The inconsistency of diagnostic criteria for malnutrition has confused clinicians since the 1980s. After the implementation of disease diagnosis related group payment (DRG) in China's public hospitals, the diagnosis of malnutrition and the correct documentation of nutrition-related diagnosis on the front sheet of medical records are related to the correct classification of the disease group and the medical insurance payment. Therefore, the reliable diagnostic criteria for malnutrition, especially disease-related malnutrition, is urgently needed in clinical practice. In September 2018, The global leadership Iinitiative on malnutrition (GLIM) diagnostic criteria consensus was launched. GLIM aimed to provide the explicit and unified diagnostic criteria for malnutrition in adult hospitalized patients. However, GLIM criteria was based on the voting by nutritional experts and was merely a consensus in nature. The clinical validity of GLIM criteria needs prospective verification, i.e., to demonstrate that patients with malnutrition as per GLIM criteria could have improved clinical outcomes with reasonable nutritional interventions. In November 2020, the article titled Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS 2002 was published on the journal Nutrition. It was the first study comparing nutritional risk screening 2002 (NRS 2002) and GLIM malnutrition diagnostic criteria among Chinese patients for the indication of nutritional support therapy. The clinical effectiveness of the two tools was retrospectively verified as well. Here we discussed the key points of this retrospective study, including the critical research methods, to inform the currently ongoing prospective validation of the GLIM malnutrition diagnostic criteria (the item of reduced muscle mass not included).

Objective:To summarize the best evidence for early enteral nutrition support in postoperative patients with gastric cancer and evaluate its effectiveness.Methods:From March to August 2021, 108 postoperative patients with gastric cancer admitted to the Gastrointestinal Surgery of the First Affiliated Hospital of Ningbo University were selected. We applied evidence-based nursing methods to summarize the best evidence for early enteral nutrition support in postoperative gastric cancer patients, and constructed and implemented the best evidence application strategy through baseline review, evaluation of evidence application clinical scenarios and barriers. We compared the various indicators of two groups of patients before the application of evidence (March to May 2021, n=55) and after the application of evidence (June to August 2021, n=53) . Results:No adverse events occurred during the application of evidence. After applying evidence, the correct nutritional assessment rate increased from 41.82% (23/55) at baseline review to 90.57% (48/53), the implementation rate of early postoperative enteral nutrition increased from 0 to 45.28% (24/53), the start time of postoperative enteral nutrition shortened from (3.75±2.33) days to (2.06±1.38) days, and the implementation rate of postoperative priority oral nutrition increased from 63.64% (35/55) to 86.79% (46/53), nutritional related complications decreased from 40.00% (22/55) to 20.75% (11/53), and the differences were all statistically significant ( P<0.05) . Conclusions:The application of the best evidence for early enteral nutrition support in postoperative gastric cancer patients can shorten the start time of postoperative enteral nutrition, reduce postoperative nutrition related complications, and promote early recovery of patients.

Objective:To construct a cluster care of oral nutrition supplements (ONS) , and to explore its effect in home care of postoperative patients with gastric cancer.Methods:Literature search was conducted to review the status quo of ONS compliance at home in patients with gastric cancer after surgery, and analyze the existing problems. We summarized and formulated the cluster care plan according to the evidence, and established the home ONS management team and process. From November 2020 to October 2021, 107 patients with gastric cancer who needed to implement ONS at home in Gastrointestinal Surgery of Ningbo First Hospital were selected as research objects by convenience sampling. Postoperative patients with gastric cancer from November 2020 to April 2021 were set as the control group ( n=40) , and those from May to October 2021 were set as the observation group ( n=67) . The control group was treated with conventional ONS, and the observation group was treated with home ONS cluster care plan on the basis of the control group. The compliance of nutritional support, weight gain, body mass index increase and follow-up experience between the two groups were evaluated. Results:After six months of intervention, the scores of ONS compliance, weight gain, body mass index increase and follow-up experience in the observation group were significantly higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The cluster care plan improves the ONS compliance at home, nutritional status and satisfaction with the follow-up by medical and nursing staff in patients with gastric cancer after surgery, which is worthy of clinical promotion.

