Objectives:To investigate the effect of body mass index(BMI)on perioperative and long-term prognosis of patients with severe aortic stenosis(AS)after transcatheter aortic valve replacement(TAVR). Methods:This retrospective study imcluded 180 patients with severe AS who received TAVR in Fujian Provincial Hospital from January 2019 to January 2022.According to the BMI,patients were divided into four groups:low weight group(BMI<18.5 kg/m2,n=23),normal weight group(18.5 kg/m2≤BMI<24.0 kg/m2,n=65),overweight group(24.0 kg/m2≤BMI<28.0 kg/m2,n=57),obesity group(BMI≥28.0 kg/m2,n=35).The general clinical characteristics,imaging parameters,perioperative indexes,all-cause death and the incidence of other adverse cardiac events during(18.0±6.8)months follow-up were compared among different groups.Risk factors for the perioperative complications and long-term outcomes of TAVR were evaluated. Results:The prevalence of hypertension and diabetes,left ventricular end-diastolic diameter,ventricular septal thickness and left ventricular posterior wall thickness were significantly higher in the obese group than in normal weight group(all P<0.05).The level of prealbumin in low weight group was lower than in normal weight group(P<0.05).The total perioperative complications in low weight group were higher than in normal weight group(60.9%vs.12.3%,P=0.042).During(18.0±6.8)months follow-up,the incidence of all-cause death in the low weight group was significantly higher than that in normal weight group,overweight group and obese group(17.4%vs.4.6%vs.3.5%vs.5.7%,P=0.003).Kaplan-Meier survival analysis evidenced higher mortality rate in low weight group at 18 months after TAVR(log-rank P<0.01).Multivariate Cox regression analysis showed that the risk of long-term adverse cardiovascular events was significantly higher in low weight group than in normal weight group(HR=7.633,95%CI:1.012-57.564,P=0.049). Conclusions:Low weight patients with severe AS have a higher incidence of perioperative complications and a poor long-term prognosis.Such patients should appropriately strengthen their nutritional intake and adjust their body weight to normal levels before performing TAVR.

Objective:To construct a preoperative rehabilitation program for gastric cancer patients, aiming to provide scientific and reasonable preoperative guidance for gastric cancer patients.Methods:On the basis of literature research and expert group meeting, the first draft of the preoperative rehabilitation program for gastric cancer patients was constructed. From October 2021 to January 2022, the Delphi method was used to conduct 2 rounds of expert letter inquiries to 16 experts in related fields from 11 hospitals in Jiangsu Province, and the entries were revised according to the experts′ inquiries.Results:In the two rounds of expert correspondence, the positive coefficients of experts were 88.89% and 100.00%, and the authority coefficients of experts were both 0.88. The coordination coefficients of the items in the two rounds of inquiry were 0.279 and 0.290, respectively. The final program consisted of 3 first-level entries, 11 second-level entries and 32 third-level entries.Conclusions:The scheme constructed in this study is scientific, reliable and applicable, and is worth being promoted further in clinical practice.

Objective:To systematically assess the effects of "internet +" nursing intervention model on rehabilitation outcomes in stroke patients so as to provide an evidence-based basis for clinical nurses to carry out "internet +" nursing service new model in stroke patients.Methods:Randomized controlled trials (RCTs) related on effects of "internet +" nursing intervention model on rehabilitation outcomes in stroke patients were retrieved in China Biological Medicine (CBM) , Chinese National Knowledge Infrastructure (CNKI) , WanFang Data, PubMed, Embase, Cochrane Central Register of Controlled Trials by computer from building database to May 2019. RevMan 5.3 was used to the systematic review for literatures meth the inclusion criteria.Results:A total of six literatures were included involving 637 samples. Systematic review showed that "internet +" nursing intervention model could improve the motor function [ MD=13.87, 95% CI (7.93, 19.81) , Z=4.57, P<0.01]and activity of daily living [ MD=14.43, 95% CI (6.15, 22.71) , Z=3.41, P<0.01]of stroke patients during rehabilitation. Conclusions:"Internet +" nursing intervention model provides a good channel for rehabilitation and health education for stroke patients after going back to family and community, helps stroke patients to improve motor function during rehabilitation and activity of daily living, but that still exhibits the problems needed to be perfected and solved by medical staff exerting themselves.

