in AIS patients.

Objective:To construct the core competence indicator system of newly recruited nurses based on the concept of safety and quality improvement, so as to provide a reference for the construction of the training system of the core competence and the formulation of evaluation standards of newly recruited nurses.Methods:Through literature retrieval and analysis, a framework of core competency indicator system of newly recruited nurses guided by the concept of safety and quality improvement was initially constructed. From November 2020 to March 2021, 15 nursing education and nursing practice experts across the country were consulted for 3 rounds through the Delphi expert consultation, and the expert opinions were collected to finally determine the indicator system.Results:Among 3 rounds of expert consultation, the response rates of the questionnaires were all 100%, and the expert authority coefficient was 0.90, and the Kendall coordination coefficient of the three-level indicators was from 0.14 to 0.20 ( P<0.05) . The finalized core competence indicator system of newly recruited nurses included 7 first-level indicators (professional knowledge and ability, patient-centered nursing, cooperative communication, quality promotion, safety, nursing information ability, professional development) , 18 second-level indicators and 103 third-level indicators. Conclusions:The indicators of the core competence indicator system of newly recruited nurses are good, which can provide a reference for optimizing the training courses for newly recruited nurses and improving the evaluation standards.

Objective:To construct a structured 3C dynamic disease observation form for patients undergoing spinal surgery and to explore its application effect in clinical work.Methods:Based on the literature evidence, a structured 3C disease observation form was formed through focus group interviews. Before the application of the form (from June 2018 to August 2018) , the related situations where responsible nurses used a traditional form to prepare information about the patients' conditions were collected 100 times. After the application of the form (from September 2018 to November 2018) , the related situations where responsible nurses used a structured 3C dynamic disease observation form to prepare information about the patients' conditions were collected 100 times. Before and after the application, the nurses' mastery rate of the patients' conditions, the time for the nurses to master the patients' conditions and the nurses' satisfaction with the form were compared.Results:After application of the structured 3C disease observation form, the average rate of nurses' mastery of patients' conditions increased from 88.2% to 95.1%, and the difference was statistically significant (χ 2=39.826, P<0.01) . The time spent for nurses to master the patients' conditions was shortened from (7.61±1.67) min before the implementation to (5.34±1.33) min after the implementation, and the difference was statistically significant ( t=10.654, P<0.01) . The satisfaction score of the nurses on the traditional form was (28.50±2.20) points and the satisfaction score of the structured 3C disease observation form was (35.80±3.15) points, and the difference was statistically significant ( t=-8.097, P<0.01) . Conclusions:The application of structured 3C disease observation form can significantly improve the nurses' mastery rate of patients' conditions, improve work efficiency and increases nurses' satisfaction with their own nursing work, which is helpful to improve the quality of nursing management.

Objective: To summarize the experience of respiratory tract management in a case of spinal muscular atrophy with neuromuscular scoliosis. Methods: Respiratory tract nursing included prevention of pulmonary infection, inspiratory muscle training, rebuilding respiratory form before surgery, and assessment of sputum expectoration capacity, pain management, airway management after surgery. Results: The patient was discharged without pulmonary complications. Conclusions For patient with breathing problem, respiratory tract management can prevent pulmonary complications during perioperative period.

Objective? To explore the cognition of nurses in high-risk surgical departments for prevention of venous thromboembolism (VTE). Methods? Totally 464 nurses in surgical departments at high risk of VTE (departments of orthopedics, general surgery, neurosurgery, thoracic surgery, and critical care medicine) from 11 provinces (municipalities and autonomous regions) nationwide who attended the seminar on nursing by the Chinese Nursing Association in September 2017 were investigated with VTE Prevention Knowledge Questionnaire for Clinical Nurses to understand their knowledge about basic, physical and drug prevention for VTE. Results? The cognition of VTE prevention of nurses in high-risk surgical departments scored (13.51±3.42), standing at a medium level. In particular, the knowledge about physical prevention was unsatisfactory, which scored (5.71±2.18). The cognition score of VTE prevention varied in nurses of different departments, and the cognition of VTE prevention of nurses from departments of general surgery, orthopedics and critical care medicine was relatively better. Multivariate analysis revealed that educational background was an independent risk factor for the cognition of VTE prevention of nurses in high-risk surgical departments (OR=1.630,95%CI:1.035-2.567). Conclusions? The cognition of VTE prevention of nurses in high-risk surgical departments is unsatisfactory and cannot meet the needs of clinical work. Targeted training should be provided according to the weak links in the cognition of VTE prevention of nurses in high-risk surgical departments to improve the quality of VTE prevention and nursing, thus reducing the incidence rate of perioperative VTE in these patients.