Objective:To explore the nutritional status and quality of life of gastric cancer patients one month after operation in the context of enhanced recovery, and analyze the correlation between them.Methods:From August 2020 to August 2021, 168 patients discharged from the Gastrointestinal Surgery of Ningbo First Hospital after radical resection of gastric cancer were selected as the study subject by convenience sampling. The Nutritional Risking Screening 2002 (NRS2002) and the Global Leadership Initiative on Malnutrition (GLIM) step 2 (excluding muscle mass measurement index) were used to assess the postoperative nutritional status of patients. The quality of life of patients with gastric cancer after operation was investigated with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) . Logistic regression analysis was used to explore the influencing factors of nutritional status of postoperative patients with gastric cancer. A total of 168 questionnaires were distributed, and 168 valid questionnaires were recovered, with a valid recovery rate of 100.0%.Results:A total of 104 patients (61.9%) had nutritional risk and 46 patients (27.4%) had malnutrition. There were statistical differences in age, education level, tumor stage, body mass index, physical function, role function, emotional function, cognitive function, general health, fatigue, nausea and vomiting, and loss of appetite among gastric cancer patients with different nutritional status after operation ( P<0.05) . Logistic regression analysis showed that body mass index, physical function, role function, emotional function and fatigue were the influencing factors of the nutritional status of patients one month after operation ( P<0.05) . Conclusions:In the context of enhanced recovery, the nutritional risk and malnutrition rate of gastric cancer patients one month after operation are high, and are closely related to the quality of life. When implementing enhanced recovery after surgery, medical and nursing staff should strengthen and optimize the nutrition management of gastric cancer patients before hospital, during perioperative period and after discharge, improve the nutritional status after operation and the quality of life of patients.

Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.

Objective:To retrieve relevant evidence for early enteral nutrition support in patients after gastric cancer surgery and summarize the best evidence, so as to provide evidence-based evidence for clinical implementation of postoperative enteral nutrition management for gastric cancer.Methods:Evidence-based questions were established according to PIPOST principles, UpToDate, Cochrane Library, Joanna Briggs Institute Library, BMJ Best Practice, Agency for Healthcare Research and Quality website, Medlive, European Society for Clinical Nutrition and Metabolism website, American Society for Parenteral and Enteral Nutrition website, Embase, Medline, PubMed, SinoMed, Wanfang Database, China National Knowledge Infrastructure were searched according to the "6S" evidence model. The retrieval period of every database was from January 1, 2016 to May 31, 2021. The Evidence Pre-Grading and Evidence Recommendation Grading System (2014) of Australian Joanna Briggs Institute Evidence-Based Health Care Center was used to extract evidence from the literature that met the quality standards, determine the evidence grading and recommendation level and form the best evidence.Results:A total of 317 literatures were retrieved, and 10 literatures were included, including 1 guideline, 4 expert consensus and 5 systematic reviews. The 10 evidences were summarized from 4 aspects, including indication evaluation, timing management, route and preparation management and risk management.Conclusions:Current evidence shows that early enteral nutrition is safe and feasible in patients after gastric cancer surgery. In the process of implementing enteral nutrition, medical staff should fully evaluate the indications and needs of patients and make clear and prudent choices for nutritional support channels and preparations of patients, so as to form the best evidence and clinical management programs for early enteral nutrition support for patients after gastric cancer surgery and accelerate postoperative recovery of patients.

Objective:To investigate the relationship between discharge readiness and nutritional status of patients undergoing gastric cancer surgery in the context of enhanced recovery after surgery (ERAS) , so as to provide individualized guidance for patients after discharge.Methods:Using the convenient sampling method, a total of 120 patients who underwent radical gastrectomy for gastric cancer from June 2020 to June 2021 in Ningbo First Hospital were selected as research objects, and they all received ERAS nursing care. One day before discharge, Nutritional Risk Screening Table and Discharge Readiness Scale were used for questionnaire analysis.Results:The total score of discharge readiness of 120 patients with gastric cancer after surgery was (81.42±6.87) . Among the three dimensions, personal status was (19.65±2.19) , adaptability was (29.67±3.10) and anticipatory support was (32.10±2.61) . 57.5% (69/120) of gastric cancer patients discharged from hospital had nutritional risk. The scores of hospital discharge readiness and the scores of each dimension in the nutritional risk group were lower than those in the non-nutritional risk group, and the differences were statistically significant ( P<0.05) . Multivariate analysis showed that nutritional status was an influencing factor for the total score of hospital discharge readiness in patients with gastric cancer surgery (standardized regression coefficient was 0.321, P<0.05) . Conclusions:Under the background of ERAS, the discharge readiness of patients after gastric cancer surgery is at a moderate level, postoperative patients are generally at nutritional risk and the discharge readiness of patients with nutritional risk is lower than that of patients without nutritional risk. Perioperative nutrition management by nursing staff can improve the discharge readiness of patients undergoing gastric cancer surgery, and continuous nutrition management should be carried out for discharged patients with nutritional risk, in order to promote home rehabilitation of patients with gastric cancer surgery.