Objective To analyze the effect of stratified nursing intervention based on aspiration risk assessment strategy in ICU mechanical ventilation patients. Methods Totally 156 patients with ICU mechanical ventilation admitted between January 2016 and December 2017 were selected as study subjects, and 78 patients were divided into treatment group and control group by random number table method. The control group was given routine nursing interventions for ICU patients undergoing mechanical ventilation, and the treatment group was combined with stratified nursing interventions based on aspiration risk assessment strategy. Compare the two groups of nurses'knowledge, attitude and practice of aspiration prevention, the complications of patient aspiration, patient satisfaction and other indicators. Results The scores of nurses′knowledge, attitude and practice of prevention of aspiration in the treatment group were (46.32 ± 3.24), (51.41 ± 3.56), and (49.36 ± 4.85), respectively, which were significantly higher than those of the control group (41.25 ± 5.32), (47.12 ± 5.45), (44.42 ± 5.46), The difference was statistically significant (t=4.815, 3.899, 4.002, P<0.05);The rate of aspiration, reflux, asphyxia, aspiration pneumonia in the treatment group was 7.69％ (6/78), 19.23％ (15/78), 1.28％ (1/78), 2.56％ (2/78), which were significantly lower than 29.49％ (23/78), 39.74％ (31/78),12.82％ (10/78),20.51％ (16/78) in the control group. The difference were statistically significant (χ2=7.892-12.309, P<0.05 or 0.01);Patient satisfaction 97.87％ (74/78) was significantly higher than the control group 83.33％ (65/78), The difference was statistically significant (χ2=5.347, P<0.05). Conclusion The stratified nursing intervention based on the aspiration risk assessment strategy can help develop nurses′ability in knowledge, attitude and practice of aspiration prevention, reduce the occurrence of complications such as aspiration, and improve patient satisfaction.

Objective? To systematicaLLy review the respiratory training on swaLLowing function and respiratory function among patients with dysphagia so as to provide a reference for rehabiLitation nursing of patients with dysphagia. Methods? From estabLishing the database to 30th ApriL 2018, we retrieved the randomized controLLed triaLs (RCTs) on respiratory training of patients with dysphagia in PubMed, EMBASE, Web of Science, Cochrane CentraL Register of ControLLed TriaLs, CINAHL, Physiotherapy Evidence Database, Chinese BioMedicaL Literature Database (CBM), China NationaL KnowLedge Infrastructure (CNKI) and WanFang Data by computer. The Literatures were screened and quaLity of the incLuded Literatures were evaLuated according to the system evaLuation method of the Cochrane coLLaboration. The RevMan5.3 was used to statisticaL anaLysis. ResuLts? A totaL of 9 Literatures were incLuded, and three of them were with the LeveL A of Literature quaLity and the rest were with the LeveL B. Meta-anaLysis showed that compared with routine dysphagia nursing, respiratory training couLd improve the swaLLowing function evaLuated by water swaLLow test [RR=1.33, 95%CI (1.17, 1.53), P＜ 0.01], forced vitaL capacity (FVC) [MD =0.47, 95%CI(0.11, 0.82), P＜ 0.01], forced expiratory voLume in one second (FEV1) [MD=0.47, 95%CI(0.20,0.74), P＜0.01], peak expiration fLow (PEF) [MD=1.00, 95%CI(0.91, 1.10), P＜0.01]and reduce the score of penetration-aspiration scaLe (PAS) [MD=-1.05, 95%CI (-1.70, -0.41), P＜ 0.01]of patients with dysphagia. ConcLusions? Compared with routine dysphagia nursing, respiratory training couLd improve the swaLLowing function evaLuated by water swaLLow test, FVC, FEV1, PEF and reduce the score of PAS of patients with dysphagia. However, the findings stiLL need be vaLidated by Large sampLe, muLticenter and high quaLity RCTs.