Objective:To conduct Meta-analysis of the effectiveness of improved activity mode in prevention of peripherally inserted central catheter (PICC) related thrombosis in tumor patients.Methods:PubMed, The Cochrane Library, CNKI, Wanfang Database and VIP database were conducted computer retrieval of studies on improved activity mode and PICC related thrombosis in tumor patients from January 1, 2010 to December 31, 2019. A total of two researchers independently screened literature, extracted data and evaluated the quality of literature. The RevMan 5.3 software was used for Meta-analysis of the included studies.Results:A total of 7 randomized controlled trials (RCT) were included in this study. Meta-analysis results showed that compared with the conventional catheterization side upper limb exercise group, the incidence of catheter-related venous thrombosis in tumor patients in the improved activity mode group was reduced ( OR=0.22, 95% CI=0.13-0.38, P<0.01) , and the maximum blood flow velocity of the axillary vein was increased ( MD=1.03, 95% CI=0.64-1.42, P<0.01) . Conclusions:Improved activities on the limb of catheterization can effectively accelerate the blood flow velocity of the axillary vein after PICC catheterization in tumor patients and reduce the occurrence of catheter-related venous thrombosis.

Objective:To explore the effect of narrative video combined with teach-back method on full-time caregivers' knowledge, attitude and practice level of preventing aspiration.Methods:The convenient sampling method was used to select full-time caregivers from a ClassⅢ Grade A hospital as the research objects. A total of 89 full-time caregivers from July to August 2018 were set as the control group, and 76 full-time caregivers from October to November 2018 were set as the observation group. The control group adopted conventional health education, while the observation group adopted narrative video combined with teach-back method to carry out aspiration prevention education on the basis of the control group. The scores of knowledge, attitude and practice of the two groups were compared.Results:The knowledge score of the observation group was 44 (37, 49) , higher than 39 (31, 45.5) of the control group, and the difference was statistically significant (Z=-3.463, P<0.01) . The attitude score of the observation group was 50 (45, 54) , which was higher than 44 (44, 52) of the control group, and the difference was statistically significant ( Z=-3.566, P<0.01) . The practice score of the observation group was 47 (41, 51) , which was higher than 41 (35, 53) of the control group, and the difference was statistically significant ( Z=-2.462, P<0.05) . Conclusions:The narrative video combined teach-back method is an effective form of health education, which helps to improve knowledge, attitude, behavior levels of preventing aspiration and clinical care ability of full-time caregivers.

Objective:To deeply understand the reason and inner experience of day surgery patients canceling surgery through qualitative research, so as to strengthen the management of day surgery patients.Methods:This research adopted phenomenological research method. From June to December 2019, purpose sampling was used to select 12 patients who had canceled the day surgery at Ningbo First Hospital in Zhejiang Province for a semi-structured interview. The Colaizzi 7-step analysis method was used for data analysis.Results:Through repeated refining, analysis and extraction of interview data, the reasons and inner experience of day surgery patients who canceled surgery were finally summarized into 5 themes. Those themes included fear of day surgery, distrust of day doctors, affected by basic diseases and physiological factors, lack of confidence in community medical care, insufficient preparation before surgery.Conclusions:The reasons for day surgery patients to cancel surgery include fear of surgery, distrust of doctors, basic diseases and physiological factors, lack of confidence in community medical care, and insufficient preparation before surgery. It is recommended that day surgery medical and nursing staff strengthen day ward management, improve their professional level and ability to communicate with patients, and at the same time promote the construction of hospital-community integration to ensure the medical safety of patients after discharge from the hospital, and further reduce the cancellation rate of day surgery.