Objective? To expLore the effects of Home FaLL Hazards Assessment (HFHA) on the incidence rate of home faLLs and recovery of hip function in patients receiving totaL hip arthropLasty (THA). Methods? TotaLLy 423 patients who received uniLateraL THA for the first time in the Department of Orthopedics, Nanjing Drum Tower HospitaL admitted from JuLy 2015 to JuLy 2017 were seLected by convenient sampLing and divided into the controL group (n=203) and the treatment group (n=220). Patients in the controL group received conventionaL postoperative nursing care and discharge guidance, whiLe the home faLL hazards of patients in the treatment group were evaLuated by HFHA in addition to conventionaL postoperative nursing care and discharge guidance. Nursing care was provided to them based on the assessment resuLts. The joint function score at discharge and 3 months after discharge, the incidence rate of faLLs over the past one year and the severity of injury caused by faLLs were compared between the two groups. ResuLts? There was no statisticaL difference in Harris index and BartheL index scores between the two groups at discharge (P＞ 0.05). Harris index and BartheL index scores 3 months after discharge were statisticaL differences in both groups (P＜0.05). 55 faLLs occurred over the past one year in the controL group, 7 of them with moderate or above injuries, whiLe 35 faLLs occurred over the past one year in the treatment group, 1 of them with moderate or above injuries. There were statisticaL differences in the incidence rate of faLLs and injury degrees between the two groups (P＜0.05). ConcLusions? HFHA, when used to assess the home faLL hazards, enabLes THA patients to know and note the high-risk hazards contributing to faLLs in their environment of rehabiLitation and effectiveLy reduces the patients home faLLs by improving the home environment.

Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting , bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33％(1/30) and 13.33％(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00％(24/30) and 83.33％(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P<0.05). There were not statistically significant in the time of anal exsufflation and first defecation time between the two groups(P>0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice.

This paper summarized key points of nursing care of 14 patients with acute iliofemoral vein thrombosis undergoing endovascular therapy via rheolytic thrombectomy system,including:assessing risk of acute pulmonary artery embolism with amendatory Geneva scale,perioperative refined management of hydrotherapy and protecting renal function,nursing care to prevent tissue and organ bleeding at different levels during catheterdirected thrombolytic therapy,and evaluating clinical effects of treatment and nursing with patented circumference measurer of lower extremity.The average duration of hospitalization was 4.42 d.Ten patients had hemoglobinuria and one had renal function impairment.Acute pulmonary artery embolism happened in one patient before surgery and catheter-directed thrombolytic therapy were performed in four patients due to unsatisfactory results of thrombectomy.

Objective To explore the effects of team management model on the prevention and control of incontinence dermatitis in patients with paraplegia.Methods A total of 113 patients with paraplegia and incontinence who were treated in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from March 2016 to February 2018 were enrolled in the study.They were divided into observation group and control group according to the sequence of admission.The patients who were admitted from March 2016 to February 2017 were assigned as the control group,with 56 cases.The patients who were admitted from March 2017 to February 2018 were assigned as the observation group,with 57 cases.The control group was treated with routine intervention.Team management was applied in the observation group on the basis of routine nursing for 4 weeks.The incidence of incontinence dermatitis and negative emotion were compared between the two groups.Results After intervention,the incidence of incontinent dermatitis of the observation group (5.26％) was significantly lower than that of the control group (14.29％),and the difference was statistically significant (P＜ 0.05).The scores of Self-Rating Anxiety Scale and Self-Rating Depression Scale of the observation group were (38.70 ± 6.83) and (41.07 ± 5.62),which were both lower than those of the control group (46.39 ± 8.15) and (47.31 ± 6.52) respectively,and the differences were statistically significant (P ＜ 0.05).Conclusions Team management can effectively reduce the incidence of incontinence dermatitis and negative emotions in paraplegic patients,which is worthy of clinical promotion.

Objective To explore the effect of workshop on postoperative function of affected limb in patients with breast cancer. Meth-ods From August, 2015 to June, 2016, 70 patients with breast cancer after modified radical mastectomy were randomly divided into control group (n=35) and observation group (n=35). The control group was instructed by the primary nurse bedside based on the traditional method, while the observation group was guided with workshop mode. Results Ten days and one month after surgery, the range of motion of the shoulder joint in the observation group was superior to the control group (t>2.030, P<0.01);the incidence of lymphedema of the affected limb in the observation group was lower than that in the control group (u=2.195, P<0.05). Conclusion Functional exercise guided with work-shop mode could improve postoperative function of affected limb in patients with breast cancer.